Increased Diameters of the Internal Cerebral Veins and the Basal Veins of Rosenthal Are Associated with White Matter Hyperintensity Volume.

BACKGROUND AND PURPOSE: White matter hyperintensities on T2-weighted MR imaging are typical in older adults and have been linked to several poor health outcomes, including cognitive impairment and Alzheimer disease. The presence and severity of white matter hyperintensities have traditionally been attributed to occlusive arteriopathy, but recent evidence also implicates deep medullary venule collagenosis and associated vasogenic edema. Historically, postmortem analyses have been the sole way to analyze cerebral veins, but SWI can be now used to examine cortical veins in vivo. The aim of the current study was to determine whether there is an association between the diameters of the large draining cerebral veins/sinuses and white matter hyperintensity volume. MATERIALS AND METHODS: T2-weighted FLAIR and SWI were performed in 682 older adults without dementia (mean age, 73.9 ± 5.9 years; 59.1% women). Total and regional white matter hyperintensity volume was derived. We measured the diameters of 5 regions of the cerebral venous draining system: internal cerebral veins, basal veins of Rosenthal, superior sagittal sinus, vein of Galen, and straight sinus terminus. RESULTS: Increased diameter of the internal cerebral veins was associated with greater total white matter hyperintensity volume (ß = 0.09, P = .02) and regionally in the parietal (ß = 0.10, P = .006), frontal (ß = 0.09, P = .02), and temporal (ß = 0.09, P = .02) lobes. Increased diameter of the basal veins of Rosenthal was associated with greater total (ß = 0.10, P = .01), frontal (ß = 0.11, P = .003), and temporal (ß = 0.09, P = .02) white matter hyperintensity volume. CONCLUSIONS: Our results suggest that the caliber of the internal cerebral veins and of the basal veins of Rosenthal relates to regional white matter disease.

Critical ovarian hyperstimulation syndrome in a coasted in-vitro fertilization patient.

We report an instance of critical ovarian hyperstimulation syndrome in a highly responsive in-vitro fertilization patient despite the preventive measure of a 4 day 'coast' interval during which no gonadotrophins were administered while gonadotrophin-releasing hormone agonist therapy continued until serum oestradiol concentrations fell below 3000 pg/ml.

"Coasting" does not adversely affect cycle outcome in a subset of highly responsive in vitro fertilization patients.

OBJECTIVE: To study the effect of postponing hCG administration while continuing daily GnRH agonist therapy ("coasting") on highly responsive patients undergoing IVF-ET. DESIGN: Retrospective analysis. SETTING: University-affiliated Center for Fertility and Reproductive Medicine. PATIENT(S): Patients undergoing IVF-ET from March 1995 to March 1997. INTERVENTION(S): Three groups of IVF-ET patients were compared to explore the effect of coasting on cycle outcome: a group of highly responsive coasted patients, a group of equally responsive noncoasted patients, and an age-matched normally responsive control group. Two groups of coasted patients were also compared to assess the effect of E2 levels at the time that they met the follicular criteria for hCG administration. Last, the effect of varying coast duration was examined by regression analysis. MAIN OUTCOME MEASURE(S): Patient characteristics, outcome parameters, and incidence of ovarian hyperstimulation syndrome (OHSS). RESULT(S): Coasting had no detrimental effect on cycle outcome in the subset studied. Regression analysis, however, suggests an inverse relationship between coast duration and the number of mature oocytes retrieved as well as the clinical pregnancy rate. CONCLUSION(S): Coasting in the studied subset of IVF patients did not adversely affect cycle outcome parameters or the incidence of OHSS, but prolonged coasting intervals may impair IVF cycle outcome.

Lymphocyte shedding from genital tract of human immunodeficiency virus-infected women: immunophenotypic and clinical correlates.

OBJECTIVE: Our purpose was to describe the lymphocyte subpopulations in genital tract samples from human immunodeficiency virus-infected women and the clinical correlates associated with lymphocyte shedding. STUDY DESIGN: Genital tract samples of women infected with human immunodeficiency virus-1 were processed for immunophenotyping analysis with a FACScan flow cytometer. Immunologic and virologic characteristics of women with and without lymphocyte shedding were compared with t test, Wilcoxon rank test, or Fisher's exact test. RESULTS: The rate of genital lymphocyte shedding among human immunodeficiency virus-1-infected women was 39%. Genital shedding was not related to age, race, use of antiretroviral therapy, or positive human immunodeficiency virus-1 culture. A negative rank correlation (r = -0.71, p = 0.047) between CD3+ CD4+ counts in peripheral blood and genital tract was observed. The majority of the lymphocyte cells were CD3+ CD8+, and > 80% of the CD3+ CD4+ cells were memory cells. CONCLUSION: The immune profile of the genital tract lymphocytes is suggestive of a local mucosal immune response.

A case of Pendred's syndrome presenting with amenorrhea.

