Disclosure of an unknown portrait of the Hungarian conjoined twin sisters Helen and Judith (1701-23).

Recently an anonymous and unknown portrait of two renowned conjoined twins, the Hungarian sisters Helen & Judith (1701-23), was discovered. The portrait shows striking similarities with the representation of the twins in a popular work on cultural anthropology and medicine printed in Augsburg, Germany, in 1805.

A new device for bone anchor fixation in laparoscopic sacrocolpopexy: the Franciscan laparoscopic bone anchor inserter.

BACKGROUND: A laparoscopic modification of the sacrocolpopexy procedure with mesh and bone anchor fixation with the Franciscan laparoscopic bone anchor inserter was developed. METHODS: We developed a laparoscopic bone anchor inserter for the placement of a titanium bone anchor in sacral segment 3 as fixation for the mesh in laparoscopic sacrocolpopexy procedures performed in women with posthysterectomy vault prolapse. RESULTS: Surgery successfully corrected vaginal vault prolapse. Laparoscopic bone anchor insertion with this new and simple device took 2 minutes and provided a firm anchor for mesh fixation. MRI demonstrated an anatomically preferable vaginal axis toward the hollow of the sacrum. CONCLUSION: Application of the newly developed Franciscan laparoscopic bone anchor inserter in laparoscopic sacrocolpopexy is an easy and safe procedure that provides firm fixation and excellent anatomical results.

Prostanoid excretion before in vitro fertilization relates to the likelihood of pregnancy.

The objective of this study was to determine the urinary excretion of prostacyclin (PGI2) and thromboxane A2 (TXA2) metabolites during in vitro fertilization (IVF) in relation to the clinical outcome of IVF. Urine was obtained overnight every 3 to 4 days from 24 women during IVF cycles. TXB2, 6-keto-PGF1 alpha and their 2,3-dinor derivatives were measured by high-pressure liquid chromatography with radioimmunoassay. The patients were women with (n = 16, 119 samples) and without (n = 8, 53 samples) a clinical IVF pregnancy. Concentrations of 2,3-dinor-TXB2 and 2,3-dinor-6-keto-PGF1 alpha were lower before embryo transfer in women who achieved a pregnancy than in those who did not conceive (p < 0.05). Contrary to women who did not conceive, women who achieved pregnancy had an increase in 6-keto-PGF1 alpha excretion after embryo transfer (p = 0.04). In women who did not conceive, levels of 2,3-dinor-TXB2 were higher before embryo transfer than after transfer (p = 0.04) and than levels in women who did conceive (p = 0.01). We concluded that differences in urinary prostanoid metabolite excretion before embryo transfer appear to relate to the likelihood of pregnancy, but the nature of this relationship remains elusive.

Which prostanoid metabolites should be determined for the study of reproductive processes?

The non-enzymatic metabolites of prostacyclin (PGI2) and thromboxane A2 (TXA2), 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha) and thromboxane B2 (TXB2), and their 2,3-dinor metabolites, 2,3-dinor-6-keto-PGF1alpha and 2,3-dinor-TXB2, were measured in early morning urine samples in 24 in vitro fertilization (IVF) cycles in 24 women and in 27 women who became pregnant after IVF and embryo transfer (ET). The sum of the non-enzymatic metabolites and their 2,3-dinor metabolites was considered to be a reflection of total PGI2 and total TXA2 production in vivo. Both the ratio of 'total' PGI2/'total' TXA2 and the ratio of the 2,3-dinor metabolites were calculated. TXB2 concentrations showed virtually no change and the ratios of the non-enzymatic metabolites of PGI2 and TXA2 versus their 2,3-dinor metabolites remained relatively constant. As a consequence, the ratio of 2,3-dinor-6-keto-PGF1alpha/2,3-dinor-TXB2 was a close reflection of the ratio of 'total' PGI2/'total' TXA2, although the latter ratio was significantly higher all the time. We conclude that for comparative studies on the balance between PGI2 and TXA2 in IVF cycles and during gestation, the determination of the 2,3-dinor metabolites alone can replace the measurement of all four metabolites.

The influence of indomethacin on the hatching of mouse blastocysts.

In order to investigate the effect of indomethacin for inhibition of the cyclooxygenase pathway on the hatching process of mouse blastocysts, 508 mouse blastocysts were cultured in modified HAM F10 medium containing 0, 8, 79 or 788 microM indomethacin, added after 24 h of incubation. Hatching was scored after 72 h of incubation. In another series of experiments, indomethacin was added only after blastulation had occurred. Indomethacin in doses of 8 microM and 79 microM, added after 24 h of incubation or after blastulation had occurred, did not influence successful hatching. A dose of 788 microM indomethacin interfered with hatching, but this dose appeared to be toxic for the embryo.

Prostanoid levels in in vitro fertilization culture medium are not related to the likelihood of implantation.

OBJECTIVE: To determine prostanoid levels (prostaglandin E2, prostaglandin F2 alpha, 6-keto-prostaglandin F1 alpha, and thromboxane B2 [TXB2]) in embryo culture medium containing inactivated maternal serum and their correlation with the clinical outcome of IVF-ET. DESIGN: Prostanoid levels were measured in blank control medium and in medium containing an embryo or nonfertilized oocyte with a high-pressure liquid chromatography (HPLC-RIA) method. Comparisons of HPLC-RIA, Seppak C18-RIA, and RIA directly in the medium demonstrated identical results for TXB2, allowing the use of direct RIA in the large investigation of 129 media. SETTING: Leiden University Hospital, The Netherlands. PATIENTS: Patients with (n = 12) and without (n = 15) an ongoing pregnancy after IVF-ET. MAIN OUTCOME MEASURES: Prostanoid levels in embryo culture medium and relationship between prostanoid levels and successful implantation. RESULTS: Thromboxane B2 is the only prostanoid consistently found in these media. In both groups there was no difference in TXB2 levels between control media, media containing a nonfertilized oocyte, and media containing an embryo. There was no difference in TXB2 levels between media that had harbored the beginning of a successful pregnancy and those that had not produced a pregnancy. CONCLUSION: Thromboxane B2 in the embryo culture medium originates from maternal serum and bears no relationship with the likelihood of fertilization and implantation.

