Canalization of human cervical mucus.

Cervical mucus forms channels when dried under a coverslip. The aim of the present work was: 1) to prove mucus canalization both in spontaneous ovulatory cycles and during ovulation induction with gonadotropins; 2) to prove the estrogen dependence of this phenomenon; 3) to check the importance of the proteidic and electrolytic concentration on chaneling; and 4) to use this phenomenon clinically, shortening the time in which it occurs. The number and arrangement of channels vary during the cycle. The phenomenon is estrogen-dependent. The comparison between estradiol values and the number of channels during spontaneous ovulatory cycles and treatment with gonadotropins showed a linear relationship. Treatment with estradiol 17 beta-valerate and ethinyl estradiol induced channel formation in women with primary amenorrhea. Canalization and ferning disappeared after dialysis or treatment with proteolytic enzymes. It follows that the two phenomena have similar characteristics. Canalization increases daily, as does estradiol, whereas ferning maintains the same grade for a longer period, and when a grade of + + + is reached, it provides no further indications. With the use of a thermostat, canalization occurred in only a few hours. Chaneling, a more precise index, could therefore substitute for ferning, particularly when monitoring the induction of ovulation.

Efficacy of leuprorelin acetate depot in symptomatic fibromatous uteri: the Italian Multicentre Trial.

A total of 110 nonmenopausal women (mean age 42.1 years) presenting with symptomatic uterine leiomyomata and/or fibromatous uteri have been enrolled in this trial to evaluate the efficacy of the depot formulation of leuprorelin acetate in decreasing uterine volume and minimizing menorrhagia, dysmenorrhoea and pressure over the bladder. All patients were treated with an intramuscular injection of leuprorelin acetate depot 3.75 mg every 4 weeks for 16 weeks. Clinical examinations and hormonal and ultrasound determinations were performed before, during and at the end of treatment. Appropriate follow-up is still ongoing for most patients. At the end of the treatment period, of 88 women with enlarged fibromatous uteri, 33 (37.5%) showed a decrease in uterine volume of greater than or equal to 50% of the original size, while nine (10.2%) remained with unchanged uterine volume. Of 80 fibromas measurable separately, 47 (52.8%) decreased by greater than 50% of the initial volume and 16 (18%) remained unchanged or even increased. During treatment, clinically advantageous effects were observed in the associated symptomatology, mainly in the production of amenorrhoea and restoration of normal haemoglobin levels. Most of the patients were affected by irregular menstrual blood loss with consequent anaemia that in 29 patients was expressed by low levels of haemoglobin (mean 9.2 g/dl; SD 1.5; range 4.5-11.8 g/dl). By the end of the treatment, only one patient still had moderate vaginal blood loss. Haemoglobin levels rose to a mean value of 11.8 g/dl (SD 1.3; range 8.5-14.1 g/dl). Three patients (2.7%) failed to complete the 16-week treatment protocol, because of headache (one patient) and increased blood pressure (two patients). As a result of the treatment, of the 107 patients who were candidates for surgery and who were included in this study, only nine (8.4%) required surgery during leuprorelin acetate treatment. Of these, four operations were vaginal excision of the submucous myomata protruding into the cervix during treatment, and in five hysterectomy performed because of persistence of symptoms. In most patients the achievement of amenorrhoea minimized the fear of surgical emergency, facilitating an increased awareness of their clinical condition. With the exception of the three patients who dropped out, side effects were mild in all patients, consisting mainly of hot flushes, which were easily tolerated. In the following 8-12 months, the regrowth of uterine volume to original size has been usual in most of the 82 patients now in follow-up.(ABSTRACT TRUNCATED AT 400 WORDS)

In vitro biosynthesis of rabbit blastokinin.

The authors have incubated, in vitro, estrous rabbit endometrium with 3H-leucine and pseudopregnant rabbit endometrium with 14C-leucine. By the double-labeling technique and the use of the 14C:3H ratio, it was shown that blastokinin (BKN) is neosynthesized in vitro and that this neosynthesis probably also affects other protein components. By ion exchange chromatography of the supernatant of the pseudopregnant endometrium and previously purified BKN, it was possible to confirm the in vitro biosynthesis and to exclude interfering phenomena. Time dynamics showed that biosynthesis was more marked between the 18th and 24th hours of incubation.

Retrograde ejaculation: a more convenient method for artificial insemination.

A case of retrograde ejaculation not responding to medical treatment is described in which the problem of sterility was overcome by artificial insemination. The semen was collected from urine after coitus by previous alkalinization with 1.63 g NaHCO3 once daily. Pregnancy occurred at the 4th insemination during the 1st treatment cycle. This technique seems to be the most suitable for artificial insemination in cases of retrograde ejaculation.

A prostaglandin analogue (ONO-802) in treatment of missed abortion, intrauterine fetal death and hydatiform mole: a dose-finding trial.

Forty-eight patients affected with missed abortion, intrauterine fetal death and hydatiform mole were treated with vaginal suppositories containing 1 mg of 16,16-dimethyl-trans-delta 2-PGE1 methyl ester (ONO-802). The patients were divided into two treatment groups. The first, Group A, was given one vaginal suppository every 3 h to a maximum of five suppositories. The product of conception was expelled in 95.8% of patients. In Group B the maximum number of suppositories was reduced to three. The product of conception was expelled in 100% of cases and the average duration of treatment was similar to that for the first group. Although side-effects were mild in both groups, they were reduced in the patients of Group B.

