In-vitro synthesis of steroid hormones in corpora lutea from normal women and women treated with 300 micrograms norethisterone.

The in-vitro oestradiol (E2) and progesterone (P) production by corpora lutea (CL) obtained at sterilization from 30 untreated women and 43 women treated with norethisterone (NET) 300 micrograms daily was measured. The CL were obtained at different stages of the luteal phase in the untreated women [luteinizing hormone (LH) 0 to +3, n = 7; LH +4 to +7, n = 7; LH +8 to +11, n = 9; LH +12 to menses, n = 7] and on days LH +8 to +11 or cycle days 22 to 26 in the NET-treated women. In the treated women, four types of ovarian reaction were identified. Four women showed ovarian reaction Type A (completely inhibited ovarian activity), 14 women Type B (marked follicular activity, but no luteal function), 12 women Type C (normal follicular activity, followed by insufficient luteal function) and 13 women Type D (apparently normal follicular and luteal activity). The CL were incubated in Eagle's medium with and without stimulation by human chorionic gonadotrophin (HCG) for 2 and 4 h. In the untreated women, P and E2 production increased significantly with both incubation time and stimulation by HCG throughout the luteal phase, except in the late luteal phase (LH +12 to menses) where P increased (P less than 0.01) only after 4 h stimulation by HCG. The maximal production of P was found after 4 h incubation with HCG stimulation of CL tissue in the early-mid luteal phase (LH +4 to +7).(ABSTRACT TRUNCATED AT 250 WORDS)     

Laparoscopy versus ultrasound guided puncture for oocyte retrieval

IVF/ET has during the last 5 years gone through a dramatic development and expansions. Since approx. 10% of the population in fertile ages has infertility problems in the Western world the demand for IVF units outside larger University hospitals with considerable resources has become urgent. To reduce costs a trend towards simplification without loss in quality has been an ambition for everyone involved. The exchange of laparoscopic techniques to simpler and cheaper sonographic methods is one step in that direction. The present review is a comparison between the various techniques for oocyte retrieval taking into consideration the principle qualitative aspects to avoid introducing a new technique which is inferior to the originally applied technique. In summary sonographic techniques seem to fullfill these quality requirements and will for such reasons in many IVF groups gradually replace laparoscopy.     

Onset and development of cyclosporin A effects on lymphocytes of cardiac patients before heart transplantation

The effects of cyclosporin A (CSA) in low dosage (4 mg/kg/24 h i.v.) were studied in 17 patients awaiting heart transplantation. The lymphocyte subsets were typed, enumerated, and their proliferation measured before CSA perfusion, after infusion (over 24 h), and then again after two further 24 h intervals (T0 h, T24 h, T48 h, and T72 h). No significant change was found in T or B enumerations although lymphocyte function was markedly modified. For all 17 patients, there was a significant decrease in lymphocyte proliferation that was, however, re-established after 72 h for 14 of the patients, but not for the remaining 3. Inhibition of the proliferative response was found to occur rapidly, to be potent although rapidly reversible in most cases, while yet subject to wide interindividual variability. These four features suggest that (a) CSA in fixed doses may later the balance between helper and suppressor cells in varying degrees according to the patient, and that (b) CSA given immediately or shortly after heart transplantation could be beneficial.     

The regulatory role of FSH in steroid formation by luteinized human granulosa cells in culture

Granulosa cells were aspirated from human pre-ovulatory folliclesfollowing a combined clomiphene-gonadotrophin stimulation inan in-vitro fertilization (IVF) programme. The cells were culturedfor 8 days in medium M199 containing 10% bovine fetal calf serumunder 5% CO₂ in air. Pure human FSH and human LH were addedalone or in combination to the culture in various concentrationsand the progesterone (P) and oestradiol-17 (E₂) levels in themedium were measured every second day by a conventional RIAtechnique. In the presence of FSH or LH the formation of P increased2- to 3-fold with the pronounced effect after 4 to 6 days inculture. Addition of testosterone (T) (3 ? 10^–7 M) tothe culture medium affected neither basal nor gonadotrophinstimulated P formation. In this system, only minute amountsof E₂ were formed and neither FSH nor LH stimulated its formation.When the medium was fortified with T, basal E₂ formation increased50- to 100-fold. FSH further stimulated this conversion significantlyafter 6 and 8 days of culture, while LH had no significant influence.     

