Los valores de pH y prolactina sanguíneos se correlacionan y son menores en las mujeres que tienen un parto en comparación con las sometidas a cesárea / Blood pH and prolactin levels are lower and correlate in women with vaginal delivery in comparison with those undergoing cesarean section

Introducción El patrón multifásico de prolactina (PRL) que ocurre durante el parto no ha podido relacionarse con factores inhibidores y liberadores de PRL ya conocidos. Objetivo Determinar si hay correlación entre las concentraciones séricas de PRL y el pH sanguíneo en las pacientes que tienen un parto vaginal, en comparación con las que se someten a cesárea. Métodos Se incluyó a un total de 23 mujeres primigestas, de las que 12 tuvieron un parto eutócico y 11 se sometieron a cesárea. A todas ellas se realizaron 7 determinaciones de pH y PRL antes y después del nacimiento, a partir del inicio del segundo peíodo del trabajo de parto o la cirugía, según el caso. Resultados Los valores de PRL y pH fueron diferentes en ambos grupos (p<0,05). En el grupo de cesárea no se observaron cambios en el pH y la PRL. En el grupo de pacientes que tuvieron un parto, los valores de PRL fueron superiores a los 45min del expulsivo y en el momento de parto, comparados con los iniciales (p<0,05). Asimismo, los valores de pH fueron menores a partir de 15min del período expulsivo hasta 21min posparto (p<0,001). Se encontró una fuerte correlación entre el pH y la PRL, en el momento del parto y a los 7 y los 14min posparto (p<0,05).Discusión Se corroboró la existencia de una secreción bifásica de PRL durante el período expulsivo, la misma que se correlaciona con la disminución en los valores de pH que ocurre durante este período (AU)

Introduction The multiphasic pattern of prolactin (PRL) secretion described during vaginal delivery has not been related to the PRL-inhibiting or -liberating factors that are already known. Objective To determine whether there is a correlation between blood PRL concentrations and pH in women with vaginal delivery compared with those undergoing cesarean delivery. Methods This study included 23 primiparous women, of whom 12 had a vaginal delivery and 11 underwent cesarean delivery. In all patients, seven blood pH and PRL determinations were performed, before and after delivery, from the beginning of the second stage of labor or surgery. Results pH and PRL levels differed between the two groups (p<0.05). In the cesarean delivery group, no changes in pH or PRL concentrations were observed. In the vaginal delivery group, PRL levels were higher 45min after the onset of the second stage of labor and at delivery compared with initial values (p<0.05). Likewise, pH levels were lower 15min after the onset of the second stage until 21min after delivery (p<0.001). A strong correlation was found between pH and PRL at delivery and at 7 and 14min after delivery (p<0.05).Discussion The results of this study confirm the existence of a biphasic PRL secreting pattern during the second stage of labor. This pattern correlates with the reduction in pH levels that occurs during this period (AU)

Insulin-like growth factors-1 and -2, but not hypoxia, synergize with gonadotropin hormone to promote vascular endothelial growth factor-A secretion by monkey granulosa cells from preovulatory follicles.

The midcycle gonadotropin surge promotes vascular endothelial growth factor-A (VEGF-A) production by granulosa cells in the ovulatory follicle, but it is unclear whether primary regulators of VEGF secretion in other tissues, including hypoxia and growth factors, are also important in the ovary. To address these issues, granulosa cells were collected from rhesus monkeys during controlled ovarian stimulation either before (i.e., nonluteinized granulosa cells, NLGCs) or 27 hours after (i.e., luteinized granulosa cells, LGCs) administration of an ovulatory bolus of hCG, and cultured in fibronectin-coated wells containing a chemically defined media. When NLGCs were transferred to various O2 environments (20%, 5%, or 0% O2) or media containing 100 mM CoCl2, LH (100 ng/ml)-stimulated progesterone (P4) levels were markedly (P < 0.05) suppressed by 0% O2 or CoCl2. VEGF concentrations also declined (P < 0.05) in control, CoCl2, and CoCl2 + LH groups in 0% O2, although CoCl2 modestly increased (75% above control; P < 0.05) VEGF levels in 20% and 5% O2. When NLGCs were cultured in the presence of recombinant human insulin-like growth factor (IGF)-1, IGF-2, or insulin, there was a dose-dependent increase (P < 0.05) in VEGF levels on Day 1 of culture. Whereas optimal doses of IGF-1 or IGF-2 (50 ng/ml), hCG (100 ng/ml), and IGF plus hCG stimulated VEGF levels on Day 1, only the combination of IGF-1 or IGF-2 plus hCG increased VEGF above controls and sustained levels through Day 3 of culture. The synergistic effects of IGF and hCG were also evident in P4 levels, and were not due to changes in DNA content between treatment groups. LGCs produced much higher levels of P4 and VEGF, but the responses to different O2 concentrations and insulin-related factors were qualitatively similar to those of NLGCs. These results suggest that hypoxia is not a primary regulator of VEGF production in primate granulosa cells. However, IGFs may act in concert with the gonadotropin surge to promote VEGF secretion in the ovulatory, luteinizing follicle.