Scanning electron microscopy of rabbit tubes at different intervals after anastomosis using fibrin glue.

Eighteen New Zealand White rabbits were submitted to tubal anastomosis using fibrin glue. The animals were then killed at different intervals (2-56 days) and the tubes were removed for analysis with the scanning electron microscope in order to study re-epithelialization and ciliogenesis. For the first 4 days after the operation the epithelium seemed to suffer considerable traumatic effects and was de-epithelialized. On the 6th day cells with microvilli appeared and towards the 10th day the first cilia were seen. Ciliogenesis was complete between 2 and 4 weeks after the operation, at which time the cilia re-acquired the ability to beat in coordination, as well as attaining normal quantity and length. The time required for recovery by the epithelium after anastomosis with fibrin glue would thus seem similar to that required when other suture materials are used. Fibrin glue thus combines the advantage of a considerable reduction in operating times with the ability to be rapidly reabsorbed, with complete restitutio ad integrum of the tissues.

Fibrin glue vs. nylon in the anastomosis of rabbit fallopian tubes.

Fibrin glue was used in end-to-end tubal anastomosis on eight sexually mature female New Zealand white rabbits. The right fallopian tubes were anastomosed with 10/0 nylon and the left with fibrin glue (Tissucol). The animals were mated with males of proven fertility six weeks after surgery and killed two weeks later. The gestational sacs and corpora lutea on the right and left sides were counted separately and the nidation index calculated for each. The presence of adhesions was also evaluated. All the tubes were finally examined under a scanning electron microscope. The fibrin glue was satisfactory in terms of patency, pregnancy and morphology of the epithelium.

[The ICSI (Intracytoplasmic Sperm Injection)]. / La ICSI (Intracytoplasmic Sperm Injection).

ICSI (Intracytoplasmic Sperm Injection) is the latest known assisted reproduction technique (ART) and it already appears to be mature. In fact the analysis of the results presented by the researchers over the years has shown that the most specific indication for this ART is the sterility of the couple with serious male pathology, up to ejaculatory azoospermia where it is possible to perform MESA, PESA or TESE. Any kind of sterility could be solved with ICSI whose only limit presently known is the high technology and therefore high costs involved. The percentage of oocytes that undergo ICSI without being damaged varies from 87% to 94% and the percentage of fertilization varies from 33% to 71%. The transfer rate is 59-100%. The rate of pregnancies per couple ranges from 12% to 40% of the couples, from 11% to 41% for the transfers. Since abortions are similar to the values of the normal population (10-15%), ICSI is actually the assisted fertilization technique with the highest incidence of pregnancies and "take home babies". The percentage incidence of the two sexes, of the malformations and the typologies of malformations corresponds to those observed in the population with spontaneous pregnancies. Since there is no natural selection of the gametes in ICSI, one may be sure that when spermatozoa with any kind of pathology are injected, the pregnancy does not take place at all.

[Outcome of drug-induced pregnancies]. / Esiti di gravidanze farmacologicamente indotte.

The authors analysed 153 pregnancies achieved after different drug treatment to induce ovulation. The outcome of single and multiple pregnancies, the fetal malformation and male/female ratio were considered. The results obtained show that induction of ovulation seem to raise the risk of miscarriage when compared with outcome of spontaneous pregnancies; the malformation risk is not considerable.

[Curettage vs. hysteroscopic resection]. / Curettage v/s resezione isteroscopica.

The aim of the present study was to evaluate the therapeutic efficacy of curettage vs hysteroscopic resection in the treatment of endometrial polyps. A group of 25 patients were examined and during surgery underwent diagnostic hysteroscopy, curettage of the uterine cavity, control hysteroscopy and resectoscopy in the event of residual polyps. Thirteen cases revealed the total persistence of the polyp after curettage and in 6 cases the polyp was only partially removed; the polyp was detached but not removed from the uterine cavity in 4 cases and the polyp was fully removed using the curette in only 2 cases. The considerable limits of curettage which emerge from this study appear to be linked to three main factors: the localization, nature and size of endometrial polyps. Curettage may therefore now be considered a method which has been surpassed in not only diagnostic but also therapeutic terms by hysteroscopic techniques.

[Surgical treatment of ovarian cysts: economic analysis as a means for the evaluation of alternative technics. Results of a biennial study]. / Trattamento chirurgico di cisti ovariche: analisi economica come strumento di programmazione e di valutazione di tecniche. Risultati di un'indagine su un biennio.

The large use of new gynaecological technologies such as the operative laparoscopy, requires both efficacy and efficiency evaluation. The aim of this work is to compare costs of the surgical treatment of ovarian cysts between two groups of patients--35 patients undergone to laparotomic cystectomy (age: mean 27.5) and 34 operated by laparoscopic technique (age: mean 27). The analysis of the costs, related to three steps of health care (pre-operative, operative, post-operative) shows that the laparoscopic cystectomy results the more efficient intervention (L. 6,244,808 vs L. 8,310,002). This economic analysis may offer a planning tool for health care to hospital managers and represent an efficiency evaluation criterion of surgical techniques employed by the gynaecologists.