Atrial natriuretic peptide concentrations and hemodynamic effects of acute plasma volume expansion in normal pregnancy and preeclampsia.

Plasma atrial natriuretic peptide (ANP) and circulatory responses were studied during rapid plasma volume expansion with crystalloid solutions. Sixteen women with preeclampsia and 16 healthy controls in the third trimester were compared. Basal mean (+/- standard error of the mean) ANP levels were not significantly higher in the preeclamptics than in controls (13.6 +/- 3.5 versus 6.4 +/- 1.1 pmol/L; not significant), but the increment following volume expansion was more pronounced (12.9 +/- 2.6 versus 6.1 +/- 2.3 pmol/L; P less than .05). The mean plasma volume expansion was less in the preeclamptic group (6.1 +/- 0.8 versus 9.3 +/- 1.1%; P less than .05), reflecting a higher capillary permeability in this disease. Left ventricular posterior-wall thickness in diastole was increased in the preeclamptics under basal conditions as compared with the controls (9.8 +/- 0.3 versus 8.9 +/- 0.3 mm; P less than .05), as was the thickness of the interventricular septum in systole (14.3 +/- 0.5 versus 12.3 +/- 0.6 mm; P less than .05). Systemic vascular resistance was higher in the preeclamptic group (19.7 +/- 0.8 versus 15.1 +/- 1.1 peripheral resistance units; P less than .01). In the controls, cardiac output increased by 23 +/- 4% and systemic vascular resistance decreased by 17 +/- 3%. The preeclamptic women reacted in a similar way. Our results indicate that preeclampsia is associated with an enhanced ANP response despite a less pronounced increase in plasma volume during acute fluid challenge.     

Blood gases and acid-base status of the human second-trimester fetus

Maternal arterial, umbilical venous, and umbilical arterial blood were obtained at fetoscopy in the second trimester and analyzed for blood gases and acid-base indexes. In comparing umbilical venous (N = 31) with maternal arterial (N = 39) samples, the mean (+/- SD) PO2 was lower (55 +/- 7 versus 100 +/- 15 mmHg, P less than .001) and PCO2 (37 +/- 4 versus 34 +/- 4 mmHg), bicarbonate (20 +/- 2.0 versus 18.5 +/- 1.5 mmol/L), lactate (1.10 +/- 0.25 versus 0.80 +/- 0.30 mmol/L), and base excess (-4.2 +/- 2.3 versus -6.0 +/- 1.5 mmol/L) were higher (P less than .001). The mean umbilical venous pH did not differ significantly from the maternal arterial (7.358 +/- 0.040 versus 7.373 +/- 0.035). Comparing umbilical arterial (N = 21) with umbilical venous (N = 31) samples, the PO2 level was lower (34 +/- 4 versus 55 +/- 7 mmHg, P less than .001) and PCO2 higher (42 +/- 4 verus 37 +/- 4 mmHg, (P less than .001); the pH was marginally lower (7.339 +/- 0.03 versus 7.358 +/- 0.040; P less than .05) and bicarbonate higher (22 +/- 1.5 versus 20 +/- 2.0 mmol/L, P less than .001). Umbilical arterial and umbilical venous values were similar in the case of lactate and base excess.     

Luteal dysfunction in ovulation induction: the role of repetitive human chorionic gonadotropin supplementation during the luteal phase

Several studies have indicated that ovulation induction with human menopausal gonadotropin (hMG)/human chorionic gonadotropin (hCG) or clomiphene citrate (CC) is associated with luteal phase defect. To assess the efficiency of luteal support by hCG to an infertile population undergoing ovulation induction, with CC/hCG or hMG/hCG, we have randomly administered 2500 IU hCG intramuscularly on days 3, 6, and 9 after ovulation induction by 10,000 IU of hCG to 74 patients on 265 treatment cycles. As controls served 357 ovulation induction cycles in the same 74 patients. The treatment cycles were randomly alternated with control cycles so that each patient served as her own control. However, the mean +/- standard deviation (SD) midluteal P was 38.1 +/- 10.8 ng/ml in the study group versus 15.7 +/- 10.5 ng/ml in the control group (P less than 0.001). Luteal phase length was 15.4 +/- 1.5 days in the treatment group versus 12.1 +/- 1.7 in the control group (P less than 0.01). In the treatment group, 64.8% of the patients achieved pregnancy (27% pregnancies/treatment cycle) versus 47.3% in the control group (11.5% pregnancies/control cycle) (P less than 0.01). The pregnancy wastage rates (including abortions and "chemical" pregnancies) were 30.6% in the treatment group versus 56% in the control group (P less than 0.01). We conclude that repetitive hCG administration may be an efficient luteal support in infertile patients undergoing ovulation induction.     