Steroids and cytokines in endometrial angiogenesis.

Angiogenesis, the formation of new blood vessels from pre-existing ones, occurs physiologically in the endometrium and pathologically e.g. during tumour growth. Sex-steroid hormones affect angiogenesis in the endometrium during the menstrual cycle and might be implicated in cancer angiogenesis. Little information is presently available regarding the exact mechanisms by which these steroids exert their function on the process of both physiological and pathological angiogenesis. In this overview a survey is given of factors important for angiogenesis and of the effects of steroids on the expression of these factors. We have focused on endometrial angiogenesis, because the endometrium is unique in its cyclic growth pattern for which angiogenesis is indispensable. Stimulators and inhibitors of endometrial angiogenesis, that have been found (or suggested) to respond to ovarian steroids, are discussed These factors include vascular endothelial growth factor (VEGF), fibroblast growth factors (FGFs), tumour necrosis factor a (TNF-alpha), erythropoietin (Epo) and trombospondin-1 (TSP-1). Also, the influence of steroids on the expression of matrixdegrading proteases, in particular the plasminogen activator/plasmin system and matrixdegrading metalloproteinases (MMPs) are reviewed, because these proteases play an important role in the migration and invasion of endothelial cells during the process of angiogenesis. An insight into the effects of steroids on endometrial angiogenesis may be helpful to understand and anticipate the potential stimulatory and inhibitory effect of various steroids on angiogenesis in other tissues, in particular tumours.

Proliferative and malignant Brenner tumours (BT) and their differentiation from metastatic transitional cell carcinoma of the bladder: a case report and review of the literature.

Up to now 110 cases of malignant Brenner tumour (BT) and 45 cases of proliferative BT have been reported in the accessible literature. To delineate the diagnostic criteria and to determine the differences between these tumours and metastatic tumours of the urinary tract, 94 cases of malignant BT and 37 cases of proliferative BT were reviewed. The difficulties encountered in determining these differences are illustrated by means of a case history.

Treatment failure in trichomoniasis and persistence of the parasite after Lactobacillus immunotherapy; two case reports.

This report describes the clinical and laboratory observations on two patients with a Trichomonas vaginalis infection resistant to metronidazole. The metronidazole resistance was confirmed in in vitro cultures under aerobic conditions, after in vitro cultivation of the strains. Trichomonas infection persisted during high-dose intravenous metronidazole administration and Lactobacillus immunotherapy was unsuccessful in both patients.

Low-grade immature teratomas with peritoneal gliomatosis; a case report.

Immature teratomas with peritoneal gliomatosis are rare. Eight cases have been registered by the Dutch Ovarian Tumor Committee and one patient, presented in this paper, was treated recently. The follow-up in these cases indicates a good prognosis, even in grade 2 teratomas. Peritoneal implants do not influence adversely the prognosis when they are composed of mature glial tissue. A conservative approach seems to be justified.

Endocrine effects of laparoscopic ovarian electrocautery in patients with polycystic ovarian disease, resistant to clomiphene citrate.

Endocrine responses to laparoscopic ovarian electrocautery were studied in 14 patients with polycystic ovarian disease (PCOD), resistant to clomiphene citrate. Patients who did not conceive within 6 months of treatment were evaluated for up to that period. Testosterone and androstenedione levels decreased after electrocautery in a way which is comparable with the reduction in androgens after wedge resection of the ovary. Androstenedione levels tended to return to pretreatment values at 6 months; four of the five pregnancies were achieved within this period. The reduction in androgens may break the vicious circle of PCOD, and lead to normal menstrual cycles.

Transient diabetes insipidus of pregnancy.

The history is presented of a near-term patient with transient diabetes insipidus. Because of the demonstrated positive response to dDAVP it is argued that increased vasopressinase activity may have been involved.

Endometrial cells in the peritoneal cavity after laparoscopy and chromotubation.

The presence of endometrial cells in peritoneal fluid before and after laparoscopy and chromotubation was studied in 35 patients at different days of the menstrual cycle. Endometrial cells were found more frequently in peritoneal fluid samples taken in the second half of the menstrual cycle.

The continuing influence of William Smellie (1697-1763) in Japan during the early Meiji Period (1868-1880s).

From the second half of the 18th century, Japanese obstetricians incorporated William Smellie's Anatomical Tables in their publications. The translation and explanation of an obstetrical print from 1880 indicates that Smellie's influence continued during the early Meiji period, a transition period characterized by a combination of western knowledge and traditional medical thoughts from the Edo period (1603-1868).

European 18th-century obstetrical pioneers in Japan: a new light in the empire of the sun.

From the second half of the 18th century, Japanese physicians incorporated concepts of European medicine in their publications. Dutch physicians had a pivotal role in this process, facilitated by their trade relations in Deshima, near Nagasaki. This paper focuses on the influence of later Dutch editions (probably the 1765 edition) of Hendrik van Deventer's pioneer work Nieuw Ligt (a New Light) on Japanese obstetrics, especially on Katakura Kakuryo's publication in 1799 of Sanka Hatsumo (Enlightenment of Obstetrics).