A Developmental Event-Related Potential Study of Picture Matching in Children, Adolescents, and Young Adults: A Replication and Extension

Event-related potentials were recorded in a developmental study of picture matching using an adaptation of Posner's (1978) letter-matching tasks. Subjects ranging in age from 6-39 were asked to decide whether two line drawings, presented sequentially, were the same or different on the basis of physical (physical identity), nominal (name identity), or categorical (category identity) criteria. The amplitude of a negativity at 400 ms (Neg400) increased as the number of dimensions on which the two line drawings differed increased. This effect held for all age groups, and was interpreted as reflecting the degree of semantic and/or physical relationship between the two pictures. However, one finding for Neg400 did suggest a qualitative difference in processing mode between the younger and older subjects. Both Neg400 and P3b latencies showed highly significant linear age trends, decreasing with increasing age. These age-related changes were interpreted as demonstrating quantitative speed of processing differences among age groups. The latencies of both Neg400 and P3b increased as the matching criteria became more complex. Moreover, P3b latency increased as the number of dimensions on which the two pictures differed increased, and this did not interact with age. Although both Neg400 and P3b showed age-related changes in scalp distribution, the fact that each was related to the experimental variables in similar fashion in all age groups suggested that they were homologous components across the age range studied. Taken as a whole, the data support continuity of information processing during these tasks across a wide age range.     

Catecholamine release after physical exercise. A new provocative test for early diagnosis of pheochromocytoma in multiple endocrine neoplasia type 2

A simple and practical provocative test is needed for early asymptomatic pheochromocytoma, which is a major risk for patients with multiple endocrine neoplasia type 2 (MEN-2). We measured plasma catecholamines before and after submaximal exercise in 26 MEN-2 gene carriers, eight of whom with asymptomatic pheochromocytoma, nine with medullary thyroid carcinoma and 10 after uni- or bilateral adrenalectomy. Seventeen clinically healthy individuals and 11 patients with neurovegetative lability and symptoms mimicking pheochromocytoma served as controls. Plasma adrenaline, noradrenaline and dopamine increased after exercise except for adrenaline after bilateral adrenalectomy. The post-exercise levels of adrenaline and the adrenaline/dopamine ratio were significantly higher in the pheochromocytoma patients compared to the healthy controls and the patients with neurovegetative lability, while the patients with medullary thyroid carcinoma represented an intermediate group with a high probability of developing adrenal tumors. The present method is a physiological test with a high sensitivity and specificity. It is practical and well suited for repeated examinations and seems to be of value for the detection of early pheochromocytoma in MEN-2 patients. Furthermore, the test could be used in the differential diagnosis between pheochromocytoma and neurovegetative lability.     

Effect of improved glycemic control by continuous subcutaneous insulin infusion on hormonal responses to insulin-induced hypoglycemia in type 1 diabetics

Glucose counter-regulatory capacity and the hormonal responses to insulin-induced hypoglycemia were studied in eight type 1 diabetics before and after improvement of metabolic control by continuous subcutaneous insulin infusion (CSII). The intensified treatment resulted in a decrease in mean glycosylated hemoglobin from 11.6 +/- 0.5 to 9.3 +/- 0.4% within a mean period of 14 weeks. During a constant rate infusion of insulin (2.4 U/h), steady state levels of glucose appeared in all subjects. The steady state glucose level was identical before and after CSII. The counter-regulatory hormonal responses showed significantly higher epinephrine levels, while glucagon, growth hormone, and cortisol were not influenced. In parallel with the heightened epinephrine response the pulse rate response was significantly enhanced. The restitution of blood glucose after insulin hypoglycemia was not modified. It is concluded that a more vigorous catecholaminergic response to hypoglycemia is achieved after improved metabolic control by CSII.     