Episodic luteinizing hormone release in hyperprolactinemic women

Episodic luteinizing hormone (LH) secretion was studied in 16 hyperprolactinemic women (microprolactinoma, 12; idiopathic, 4) with amenorrhea of 1.4 to 7 years' duration. Blood samples obtained through an indwelling venous catheter at 20-minute intervals over 5 hours were assayed for LH, follicle-stimulating hormone (FSH), prolactin (PRL), and estrogen (E) (selected samples). LH pulse patterns were divided arbitrarily into high-amplitude release (LH pulse greater than 10 mIU/ml) (n = 7), low-amplitude release (LH pulse less than 10 mIU/ml (n = 6), and no release (n = 3). Mean pulse frequencies in women with high-amplitude and low-amplitude release were 2.4 +/- 0.3 (mean +/- standard error) and 1.3 +/- 0.2 pulses/5 hours and differed significantly (P greater than 0.02), whereas mean percentages of secretory increment were 155% and 62%, respectively. Mean LH concentrations in the high-amplitude (18.0 +/- 0.8 mIU/ml), low-amplitude (13.2 +/- 0.6 mIU/ml), and no-pulse groups (7.5 +/- 0.2 mIU/ml) differed significantly (P greater than 0.02). Despite the different pulse patterns, mean serum FSH, PRL, and total E concentrations were similar. The lack of episodic LH release and/or low infrequent LH release could account for the absence of cyclic hypothalamic pituitary ovarian function, although other mechanism(s) may be operative in women with augmented LH secretory pulses.     

Activity of gonadotropin-releasing hormone neurons during the preovulatory luteinizing hormone surge

We assessed the frequency of luteinizing hormone (LH) pulsatility (reflecting the activity of gonadotropin-releasing hormone [GnRH] neurons in the hypothalamus) in six women during the periovulatory LH surge, in five women during the early follicular phase, and in seven women in the midfollicular phase (MFP) (calculated as being 3 to 8 days before the LH surge). Collection of blood at 5-minute, versus 15-minute, intervals allowed detection of a larger number of LH pulses in both the MFP (16, versus 27) and periovulatory phase (POP) (11, versus 22) groups of women, but it made no difference in the early follicular phase (EFP) (10 pulses with both methods). During the EFP, the mean number of LH pulses per 4 hours (detected by 5-minute sampling) was 2.0 +/- 0.7 (+/- standard deviation [SD]), and the mean LH amplitude (+/- SD) was 1.3 +/- 0.4 IU/l. There was a significant increase in the number of pulses in the MFP group (3.9 +/- 1.3 pulses/4 hours; P less than 0.05) but no significant change in pulse amplitude (1.1 +/- 0.1 IU/l). During the POP, the mean pulse amplitude was increased (8.5 +/- 1.4 IU/l; P less than 0.001), compared with the MFP and EFP groups, but the mean pulse frequency (3.7 +/- 1.2 pulses/4 hours) was not significantly different from the MFP frequency. We conclude that an acceleration of LH pulsatility occurs several days before the LH surge and does not change thereafter. However, there is an increase in LH pulse amplitude during the LH surge; we attribute this to the increase in pituitary sensitivity at this time.(ABSTRACT TRUNCATED AT 250 WORDS)     

Control of bleeding is essential for a successful treatment of hemorrhagic shock with 7.5 per cent sodium chloride solution