Regulation and action of angiogenic factors in the primate ovary.

The ephemerality of the maturing follicle and subsequent corpus luteum as they perform their gametogenic and/or endocrine functions during the ovarian cycle is associated with remarkable changes in local vasculature. Studies on the angiogenic and angiolytic process in the ovary, rare in healthy adult tissues, complement recent efforts to understand vasculogenesis in embryonic tissues and to control angiogenesis in pathologic states such as cancer. Several reports indicate that the newly discovered vascular-specific angiogenic factors are expressed in the ovary, notably members of the vascular endothelial growth factor (VEGF) and angiopoietin (Ang) families plus their receptors (VEGF-Rs, neuropilins, Tie). Unlike in many other tissues, gonadotropic hormones (particularly luteinizing hormone, [LH]) are major stimulators of angiogenesis and VEGF/Ang expression in the ovary. However, local factors such as insulin-like growth factors or oxygen tension likely modulate the angiogenic processes. Recent studies employing systemic or local administration of anti-angiogenic drugs (TNP-470 or fumagillin) or specific VEGF antagonists (VEGF antibody or soluble VEGFR-1) demonstrate a vital role for normal angiogenesis and VEGF action in follicle development, ovulation, or corpus luteum function. Further studies discerning the various angiogenic factors and their roles in controlling the growth, maturation, function, and regression of the vasculature in ovarian compartments during the menstrual cycle could yield novel strategies for manipulating fertility or for alleviating infertility.

Randomized placebo-controlled evaluation of intramuscular interferon beta treatment of recurrent human papillomavirus.

OBJECTIVE: To evaluate the effectiveness and safety of interferon beta in women with recurrent cervical human papillomavirus (HPV) lesions. METHODS: Women with recurrent HPV of the cervix were assigned randomly to received either 3 million IU of interferon beta daily for 5 days, followed by 2 days of rest for 3 weeks, or placebo on the same schedule (N = 61 in each group). They were evaluated at 6 and 12 months after cytology, colposcopy, and directed punch biopsy. Comparison between groups was carried out by chi(2), Fisher exact test, and Student t test, depending on the variable. Multivariable logistic regression was used to evaluate influence of variables to treatment and categorical and continuous variables were compared by Mantel-Haenszel and Wilcoxon tests. RESULTS: When treatment success rates for all patients at 6 and 12 months were compared, a highly significant statistical difference was found in the treated group compared with the placebo group [48 of 61 (79%) versus 33 of 61 (54%), P =.001, and 43 of 61 (70%) versus 26 of 61 (43%), P =.002, respectively]. Multivariable analysis showed treatment success rates with interferon beta were higher between the group with initial histopathology of cervical intraepithelial neoplasia (CIN) (odds ratio 4.86; 95% confidence interval 1.75, 13.49), and the group receiving placebo (P =.002). Side effects treatments were minimal in 70% of women; the most severe events were headaches and flulike symptoms that did not interfere with the treatment. No clinically significant changes were found in laboratory measurements of glucose or transaminases during treatment or follow-up. CONCLUSIONS: Intramuscular injections of interferon beta were effective for treating recurrent HPV lesions, particularly when associated with CIN. The only side effects were mild and controllable.

[Comparative study between estradiol valerate combined with cyproterone acetate, and conjugated equine estrogens combined with medroxyprogesterone acetate as hormone replacement therapy in climacteric]. / Estudio comparativo entre la combinación valerianato de estradiol-acetato de ciproterona y estrógenos conjugados equinos-acetato de medroxiprogesterona como terapia hormonal de reemplazo en el climaterio.