Release of corticosteroids from human adrenals in vitro

From morphological criteria, it is often difficult to evaluate whether adrenocortical tumors secrete hormones or not. An increasing number of nonfunctioning tumors are detected using modern imaging techniques. In a consecutive series of 13 patients with adrenocortical disease, a functional characterization was done by determining the ability of the resected tissue to release cortisol and aldosterone in vitro. Significant secretion of aldosterone was only found in tumors from 4 patients with hyperaldosteronism, 1 of whom turned out to have a cortisol-secreting tumor as well. All other tumors, both from patients with Cushing's syndrome and patients judged to have nonfunctioning adenoma, released cortisol in vitro. The method provides valuable pathophysiological information on adrenal tumors.

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Resumen Con base en criterios morfológicos, frecuentemente es difícil determinar si los tumores adrenocorticales secretan hormonas o no. Con el uso de las modernas técnicas de imagenología, se détecta un numéro creciente de tumores no funcionantes. En una serie consecutiva de 13 pacientes con patología adrenocortical, se realizó una caracterización funcional determinando la capacidad del tejido resecado para liberar cortisol y aldosterona in vitro. Se encontró secreción significativa de aldosterona sólo en tumores provenientes de 4 de nuestros pacientes con hiperaldosteronismo, 1 de los cuales también presentó un tumor secretor de cortisol. Todos los otros tumores, tanto de pacientes con síndrome de Cushing como de pacientes que se considéró tenían adenoma no funcionante, liberaron cortisol in vitro. El método provee valiosa información patofisiologica sobre los tumores suprarrenales.

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Résumé Il est souvent difficile, à partir des critères morphologiques, d'évaluer si les tumeurs corticosurrénaliennes sont des tumeurs sécrétantes ou non. Un nombre croissant de tumeurs dites nonfonctionnantes sont détectées par l'utilisation des techniques modernes d'imagerie. Une caractérisation fonctionnelle est réalisée par les auteurs à partir d'une série consécutive de 13 patients présentant une pathologie corticosurrénalienne en determinant les capacités de sécrétion in vitro de cortisol et d'aldostérone du tissu réséqué. Une sécrétion significative d'aldostérone est présente seulement dans les tumeurs de 4 patients avec hyperaldostéronisme, l'un d'entre eux révéla posseder de même une tumeur sécrétant du cortisol. Dans tous les autres cas, aussi bien chez les patients avec un syndrome de Cushing que chez les patients considérés comme ayant un adénome nonfonctionnant, les auteurs observent une sécrétion de cortisol in vitro. Cette méthode donne une information physiopathologique précieuse sur les tumeurs surrénaliennes.

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Presented at the International Association of Endocrine Surgeons in Paris, September 1985.

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Supported by grants from the Swedish Medical Research Council (2330) and Karolinska Institute.     

Preoperative radiotherapy for early endometrial carcinoma

A retrospective study was undertaken to compare the use of one versus two preoperative radium systems for early endometrial carcinoma. The charts of 73 patients treated between 1977 and 1980 were reviewed. No difference was noted between the two groups when compared for stage, grade, depth of myometrial invasion, and histologic type of tumor. One of thirty-eight (2.6%) patients in the one-radium group developed an isolated central recurrence; there were no central recurrences in the two-radium group. Total duration of therapy and total hospitalization for the one-radium versus the two-radium group were 17.6 and 15.3 days versus 77.0 and 17.3 days, respectively. Follow-up ranged from 48 to 84 months. Corrected survival figures are comparable to 94.6% for the one-radium group versus 100% for the two-radium group. These data suggest comparable effectiveness and morbidity between the two treatment regimens, with the single-radium application more efficient and cost effective.