Small volume hypertonic saline (HTS) solution resuscitation has been shown to restore hemodynamic derangements and to protect against mortality in "controlled" hemorrhagic shock (CHS), but it exacerbates the shock state in "uncontrolled" hemorrhagic shock (UCHS). To study the mechanisms associated with the divergent outcome of HTS treatment in CHS versus UCHS, HTS was administered to anesthetized rats (n = 7) subjected to 15 per cent resection of the tail followed by controlled or uncontrolled bleeding. HTS treatment of UCHS increased bleeding (13.3 +/- 1.6 milliliters, p less than 0.05), dropped mean arterial pressure (MAP) (-84.5 +/- 8.9 millimeters of mercury, p less than 0.001), central venous pressure (zero millimeters of mercury, p less than 0.001) and cardiac index (CI) (41 per cent of basal value, p less than 0.001) and increased acidosis (pH 7.23 +/- 0.12, p less than 0.05) and mortality (mean survival time 75 +/- 15 minutes versus 122 +/- 23 minutes of untreated rats, p less than 0.05). In contrast, when administered after application of a ligature proximal to the resection site (at 15 minutes), HTS completely reversed the changes in MAP, CI and total peripheral resistance index (TPRI), and improved mean survival time (172 +/- 7 minutes, p less than 0.05). These data support the assumption that HTS should be used in the treatment of hemorrhagic shock only after bleeding was controlled.     

R-pulse wave timing in cardiovascular monitoring: further observations.

Pulse wave arrival times measured from the peak of the R-wave of the electrocardiogram to the onset of a peripheral pulse wave were recorded with a miniature pressure transducer in a group of 72 hypertensive pregnant women, of whom 19 were receiving sympatholytic antihypertensive medication and 53 were not. The mean (+/- SD) pulse wave arrival time of the hypertensive pregnant group was 204 +/- 15 milliseconds, which was significantly shorter than that measured in a group of 49 uncomplicated normotensive pregnant subjects (222 +/- 16 milliseconds) (P less than .001). The mean pulse wave arrival times were shortest in the subset of pregnant hypertensive patients not on sympatholytic medication (201 +/- 13 milliseconds) as compared with patients on such medication (212 +/- 18 milliseconds) (P less than .01). These observations suggest that patients with pregnancy hypertension have much shorter pulse wave arrival times than normotensive pregnant women. Further studies are needed to determine the potential usefulness of this cardiovascular index for evaluation of hypertensive states during pregnancy.     

Amenorrhea in Olympic marathon runners

Women who exercise heavily may develop secondary amenorrhea. Since the mechanism of so-called "runner's amenorrhea" has not been conclusively established, the authors examined the occurrence of amenorrhea in one of the most intensively exercising groups of female runners in the United States (average, 70 miles/week): those women participating in the marathon trials for the 1984 Olympics. Nineteen percent of these Olympic runners were amenorrheic. When compared with eumenorrheic marathon runners, these amenorrheic runners were significantly (P less than 0.05) younger (24.8 +/- 1.2 [standard error of the mean] versus 30.8 +/- 0.8 years), lighter (108.4 +/- 2.5 versus 114.6 +/- 1.7 lb), and leaner (11.2 +/- 0.5 versus 12.5 +/- 0.3% body fat). There were no differences between the two groups in weekly training mileage, proportion completing the marathon trial, finishing time, basal serum prolactin, or postmarathon serum prolactin. Although basal serum cortisol was slightly higher in the amenorrheic group (26.6 +/- 0.8 versus 22.3 +/- 0.7 micrograms/dl; P less than 0.05), postmarathon serum cortisol was similar in the two groups. This study supports the concept that training intensity above a certain threshold seems to have little effect on the development of runner's amenorrhea, and vigorously training national caliber marathon runners have a lower incidence of amenorrhea than previously predicted.     