OBJECTIVE: To compare the effectiveness in the control of climacteric symptoms, the tolerability and the uterine bleeding pattern between two types of hormone replacement therapy. MATERIAL AND METHODS: 81 postmenopausal women between 40 and 60 years age with vasomotor symptoms were studied. Randomly it was administered: I. Conjugated equine estrogens (CEE)-Medroxyprogesterone acetate (MPA): 21 tablets with 0.625 mg of CEE and 10 tablets with 5 mg of MPA which were taken with the last ten tablets of CEE in each cycle (n = 3 7). II. E2V-CPA: 11 tablets with 2 mg of E2V and 10 tablets with 2 mg of E2V and 1 mg of CPA (n = 44). Each cycle comprised 28 days. The treatments were compared with squared Chi and Mann-Whitney U test. RESULTS: The hot flushes presence was significantly greater in the group with CEE-MPA (p < 0.03). Severe throbs at the end of the study had a trend to be more frequent in the group with EC-MPA (p < 0.06). At the end of the study there was a greater frequency of breast tenderness in the group with CEE-MPA (P = 0.009). CONCLUSIONS: Both treatments have good effectiveness, tolerability and same bleeding pattern. Only the frequency of hot flushes, the presence of severe throbs and breast tenderness were lower in the group with E2V-CPA, that makes this preparation an option that can have a better acceptance by the women.

[Distribution of adipose tissue and insulin serum levels in women with gestational diabetes]. / La distribución del tejido adiposo y los niveles séricos de insulina en la mujer obesa que desarrolla diabetes mellitus gestacional.

Obesity has been mentioned as a major risk factor to develop gestational diabetes mellitus (GDM). In this work the main purpose was to compare the distribution of body fat tissue and insulin serum levels in obese women suffering GDM. Twenty obese pregnant patients, ten with GDM and ten non-diabetic control subjects were selected. To define the body fat distribution the following anthropometric indexes were performed: subscapular/triceps skinfold index (STI) during pregnancy (24-28 weeks) and STI plus waist/hip ratio (WHR) in postpartum (6 weeks). The two obese groups were evaluated through an oral glucose tolerance test, taking blood at 0, 60, 120 and 180 minutes; after centrifugation glucose serum levels were measured immediately by the glucose oxidase technique and the rest of the sample was kept frozen at -20 degrees C until insulin determinations by radioimmunoassay. The ten patients with GDM presented upper body fat, segment distribution, while among those without GDM, only six had this last feature and four were found with lower body fat segment distribution (p < 0.047). Insulin serum levels in GDM group were higher than in women without GDM (p < 0.01). The STI during and after pregnancy correlated positively (r = 0.77, p < 0.00003) and also with WHR (r = 0.61, p < 0.0001). There was correlation between STI and WHR both measured in postpartum (r = 0.52, p < 0.0007).

Rokitansky syndrome and MURCS association--clinical features and basis for diagnosis.

OBJECTIVE: To describe 19 cases with Rokitansky syndrome, as well as their endocrine features, and other associated malformations. METHODS: Nineteen cases of utero-vaginal atresia are reported. Serum levels of luteinizing hormone, follicle stimulating hormone, prolactin, estradiol, and progesterone were measured. Genetic study was done by karyotype and X chromatin. Pelvic ultrasound was performed, and searches for associated urinary and bone malformations were done by intravenous pyelogram and spinal column X-rays, respectively. RESULTS: In all patients, mammary growth began between 9 and 12 years, and pubic hair growth between 11 and 14 years. Nine of them sought advice for primary amenorrhea, and 10 for difficulty in sexual intercourse. Thirteen patients had begun sexual activity, between 18 and 30 years of age; six of them had dyspareunia, and in four it was impossible to have sexual intercourse, but three reported satisfactory sexual relations. External genitalia were normal in all, vaginal length was between 0.5 and 7 cm, and in all ended in a blind pouch. On pelvic ultrasound, normal ovaries and absent uterus were delineated; only one had polycystic ovaries. All had a 46XX karyotype and positive X chromatin. Hormone levels were normal in 16, 3 had hyerprolactinemia. In 7 out of 11 in whom progesterone was measured, it was ovulatory. In 8 out of 11, the pyelogram was abnormal, and in the same number, skeletal anomalies were found. CONCLUSIONS: In three patients, MURCS association was documented. It is proposed as an easy and minimally invasive study protocol for diagnosis.

Relationship between hormone levels and testicular biopsies of azoospermic men.

This study was conducted to evaluate the testicular biopsies and the sera levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T), and prolactin (PRL) in 96 azoospermic men attending the Andrology Clinic. Plasma levels of FSH were the most common hormone abnormality in the evaluation of azoospermia. Plasma levels of LH and T were useful only in azoospermic men with hypogonadism, whereas plasma PRL levels rarely occurred in azoospermia.

