Acceptability of five nonoxynol-9 spermicides

OBJECTIVE: To examine the acceptability of five nonoxynol-9 (N-9) spermicides. METHODS: We analyzed data from a randomized trial of five products, including three gels containing different amounts of N-9 per dose, a film and a suppository. In the trial, 1536 participants were asked to use the assigned spermicide for 7 months and to complete questionnaires 4 weeks after admission and at discontinuation. RESULTS: Overall, 43% of participants liked their spermicide "very much." This proportion was higher in the three gel groups than in the suppository and film groups. Difficulty with insertion, messiness and discontent with timing of insertion were common complaints in all groups. After adjustment for selected baseline factors, acceptability on the first questionnaire was not related to duration or consistency of subsequent spermicide use or to subsequent time to pregnancy. CONCLUSIONS: In this study, all five spermicides were considered acceptable by most users. Acceptability did not appear to influence spermicide use or pregnancy risk.     

The alpha(2)beta(1) and alpha(3)beta(1) integrins do not mediate attachment of endometrial cells to peritoneal mesothelium

OBJECTIVE: To evaluate the possible role of mesothelial alpha(2)beta(1) and alpha(3)beta(1) integrins in the attachment of endometrial stromal cells (ESCs) and endometrial epithelial cells (EECs). DESIGN: In vitro study. SETTING: University medical center. PATIENT(S): Women of reproductive age (n = 26). MAIN OUTCOME MEASURE(S): Mesothelial cells were grown on collagen IV. Endometrial stromal cells and EECs were plated on mesothelial cells for 1 hour. Before plating, mesothelial cells or endometrial cells were incubated with antibodies to alpha2, alpha3, and beta1 integrin subunits. The effect of these antibodies on ESC and EEC binding to collagen IV and collagen I was also examined. The expression of collagen I, collagen IV, fibronectin, and laminin by cultured ESCs and EECs was examined. RESULT(S): The anti-integrin antibodies had no effect on endometrial binding to mesothelium. The beta1 integrin antibody decreased binding of ESCs and EECs to the collagen matrices. In culture, ESCs and EECs expressed collagen I, collagen IV, fibronectin, and laminin to varying degrees. CONCLUSION(S): The initial adhesion of ESCs and EECs to mesothelium is not mediated by beta1 integrins. In contrast, ESC and EEC attachment to collagen IV and collagen I, which are present in the submesothelial extracellular matrix, is mediated by beta1 integrins.     

Reoperation after initial treatment of endometriosis with conservative surgery

One hundred and fifty-three patients with pelvic endometriosis met the study criteria of inferility, tissue diagnosis, treatment with conservative surgery, and adequate follow-up. The extent of disease was classified according to Acosta and and associates. Pregnancy rates were 10 to 100% in various subclassifications of patients; these pregnancy rates were related to the extent of disease and the existence of concurrent inferitility factors. One hundred and seventeen patients were followed up for three years. Reoperation in this group was carried out in 28 patients for recurrent pain and/or persistent infertility. Each patient had diagnostic laparoscopy preceding relaparotomy. The reoperation rate was 40.6% in those patients who remained infertile, whereas this rate was only 3.7% in those patients who conceived following initial operation. The incidence of conception after a second conservative procedure was 12%. However, an equal number of patients in this group required total abdominal hysterectomy as a third procedure for control of recurrent pain. Thus, repeat conservative surgery should play a secondary role in the treatment of patients with infertility and recurrent endometriosis.     

Hysterosalpingography in the preoperative evaluation of tubal anastomosis candidates

The value of the hysterosalpingogram (HSG) in the investigation of women requesting reversal of tubal sterilization has never been established. Accordingly, we reviewed the preoperative HSGs performed on 54 women and the surgical findings of these and 27 additional patients who underwent laparoscopy and/or laparotomy for tubal anastomosis. The observation of interstitial, isthmic, and ampullary obstruction by HSG correctly correlated with surgical findings in 12%, 94%, and 69% of cases, respectively. The decision to perform an anastomosis was made in 14 of 17 (82.4%) tubes with interstitial obstruction, 45 of 51 (88.2%) tubes with isthmic occlusion, and 26 of 36 (72.2%) tubes with ampullary occlusion. When distal tubal occlusion was demonstrated by HSG (36/104 tubes, 34.6%), 10 had no repairable ampullary segments. The site of tubal occlusion on HSG was not predictive of a repairable tube. We conclude that the routine HSG is not warranted in the preoperative evaluation of candidates for tubal anastomosis.     

Localization of Chlamydia trachomatis hypothetical protein CT311 in host cell cytoplasm

The chlamydia-specific hypothetical protein CT311 was detected both inside and outside of the chlamydial inclusions in Chlamydia trachomatis-infected cells. The extra-inclusion CT311 molecules were distributed in the host cell cytoplasm with a pattern similar to that of CPAF, a known Chlamydia-secreted protease. The detection of CT311 was specific since the anti-CT311 antibody labeling was only removed by absorption with CT311 but not CPAF fusion proteins. In addition, both anti-CT311 and anti-CPAF antibodies only detected their corresponding endogenous proteins without cross-reacting with each other or any other antigens in the whole cell lysates of C. trachomatis-infected cells. Although both CT311 and CPAF proteins were first detected 12 h after infection, localization of CT311 into host cell cytosol was delayed until 24 h while CPAF secretion into host cell cytosol was already obvious by 18 h after infection. The host cell cytosolic localization of CT311 was further confirmed in human primary cells. CT311 was predicted to contain an N-terminal secretion signal sequence and the CT311 signal sequence directed secretion of PhoA into bacterial periplasmic region in a heterologous assay system, suggesting that a sec-dependent pathway may play a role in the secretion of CT311 into host cell cytosol. This hypothesis is further supported by the observation that secretion of CT311 in Chlamydia-infected cells was blocked by a C16 compound known to inhibit signal peptidase I. These findings have provided important molecular information for further understanding the C. trachomatis pathogenic mechanisms.     

Phorbol esters stimulate in vitro GnRH release from the hypothalamus of the estrogen-primed, ovariectomized rat: inhibitory effects of cocaine.

The purpose of this study was (1) to characterize more fully the effects of phorbol esters to stimulate GnRH release in vitro and (2) to determine whether cocaine (which disrupts estrous cyclicity in rats) affected phorbol ester stimulation of GnRH release in vitro. Hypothalami were collected from ovariectomized rats injected subcutaneously with 50 micrograms/kg of 17 beta-estradiol benzoate the two previous mornings. Sagittal sections of this block of CNS tissue comprising the preoptic area/anterior hypothalamus and mediobasal hypothalamus/median eminence were perfused at a rate of 6.2 ml/h with a modified Krebs-Ringer buffer (pH 7.4) using a programmable perfusion system. Perfusion results showed that 10-min pulses of phorbol 12-myristate 13-acetate or phorbol 12,13-dibutyrate (PDBu) increased GnRH release in dose-dependent fashion (10(-10) to 10(-6) M) but had no effect on aminergic transmitter release. The biologically inactive alpha-phorbol was without effect on GnRH release. PDBu-stimulated GnRH release was blocked by both tetrodotoxin and cocaine, known inhibitors of Na+ influx. These results suggest a role for protein kinase C in regulating the release of GnRH. Our results that cocaine and tetrodotoxin attenuated phorbol ester stimulation of GnRH, presumably through inhibition of Na+ influx, suggest a direct biochemical mechanism for cocaine disruption of hypothalamic GnRH secretion and, consequently, cyclic reproductive function.