A comparison of bed rest and immersion for treating the edema of pregnancy

Bed rest and immersion both lead to a mobilization of extravascular fluid and thus reduce edema. This study compared three treatments for edema in healthy pregnant women in the third trimester: lateral supine bed rest at room temperature, sitting in a bathtub of waist-deep water at 32 +/- 0.5C with legs horizontal, and sitting immersed in shoulder-deep water at 32 +/- 0.5C with legs extended downward. Post-treatment diuresis was selected as the indicator of extravascular fluid mobilization. The mean (+/- SD) diuresis was 105 +/- 48, 161 +/- 155, or 242 +/- 161 mL/hour for bed rest, bathtub, and immersion tank, respectively (P less than .008, tank versus bed rest; P less than .05, tank versus bath). In all treatments, mean arterial pressure (MAP) declined from a baseline value of 88 +/- 9 to 77 +/- 10 mmHg 25 minutes into treatment and 77 +/- 11 mmHg at 50 minutes (both P less than .0001 compared with pre-treatment). Shoulder-deep immersion produced the greatest decline in MAP. Sodium clearance increased from 0.7 to 1.0 mEq/minute in all treatments (P less than .01). Serum sodium, potassium, creatinine, osmolarity, total protein, 6-keto prostaglandin F1 alpha, and plasma volume did not change significantly after the treatments. Serum prolactin declined significantly from 137.8 +/- 44 to 124 +/- 31 ng/mL after treatment; there was no difference among treatments. Immersion appears to be a safe and more rapid method than bed rest to mobilize extravascular fluid during pregnancy.     

Comparison of microtransducer and fiberoptic catheters for urodynamic studies

OBJECTIVE: To assess the validity and reproducibility of a fiberoptic transducer urodynamic catheter for urethral closure pressure profiles and leak point pressure determination, using a microtransducer catheter as the standard. METHODS: Ninety women without significant pelvic organ prolapse underwent urodynamic evaluations with both fiberoptic and microtransducer catheters. Maximal urethral closure pressures and "leak point pressures" were repeatedly measured by the two catheters and statistically compared. The order of catheter use was randomized. RESULTS: Significantly lower mean maximal urethral closure pressures were recorded by the fiberoptic system than by the microtransducer system (28.9 cmH(2)O +/- 17.3 versus 43.2 cmH(2)O +/- 24.9, P <.001). The fiberoptic catheter predicted microtransducer values for maximum urethral closure pressure only within a range of 27 cmH(2)O. Mean "leak point pressure" recorded by the fiberoptic catheters (66.9 cmH(2)O +/- 2.9) was not significantly different than that recorded by the microtransducer catheters (66.4 cmH(2)O +/- 2.9, P =.97). CONCLUSION: There is a significant difference between maximum urethral closure pressure values recorded by the microtransducer and fiberoptic catheter systems. No significant difference was found between the two systems in measurement of Valsalva "leak point pressure."     

Cardiovascular and metabolic responses to intermittent umbilical cord occlusion in the preterm ovine fetus

OBJECTIVE: To determine the cardiovascular and metabolic responses to umbilical cord occlusion in the preterm ovine fetus and the impact of repetitive intermittent insults over a 4-day period. METHODS: Repetitive umbilical cord occlusions (experimental group, n = 7; control group, n = 7) were performed daily (112-115 days' gestation, term = 147 days). Mean arterial pressure (MAP), fetal heart rate (FHR), and FHR variation were monitored, and arterial blood was sampled at predetermined intervals. RESULTS: During umbilical cord occlusions, arterial oxygen pressure (PaO2) (approximately 17 mmHg) and glucose (approximately 0.3) millimoles per liter (mmol/L) fell and arterial carbon dioxide pressure (approximately 8 mmHg) rose (P < .01) to a similar extent on days 1 and 4. Umbilical cord occlusion produced a rise in lactate over the course of successive umbilical cord occlusions each day, the magnitude of which tended to be reduced by day 4 (0.3 +/- 0.1 versus 0.6 +/- 0.1 mmol/L). Control hour FHR and MAP were unaltered over the 4 days, but the delta (delta) FHR to delta PaO2 ratio during umbilical cord occlusions was less on day 4 than on day 1 (6.0 +/- 0.4 versus 10.9 +/- 1.5 beats per minute/mmHg; P < .01). During occlusion hours, high FHR variation episodes, as a measure of fetal activity, were reduced (14.6 +/- 1.5 versus 4.2 +/- 1.3 min/h; P < .01), whereas the reduction in short-term (7.4 +/- 0.7 to 5.8 +/- 0.6 milliseconds; P < .05) and long-term (34.9 +/- 2.7 to 30.0 +/- 0.6 milliseconds; P < .05) FHR variation reached significance only on day 4. CONCLUSION: The increase in lactate and reduced high-FHR variation episodes over successive umbilical cord occlusions may affect fetal growth and development. Furthermore, repeated umbilical cord occlusions over several days alter the preterm FHR response to subsequent stresses, suggesting an altered chemoreflex response.     