Endometrial changes according to hormone replacement therapy schedule.

OBJECTIVE: The purpose of this study was to assess differences in endometrial thickness, ultrasonographic characteristics, and histological and bleeding patterns in two groups of women according to the type and length of hormone replacement therapy (HRT) administered. DESIGN: Twenty-seven women were divided into two groups. Group I received oral conjugated estrogens 0.625 mg/day for 21 days, plus chlormadinone 2 mg the last 12 days, for a median length of 6.5 months' time. Group II received oral conjugated estrogens 0.625 mg/day plus chlormadinone 1 mg/day, both continuous and uninterrupted (n = 13), for a median length of 3 months' time. Using transvaginal ultrasound, endometrial thickness, refringence, and the presence of liquid in the uterine cavity were analyzed. An endometrial biopsy was performed the same day and the histological and bleeding patterns were described. Statistical analysis was performed with Mann-Whitney U test, Fisher's exact test, and Spearman correlation coefficient. RESULTS: Results of these tests showed that liquid in the uterine cavity and secretory endometrium were frequently found in those with sequential schedule (Group I); regular uterine bleeding was also frequent in this group. Negative correlation coefficients were found in this group between duration of HRT and endometrial thickness and uterine bleeding patterns, and in the continuous schedule group, between the duration of HRT and uterine bleeding pattern. CONCLUSIONS: We conclude that endometrial and ultrasonographic changes depend on the type of HRT schedule and the duration of therapy.

Effects of cigarette smoking on semen characteristics of a population in Mexico.

A study of semen quality was conducted in 197 smoking and 161 non-smoking men undergoing initial infertility investigation. The men were allocated into groups according the number of cigarettes smoked per day < 10 (n = 57), 11-20 (n = 115), and > 20 cigarettes (n = 25). Smokers had significantly poorer sperm density (P < .005), a lower percentage of viability (P < .007), a lower percentage of normal sperm morphology (P < .005), and the percentage of motile sperm was lower (P < .005). These parameters were worse in the heavy smoking groups. Thus the present study corroborates reports of detrimental effects of cigarette smoking on sperm characteristics. Further studies are needed to explain the mechanism by which smoking affects spermatogenesis.

Effects of pentoxifylline on sperm motility in normogonadotropic asthenozoospermic men.

Forty-seven normogonadotropic men with idiopatic asthenozoospermic were divided at random: group I (N = 22) received placebo and group II (N = 25) received 1200 mg of pentoxifylline/day during 6 months. Semen analysis was performed basal and at 3 and 6 months of the study period. No statistical changes in serum hormone concentration were found, nor in volume, sperm counts, viability, and morphology before and after treatment. Sperm motility increased following pentoxifylline treatment after 3 and 6 months from 25.5 (21.0-30.0) to 35.5 (31.5-39.0) (p < .00001) and to 42.0 (38.0-46.0) (p < .00001), respectively. Although in the placebo control cases some changes were observed in the sperm motility, they were less significant. Furthermore, progressive motility only in grade A increased with pentoxifylline from 2.5 (0.0-6.0) to 12.0 (6.0-19.5) (p < .001) at 3 months and to 22.5 (17.0-26.0) at 6 months (p < .00001). In conclusion, pentoxifylline had an additional effect rather than placebo and was useful treatment in these cases of male factor infertility.

Hyperprolactinemia in men with asthenozoospermia, oligozoospermia, or azoospermia.

The role of serum prolactin (PRL) in male infertility is still unclear. To assess the clinical significance of PRL determination during infertility studies, serum hormones and semen samples from 167 men attending the Andrology Clinic were analyzed, and PRL seric values were correlated with volume, sperm count, motility, viability, and morphology. The range of PRL levels (ng/mL) was 7.3 +/- 2.1 in the control group (n = 46), 13.9 +/- 6.6 in asthenozoospermic (n = 51), 12.6 +/- 7.8 in oligozoospermic (n = 42), and 10.9 +/- 4.8 in azoospermic patients (n = 28). Significantly higher (p < .0001) levels of PRL were found in the men with asthenozoospermia, oligozoospermia, and azoospermia. In the 121 infertile patients with abnormal semen analysis, serum PRL levels were below 14.0 ng/mL (normal mean + 3 SD) in 81 (66.9%) and above this level in 40 (33.1%) cases. Serum FSH and LH concentrations in azoospermic men were significantly higher (p < .0001) when compared with those of the control group, which indicates some disturbance of the spermatogenic process, and estradiol was significantly higher (p < .02) in oligozoospermic patients. No significant differences were found in serum testosterone. Twenty-one patients with idiopathic oligoasthenozoospermia and hyperprolactinemia were treated with 2.5 mg of bromocriptine daily for 6 months, resulting in a nonmeasurable effect on their sperm analysis. In conclusion, two-thirds of patients with oligozoospermia, asthenozoospermia, and azoospermia have normal PRL levels. Infertility in men due to moderate hyperprolactinemia could be associated with these sperm disturbances, but bromocriptine was of no therapeutic utility.

