Leptin concentrations in the follicular phase of spontaneous cycles and cycles superovulated with follicle stimulating hormone

It has been reported that oestradiol may play a role in the production of leptin from adipocytes. To investigate this relationship further, nine normally ovulating women were studied during two menstrual cycles, i.e. an untreated spontaneous cycle and a cycle treated with follicle stimulating hormone (FSH) from cycle day 2 until the day of human chorionic gonadotrophin (HCG) injection. Serum leptin values on cycle day 2 did not differ significantly between the spontaneous and the FSH cycles. In the spontaneous cycles, leptin values declined gradually and significantly up to day 7 and then increased progressively up to the day of luteinizing hormone (LH) surge onset, at which point they achieved the highest values. In the FSH cycles, serum leptin values increased gradually and significantly up to day 6, remaining stable thereafter, and were in the midfollicular phase significantly higher than in the spontaneous cycles. Significant positive correlations were found between mean values of leptin and mean values of oestradiol during the second half of the follicular phase in the spontaneous cycles and during the first half in the FSH cycles. A significant negative correlation was found between these two parameters in the spontaneous cycles during the first half of the follicular phase. Serum leptin levels were significantly higher in the midluteal than in the follicular phase in both cycles. These results demonstrate for the first time significant changes in leptin values during the follicular phase of the human menstrual cycle and a significant increase during superovulation induction with FSH. It is suggested that oestradiol may be involved in the regulation of leptin production in women.      

Current and future status of ovulation induction in polycystic ovary syndrome

Great progress has been achieved during the last 20 years inthe field of ovulation induction in patients with polycysticovary syndrome (PCOS). Clomiphene citrate remains the firstline of treatment for all anovulatory women with PCOS, sincein properly selected patients the cumulative pregnancy rateapproaches that in normal women. Human urinary gonadotrophinshave been used extensively for ovulation induction but the developmentof low-dose regimens has opened a new era in the managementof anovulation related to PCOS. This article discusses the mainadvantages and disadvantages of the principal methods and regimenscurrently used for ovulation induction in patients with PCOSincluding clomiphene citrate, gonadotrophins, pulsatile gonadotrophin-releasinghormone (GnRH) and GnRH agonists. It also discusses new drugsdiscovered recently, particularly recombinant gonadotrophinsand GnRH antagonists, and provides some thoughts regarding theiruse in future protocols. Finally, based on the discovery ofnew ovarian substances which specifically control luteinizinghormone (LH) secretion, this article develops assumptions onpossible implications of these substances in the pathophysiologyof PCOS and their potential use in the management of the syndrome.     

Approaches to the secondary prevention of arterial hypertension among the population (data from a cooperative study on the multifactorial prevention of ischemic heart disease)

A cooperative study has reviewed the prevalence of arterial hypertension (AH) among 40- to 59-year-old male residents of three cities (Moscow, Minsk and Kaunas) and the possibility of organizing a long-term outpatient treatment of newly-detected AH cases as well as the efficiency of the latter. Of 16,703 individuals screened, AH was detected in 27.9%. Evidence is obtained that preventive and therapeutic procedures for hypertensive patients are in need of an improvement. In a middle-aged population, moderate AH is prevalent (nearly 67.7%). Coronary risk factors, such as hyperlipoproteinemia and excessive body weight, were more frequent in AH patients, as compared to the general population, an argument in favor of the need for an improved combined approach to AM control in the population. Active combined treatment of the recognized cases over 5 years proved effective as it brought arterial blood pressure back to normal. Patient participation in the treatment and its contribution to treatment efficiency are reviewed.     

Parameters of mortality in a program of multifactorial prevention of ischemic heart disease

Multifactorial prophylaxis carried out for 5 years among men aged 40 to 59 years brought about a significant decrease in the total death rate (by 22.2%), mainly because of the lowering of the death rate due to cardiovascular diseases (by 41.3%), determined by a reduction of these indicators among persons who initially had coronary heart disease. The data indicate that in order to reach a positive effect, the primary care should be exercised for a longer time. At the same time, the prophylactic measures are to be multifactorial and include not only correction of risk factors but also the screening and treatment of patients suffering from coronary heart disease.