Early endocrine events in induced pregnancies

Progesterone (P) and human chorionic gonadotropin (beta-hCG) levels were measured randomly or serially in 141 single clinical intrauterine pregnancies resulting from treatment of infertility. Seventy (group I) were conceived during spontaneous cycles, 36 (group II) with clomiphene citrate, and 35 (group III) with menotropins (hMG). Each group was subdivided into subgroup A (normal pregnancies) and B (pregnancies ending in abortion). Thirteen percent of patients in group I aborted, 19% in group II, and 31% in group III (P less than .05). The overall mean (+/- SD) P level in group IA was 25.8 +/- 10.3 ng/mL and in group IB, 16.6 +/- 9.9 ng/mL (significantly lower, P less than .001); in group IIA the mean P level was 37.8 +/- 21.9 ng/mL and in group IIB, 22.9 +/- 17.9 ng/mL, again significantly lower (P less than .01). In subgroups IB and IIB, 11 of 16 patients showed early abnormal beta-hCG patterns; these findings suggest defective embryonic development and/or deficient corpus luteum function as the cause of abortion. There was no significant difference between mean P in group IIIA (71.1 +/- 43.7 ng/mL) and IIIB (75.7 +/- 55.9 ng/mL). In group IIIB, the mean "peak" P level of 101.1 +/- 73.6 ng/mL was followed by a mean "nadir" of 35.4 +/- 24.8 ng/mL at 6-9 weeks. In group IIIB, 7 of 11 patients showed normal beta-hCG patterns. Three patients with precipitous P decline aborted karyotypically normal fetuses in spite of normally rising beta-hCG levels and the presence of fetal cardiac activity.(ABSTRACT TRUNCATED AT 250 WORDS)     

Nifedipine in the treatment of severe preeclampsia

We conducted a randomized clinical trial in which patients with severe preeclampsia between 26-36 weeks of gestation received either nifedipine (10-30 mg sublingually, then 40-120 mg/day orally; N = 24) or hydralazine (6.25-12.5 mg intravenously, then 80-120 mg/day orally; N = 25). Effective control of blood pressure was achieved with nifedipine in 95.8% of subjects and with hydralazine in 68%, a statistically significant difference (P less than .05). Maternal side effects were minor in both groups. Acute fetal distress developed in one nifedipine subject and in 11 treated with hydralazine. Mean prolongation of gestation was 15.5 +/- 10 days with nifedipine and 9.5 +/- 11 days with hydralazine, a difference that did not reach statistical significance (P less than .07). Infants born to women treated with nifedipine were delivered at more advanced gestational ages (34.6 +/- 2.3 versus 33.6 +/- 2.4 weeks; statistically not significant), weighed more (1826 +/- 456 versus 1580 +/- 499 g; statistically not significant), and tended to have fewer, mainly minor, complications. The average number of days spent in the neonatal intensive care unit was significantly lower in the nifedipine group (15.1 versus 32.7 days; P less than .005), leading to an average 31% reduction in total (maternal and neonatal) hospitalization-related charges for each nifedipine-treated pregnancy. We conclude that nifedipine is an effective, convenient, and low-cost treatment for patients with severe preeclampsia, and is not associated with undesirable side effects.     

Lower serum osteocalcin levels in pregnant drug users and their newborns at the time of delivery

Osteocalcin was evaluated by radioimmunoassay at the time of delivery in mothers and in the umbilical arteries of newborns in a group of pregnant drug users (eight heroin users and seven cocaine users) and compared with findings from a group of normal mothers and their newborns (N = 18). Drug users had lower osteocalcin values than did the normal women (1.3 +/- 0.7 versus 2.7 +/- 0.8 ng/mL, P less than .001); and infants of drug users had lower values than normal infants (14.1 +/- 3.8 versus 19.0 +/- 4.0 ng/mL, P less than .005). The birth weights of drug users' infants were smaller (3160 +/- 402 versus 3591 +/- 374 g, P less than .05) and there was a significant negative correlation (P less than .001) between osteocalcin and drug intake during pregnancy, but no changes in osteocalcin dependent on the type of drug used. These results suggest a toxic effect of these drugs on the osteoblast, which could account for the lower birth weights and skeletal alterations reported in the infants of drug users.     