Pendred's syndrome is manifested by congenital sensorineural deafness in association with familial goiter due to defective organic binding of iodine in the thyroid gland. The majority of patients with Pendred's syndrome are euthyroid. We report on an unusual case of a patient with Pendred's syndrome presenting with amenorrhea and late-onset hypothyroidism.

Relaxin secretion into human semen independent of gonadotropin stimulation.

To investigate the control of relaxin (Rlx) secretion in men, we studied seminal plasma Rlx concentrations after physiologic and supraphysiologic gonadal stimulation. In the first experiment, 14 men with idiopathic hypogonadotropic hypogonadism provided semen samples at various time points before and during therapy with pulsatile GnRH. These data were compared to seminal plasma Rlx values in 5 normal men. In a second experiment, pharmacologic doses of hCG were administered in a fashion similar to that previously shown to have stimulated Rlx secretion from the CL of women. In men with idiopathic hypogonadotropic hypogonadism, no relationship was detected by linear regression analysis between seminal plasma Rlx and testosterone, testicular volume, ejaculate volume, or the appearance of sperm in the ejaculate. Rlx concentrations varied considerably between subjects (6-120 ng/ml) but remained fairly consistent within the same individual over time. Supraphysiologic gonadal stimulation with hCG similarly failed to alter seminal plasma Rlx (n = 5, mean +/- SEM; 48 +/- 9 ng/ml, 42 +/- 7 ng/ml, and 56 +/- 9 ng/ml on Days 1, 3, and 6, respectively; p < 0.05) in normal men despite dramatic increases in serum testosterone (763 +/- 25 ng/dl, 1702 +/- 136 ng/dl, and 1494 +/- 97 ng/dl on Days 1, 3, and 6, respectively; p < 0.05 vs. Day 1). Taken together, these data suggest that Rlx in men is secreted independently from direct gonadotropin control.

Controlled micromanipulation of human sperm in three dimensions with an infrared laser optical trap: effect on sperm velocity.

Individual human sperm can be micromanipulated in three dimensions using a 1.06 microns Nd:YAG laser trap. Single sperm swimming with velocities in the range of 65 to 85 microns/sec can be trapped with 40 mW of power through 120 seconds without a deleterious effect on velocity. Even though it will be necessary to further evaluate the effects of laser light on specific functions of sperm, our data suggest that decreasing the time of manipulation to a minimum will increase the safety of the micromanipulation procedures. Laser traps may play a role in assisted reproductive technology by facilitating the selective transport of individual sperm.

Transfer of cryopreserved-thawed embryos: the natural cycle versus controlled preparation of the endometrium with gonadotropin-releasing hormone agonist and exogenous estradiol and progesterone (GEEP).

Modeled on our successful experience with oocyte donation, we present a novel, viable approach to cryopreserved-thawed embryo transfers (ETs) in women with recalcitrant ovarian dysfunction: gonadotropin-releasing hormone agonist and exogenous estradiol and progesterone (GEEP). After attainment of ovarian suppression, seven such women received physiological steroidal replacement regimens with cryopreserved-thawed ETs prospectively synchronized with the 4th day of progesterone administration and two conceived. These GEEP cycles and cryopreserved-thawed ETs were prospectively compared with cryopreserved-thawed ETs performed on the 4th day of exposure to progesterone in 20 spontaneous cycles and in 5 oocyte donation-steroidal replacement cycles. Pregnancies occurred after three cryopreserved-thawed ETs in each of these groups. We conclude that GEEP constitutes a successful preparation for cryopreserved-thawed ETs, at the least, in women with ovulatory dysfunction.

Hyperprolactinemia in clinically asymptomatic, fertile men: report of two cases.

Although the role of prolactin (PRL) in men is undefined, hyperprolactinemia has been associated with decreased reproductive potential. Two healthy, fertile, asymptomatic men with hyperprolactinemia are reported. Both men had normal puberty. Both were euthyroid and had normal gonadotropin levels and androgen profiles. Semen analyses were normal and both had fathered children. The serum PRL level (mean +/- standard error of the mean) (N = 5) of subject 1 was 48 +/- 12 ng/mL, and of subject 2 was 214 +/- 5 ng/mL. Sella turcica computed tomography scans with contrast were normal. The two subjects underwent a thyrotropin-releasing hormone stimulation test. Serum PRL and TSH were measured by radioimmunoassay. At time 0 and at 15 minutes, PRL bioactivity was measured in the Nb2 node rat lymphoma assay. Both subjects showed a normal TSH response to thyrotropin-releasing hormone. Subject 1 had baseline PRL immunoactivity and bioactivity measuring 41 and 50 ng/mL, respectively, peaking at 76 and 70 ng/mL 15 minutes after infusion of thyrotropin-releasing hormone. Subject 2 had baseline PRL immunoactivity of 200 ng/mL and bioactivity of 67 ng/mL, neither of which were altered by infusion of thyrotropin-releasing hormone. Administration of L-dopa decreased the serum PRL of subject 1 from 33 to 7 ng/mL, but had no clinically significant effect in subject 2. Prolactin and gonadotropin secretion may be dissociated in men so that hyperprolactinemia may not always manifest as reproductive dysfunction.