[Evaluation of ultrasonographic variables of the endometrium in relation with histopathologic findings in patients with postmenopausal uterine bleeding]. / Evaluación de las variables ultrasonográficas del endometrio en relación con los hallazgos histopatológicos en pacientes con sangrado uterino posmenopáusico.

The purpose of this study was to determine the sensitivity, specificity, positive and negative predictive value of analyzed variables in the ultrasonographic endometrial study in patients with postmenopausal uterine bleeding. Nineteen women with postmenopausal uterine bleeding were studied, in all of them and in the same day a transvaginal ultrasound and endometrial biopsy were performed. It was observed that endometrial thickness median was 4 mm; most of the endometria were proliferative (n = 12), and a greater trend to obesity and upper segment fat distribution was found. Endometrial thickness, refringence and liquid on uterine cavity had a sensitivity and a negative predictive value NPV) of 100%, specificity and positive predictive value were lower. When endometrial thickness and refringence were associated also a sensitivity and NPV of a 100% was found. It can be concluded that transvaginal ultrasound is useful to define in which patient with postmenopausal uterine bleeding the endometrial biopsy is indicated.

[Correlation of histopathologic findings with ultrasonography variables of the endometrium according to body weight and adipose tissue distribution in postmenopause]. / Correlación de los hallozgos histopatológicos con las variables ultrasonográficas del endometrio conforme al peso corporal y distribucióndel tejido adiposo en la posmenopausia.

The purpose of this work was to correlate the histologic findings and ultrasonographic variables of the endometrium in relation to corporal weight and body fat distribution, in two groups of women: one with posmenopausal uterine bleeding and other under hormonal replacement therapy (HRT). Thirty one posmenopausal women were studied and divided into two groups: I. women with posmenopausal uterine bleeding (n = 19) and II women with HRT (conjugated estrogens and chlormadinone) (n = 12). In both groups transvaginal ultrasound was accomplished the same day previous to the endometrial biopsy (EB). The EB was taken in the group I the day they attended the hospital referring transvaginal bleeding and in group I a statistical significant correlation was found among the corporal weight and histologic findings and among the endometrial refringence and the histologic findings. In group II there was a statistical significant correlation among the body fat distribution and endometrial refringence and among the endometrial thickness and histologic findings. It can be concluded that in women with posmenopausal bleeding the corporal weight influences the histologic findings and the refringence is related with histologic findings, while those under HRT is more important the body fat distribution over endometrial refringence and the endometrial thickness is related with histologic findings.

Sperm characteristics and hormonal profile before and after treatment with follicle-stimulating hormone in infertile patients.

Fourteen asthenoteratozoospermic (ATZS) patients were treated with 75-IU follicle-stimulating hormone (FSH) injections 3 times a week for 3 months. In the group as a whole, sperm motility, viability, and morphology were improved, but not significantly. Only 3 patients impregnated their wives following treatment. Semen characteristics of the 3 patients whose wives were pregnant showed significant improvement in sperm morphology (p = .001). Only FSH levels were statistically higher (p = .022) than controls. The administration of FSH in weekly doses can improve the fertilization potential of sperm.

[Determination of gastrin levels in maternal and neonatal serum as well as in amniotic fluid in acute fetal distress]. / Determinación de los niveles de gastrina en suero materno, neonatal y líquido amniótico en el sufrimiento fetal agudo.

The objective was to measure gastrin (G) levels in maternal and neonatal sera as well as in amniotic fluid in patients with fetal distress and a control group. Twenty-five patients with term pregnancies were assigned to the following two groups: fifteen with acute fetal distress and ten with previous cesarean section. Maternal and neonatal blood and amniotic fluid samples were taken at the time of delivery. Differences between groups were calculated with non-parametric Mann Whitneys' U test. A significant difference (p < 0.001) between G levels in amniotic fluid of fetal distress and those of the control group was found. In conclusion, serum G levels can be used as another predictor of fetal distress, although further studies must be performed before it can be used as a clinical tool.