The concentration of testosterone in serial samples of peripheral venous plasma from infertile women.

The concentration of testosterone has been determined in daily samples of peripheral venous plasma throughout one complete menstrual cycle from each of 4 women with regular, but anovulatory cycles (Group 1) and 13 apparently normal, but infertile women (Group 2). The individual patterns and combined values have been compared with those obtained from 9 healthy volunteers (Group 3), who appeared to satisfy strict criteria for normal ovarian and uterine function. The menstrual cycles from subjects in groups 2 and 3 were subdivided retrospectively into follicular, periovulatory and luteal phases according to the day of the LH peak. The results show that the values for every subject in Group 1 tended to remain relatively costant and the overall concentration (32.3 +/- 10.4; ng/100ml; mean +/- SD) was significantly lower (P less than 0,05, student's "t" test) than the corresponding figure for Group 3 (41.6 +/- 11.8). The patterns of testosterone in Groups 2 and 3 were variable, but the overall concentrations in Group 2 during the periovulatory phase (53.7 +/- 12.7) was significantly higher (P less than 0.025) than the corresponding value (41.9 +/- 11.9) for Group 3. The findings are discussed.     

Placental weight in diabetic pregnancies

The placenta from 30 women with diabetes mellitus were examined and weighed at delivery. Nineteen of these were from women with overt and eleven from women with gestational diabetes. Eleven placentae from normal pregnancies served as controls. There was no difference between the mean +/- s.d. placental weight for the diabetic group and the control group (609 +/- 148 versus 591 +/- 93 g, NS). The mean placental weight ratios for the diabetic group and the control group were also similar (0.98 +/- 0.23 versus 0.89 +/- 0.15, NS). Moreover, there was no difference between the weights and weight ratios of placentae from women with overt (622 +/- 173 g, 1.02 +/- 0.27) and those with gestational diabetes (586 +/- 90 g, versus 0.90 +/- 0.13). Placental weights correlated with birthweights (r = 0.70, P less than 0.01) and with skinfold thickness measurements fo the infants (r = 0.40, P less than 0.05), but neither with gestational ages (r = 0.15, NS) nor with maternal glycosylated haemoglobin levels in the third trimester (r = 0.24, NS). Among the women with overt diabetes, placental weights were greater in those in White's class B and C than those in class D and R (689 +/- 143 versus 530 +/- 177 g; P less than 0.05). In general, placentae from well controlled diabetic patients were not heavier than those from normal pregnant women, although there was an increase in placental weight in White's class B and C, as compared with those in class D and R.     

Menstrual cyclicity has a profound effect on glucose homeostasis

Results from oral glucose tolerance tests have frequently demonstrated a deterioration in glucose metabolism during the luteal phase of the menstrual cycle. To examine this issue further, eight women underwent both midfollicular (days 3 to 10) and midluteal (days 20 to 25) phase hyperglycemic clamp studies (+125 mg glucose/dl) after an overnight fast. Glucose levels rose from 83 +/- 1 to 207 +/- 2 and 87 +/- 1 to 207 +/- 2 mg/dl, respectively, during the follicular and luteal phases. The basal (6 +/- 1 versus 7 +/- 1 microU/ml) and glucose-stimulated (42 +/- 5 versus 43 +/- 6 microU/ml) insulin responses were similar in the follicular and luteal studies. However, glucose uptake was significantly higher during the follicular versus the luteal phase (10.99 +/- 0.97 versus 6.93 +/- 0.37 mg/kg-min; P less than 0.01), as was the ratio of glucose uptake to insulin concentration (30.0 +/- 5.5 versus 19.7 +/- 3.7, P less than 0.01). The authors conclude that: (1) Glucose metabolism is impaired in the luteal phase of the menstrual cycle; (2) This defect cannot be explained by differences in the plasma insulin response; and (3) This impairment in the ability to promote glucose uptake under hyperglycemic conditions suggests a defect in the mass action effect of glucose per se.     