The effect of relaxin on calcium fluxes in the rat uterus.

Relaxin is a polypeptide hormone that inhibits rat uterine contractions. To test the hypothesis that the mechanism of action of this effect may involve shifts in calcium ions, the biologic action of relaxin on isolated rat uterine horns was directly correlated with measurements of 45Ca2+ efflux from and uptake into the tissues. Kinetic analysis demonstrated that the efflux of 45Ca2+ from rat uterine horns was significantly faster when tissue was incubated with 25 ng/ml relaxin as compared with control tissues incubated with no relaxin. In addition, at the end of the efflux experiments, control uteri contained 3.9% of the starting 45Ca2+, whereas the relaxin-treated uteri contained only 2.55%, indicating greater total Ca2+ efflux from the relaxin-treated horns (p less than 0.05). The effect of relaxin on 45Ca2+ uptake by uterine tissue was also studied. Analysis of uptake curves by linear regression demonstrated that relaxin treatment leads to less total uptake of 45Ca2+ in the uterine tissue, although the differences are not statistically significant. These experiments demonstrate that relaxin inhibition of rat uterine contractions in vitro is associated with a decrease in intracellular free Ca2+, caused, at least in part, by the promotion of Ca2+ efflux. These results represent the first step in defining the mechanism of action of this hormone.

The effect of thyrotropin-releasing hormone stimulation on serum levels of gonadotropins in women during the follicular and luteal phases of the menstrual cycle.

Thyrotropin-releasing hormone (TRH) can stimulate the secretion of adenohypophyseal thyroid-stimulating hormone and prolactin (PRL). The effect of TRH on gonadotropin secretion has not been well defined. This study investigated the effect of TRH administration on the peripheral levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) during the early follicular and midluteal phases of the menstrual cycle in five ovulatory, euthyroid, and normoprolactinemic women. Two hundred micrograms of TRH were administered intravenously on days 3 to 5 and on days 21 to 23 of the same cycle. LH and FSH were measured prior to and every 30 minutes for 2 hours following TRH injection. Ovulation was confirmed in all cycles by midluteal progesterone. All women had normal thyroid-stimulating hormone (TSH) and PRL responses to TRH stimulation in both cycle phases. Baseline and stimulated gonadotropin levels were analyzed by analysis of variance. Thirty minutes following TRH infusion, follicular and luteal levels of LH (mIU/ml, mean +/- standard error of the mean) significantly increased from 6.0 +/- 0.8 to 8.0 +/- 1.1 (P less than 0.005), and from 4.8 +/- 0.6 to 7.6 +/- 0.7 (P less than 0.005), respectively. Levels of FSH increased during both phases of the cycle, but the elevation was not statistically significant. These results suggest that TRH can stimulate gonadotrope secretion of LH, but not of FSH, in both the follicular and luteal phases of the cycle.

The effect of relaxin and prostaglandin E2 on the motility of human spermatozoa.

Relaxin and prostaglandin E2 (PGE2) are present in human semen and have been shown to affect sperm motility. The authors further examined the effects of porcine relaxin and PGE2 on the motility of human spermatozoa. A dose-response study revealed that PGE2 at a concentration of 25 micrograms/ml is most effective in improving the motility of washed human sperm. Relaxin (100 ng/ml), PGE2 (25 micrograms/ml), or the two combined have no effect on the motility of spermatozoa in fresh, normal semen, suggesting that the constituents of fresh semen are optimal for motility. Relaxin and PGE2 individually improve the motility of washed spermatozoa. However, relaxin, but not PGE2, improves the motility of sperm in semen incubated at 37 degrees C for 5 hours (aged). In contrast to the individual substances, a combination of relaxin + PGE2 has no effect on the motility of washed spermatozoa or aged spermatozoa, suggesting that these two substances antagonize each other's actions on sperm motility. The presence of both relaxin and PGE2 in seminal plasma with normal motility spermatozoa suggests that other factors in seminal plasma regulate the effects of these substances on sperm motility.

Effect of relaxin on human spermatozoa.

To study its effect on the motility of human spermatozoa, relaxin was added at different concentrations to human semen samples of various qualities as well as to washed spermatozoa. Relaxin in physiologic concentrations (10-100 ng/mL) had no significant effect on sperm motility in normal semen samples. However, the addition of relaxin to semen samples with low sperm motility significantly increased the motility. Addition of relaxin similarly increased the motility of spermatozoa from normal semen samples that were either aged or washed; the treatment resulted in a decrease in motility. When sperm motility was optimal, as in normal samples, addition of relaxin did not increase motility. However, in some situations of decreased motility, addition of relaxin resulted in improvement of spermatozoan motility. Relaxin may have clinical value in the treatment of male infertility.