Laparoscopically assisted vaginal hysterectomy for large uterus: a comparative study

OBJECTIVE: To examine the safety and feasibility of laparoscopically assisted vaginal hysterectomy (LAVH) for uteri weighing 500 g or more as compared to uteri weighing less than 500 g in the management of benign gynecological diseases. METHOD: In this prospective comparative study, 189 women with different benign gynecological diseases were scheduled for laparoscopically assisted vaginal hysterectomy. They were divided into two groups, with uterine weight greater than 500 g and uterine weight less than 500 g. Outcome measures for both the groups were studied comparatively in terms of length of operative time, amount of blood loss, requirement of blood transfusion and length of hospital stay. RESULTS: Length of operation and amount blood loss were significantly greater in the uteri >o r = 500 g group than in the <500 g at 91.1 +/- 28.7 min versus 77.4 +/- 26.6 min (P < 0.01), and 570.5 +/- 503.6 ml versus 262.5 +/- 270.0 ml (P < 0.001), respectively. However, there was no difference in length of hospital stay and overall incidence of operative complications between the two groups. None of the women had any major complications though 17 minor complications were noted. There was no incidence of switching to abdominal laparatomy during the operation except for one patient who required "minilaparotomy" for removal of large surgical specimen (2400 g). Extreme intra-operative hemorrhage of more than 1000 ml occurred in five patients, however, they made full recovery after blood transfusion. Rate of blood transfusion was significantly lower in the uteri <500 g group (4.8% versus 34.9%, (P < 0.001). CONCLUSION: This study demonstrates that despite the increased operating time and blood loss, LAVH can be safely performed for large uterus. However, surgeons need to be aware of the high risk of blood transfusion in these patients.     

Comparison of gonadotropin-releasing hormone and gonadotropin therapy in male patients with idiopathic hypothalamic hypogonadism.

OBJECTIVE: To compare pulsatile gonadotropin-releasing hormone (GnRH) therapy with gonadotropin therapy in male patients with idiopathic hypothalamic hypogonadism. DESIGN: Prospective study. Patients had free choice between the two forms of therapy. SETTING: Patients were treated on an outpatient basis in our department. PATIENTS: Eighteen patients of matched age (mean [+/- SD] age: 21.1 +/- 3.0 years and 23.6 +/- 7.3 years) and similar testicular volume were treated in each group. INTERVENTIONS: Pulsatile GnRH therapy was started with 4 micrograms GnRH subcutaneously every 2 hours using a portable pump and gonadotropin therapy with 3 x 2,500 IU human chorionic gonadotropin (hCG) weekly injected intramuscularly. After 8 to 12 weeks of hCG treatment, 150 IU human menopausal gonadotropin two to four times weekly were added. RESULTS: Testosterone (T) and estradiol (E2) levels increased significantly higher (T: P less than 0.03; E2; P less than 0.001) in the gonadotropin group than in the GnRH group (T: 22.5 +/- 8.1 versus 16.8 +/- 5.5 nmol/L; E2: 150 +/- 70 versus 88. +/- 59 pmol/L). Five patients developed gynecomastia during gonadotropin therapy. The rise of testicular volume was significantly more pronounced (P less than 0.001) in the GnRH group (delta testicular volume = 8.1 +/- 2.0 mL) than in the gonadotropin group (delta testicular volume = 4.8 +/- 1.8 mL). Ten patients of the GnRH and 8 of the gonadotropin group had positive sperm counts, ranging from 1.5 to 26 x 10(6) spermatozoa/mL. The latter was achieved more rapidly in the GnRH group (12 +/- 1.6 versus 20 +/- 2.3 months: P less than 0.02). CONCLUSIONS: Endocrine and exocrine testicular function can be normalized by both forms of therapy. Gonadotropin therapy has more side effects. Gonadotropin-releasing hormone leads to a higher testicular volume and a more rapid initiation of spermatogenesis compared with gonadotropin therapy.     

Oral Ibuprofen and ductus arteriosus in premature infants: a randomized pilot study

The purpose of this study was to evaluate the feasibility of the use oral ibuprofen suspension (OIS) in the treatment of patent ductus arteriosus (PDA) in premature infants. Premature infants (相似文献