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PubMed1991

Growth hormone in serum of women during the menstrual cycle and during controlled ovarian hyperstimulation.

STUDY OBJECTIVE: To investigate the interrelationships between circulating levels of endogenous human growth hormone (hGH), gonadotropins, estradiol (E2), and progesterone (P). DESIGN: Retrospective. SETTING: Assisted reproductive technology center. PATIENTS: Nine normally cycling women from whom blood samples were drawn daily; 18 patients undergoing controlled ovarian hyperstimulation. RESULTS: During the menstrual cycle, average (+/-SE) hGH levels in serum ranged between 7.97 +/- 2.71 microIU/mL on day 11 and 2.11 +/- 0.38 microIU/mL on day 22. Serum hGH levels did not correlate with peripheral levels of follicle-stimulating hormone (FSH), luteinizing hormone, P, or E2 and were related to the serum E2:FSH ratio (adhibited as an index of ovarian response to FSH) on cycle day 10 only. Levels of hGH in sera of patients undergoing controlled ovarian hyperstimulation were near 4 microIU/mL and were directly related to peripheral E2 levels at the time of induction of oocyte maturity. When corrected for differences in follicle number between stimulated patients, changes in serum E2 content were independent of respective hGH levels. CONCLUSION: The findings challenge speculation that endogenous peripheral hGH content might relate to ovarian responsiveness to FSH.

Adult↗
PubMed2004

Pneumocystis carinii infection. Update and review.

OBJECTIVE: To review and update the literature on current trends with regard to Pneumocystis carinii (jiroveci ) diagnosis, treatment modalities, and its role in human disease processes. DATA SOURCES: Bibliographic databases (PubMed and Ovid) were searched for material and data between 1980 and September 2003 relevant to the review. Indexing terms used were "Pneumocystis carinii pneumonia," and "Pneumocystis jiroveci," with the English language as a constraint. Other sources were the PhD thesis of one of the authors (J.F.W., London University, 1993) and the library at the Arabian Gulf University in the Kingdom of Bahrain. STUDY SELECTION: Acquired immunodeficiency syndrome and organ transplant cases with Pneumocystis carinii pneumonia. DATA EXTRACTION: Independent extraction by 2 observers. DATA SYNTHESIS: We reviewed the major characteristics of P carinii (jiroveci ) with special emphasis on the more recently acquired data including the presence of a round pore in the cyst wall, which appears to be used for the release of sporozoites, supporting the hypothesis of sexual reproduction in P carinii (jiroveci ). CONCLUSIONS: Opportunistic infection with P carinii (jiroveci ) remains a significant cause of morbidity and mortality in human immunodeficiency virus and non-human immunodeficiency virus-associated immunosuppressed patients. Diagnosis may be achieved in the majority of cases by routine cytochemical stains and specialized techniques such as immunocytochemistry and polymerase chain reaction. The incidence of P carinii pneumonia can significantly be reduced with effective use of prophylaxis and early detection of cases at high risk. Immunization for P carinii pneumonia is in the early stages and presents a challenging area for research.

Animals↗
PubMed1996

Evaluation of reproductive function among men occupationally exposed to a stilbene derivative: I. Hormonal and physical status.

This is the first of two reports describing a National Institute for Occupational Safety and Health (NIOSH) Health Hazard Evaluation conducted in response to complaints of impotence and decreased libido among male employees who manufactured 4,4'-diaminostilbene-2,2' disulfonic acid (DAS; CAS 81-11-8), an intermediate in the manufacture of fluorescent whitening agents. DAS is structurally similar to the synthetic estrogen diethylstilbestrol (DES). Levels of six reproductive hormones in 30 male workers who manufactured DAS (current DAS workers) and 20 former DAS workers were compared to levels of 35 workers who manufactured plastics additives. Current and former DAS workers had lower mean total testosterone (TT) levels compared to additives workers (458 and 442, respectively, vs. 556 ng/dL; p = 0.05 and 0.04). Current and former DAS workers were 3.6 (95% CI, 0.5-24.4) and 2.2 (95% CI, 0.3-18.0) times more likely than additives workers to have lowest quartile TT levels (< 386 ng/dL) after adjustment for age and body mass index. Duration of employment in DAS production was negatively related to the workers' testosterone levels. These data suggest that occupational DAS exposure may be associated with alterations in male reproductive hormone levels.

Adult↗
PubMed1989

Correlation of serum inhibin concentrations with results in an ovarian hyperstimulation program.

In order to appraise follicular development, human serum inhibin was measured daily by radioimmunoassay in 18 women undergoing ovarian hyperstimulation. Serum inhibin in the early follicular phase correlated with the number of follicles greater than or equal to 17 mm in diameter (r = 0.57, n = 18, P less than 0.05), follicles greater than or equal to 14 mm in diameter (r = 0.67, n = 18, P less than 0.01) on the day of human chorionic gonadotropin (hCG) administration and the number of oocytes retrieved (r = 0.67, n = 15, P less than 0.01). The number of oocytes retrieved showed a significant correlation with serum inhibin level on the day of hCG administration (r = 0.84, n = 15, P less than 0.001). These data suggest that: (1) In the early follicular phase, serum inhibin may be a valid index to predict ensuing follicular growth; (2) In the preovulatory phase, serum inhibin may be one of applicable indexes of follicular development during the hyperstimulation cycle.

Adult↗
PubMed1998

The use of serum CA-125 as a marker for endometriosis in patients with dysmenorrhea for monitoring therapy and for recurrence of endometriosis.

BACKGROUND: To estimate the value of CA-125 for the diagnosis of endometriosis in women with dysmenorrhea, as well as its significance in monitoring therapy and follow-up. METHODS: One hundred and fifty-seven women undergoing laparoscopy for dysmenorrhea were prospectively studied for serum CA-125 concentration. For those with advanced endometriosis receiving danazol treatment after conservative surgery, CA-125 was also determined every month during medication and once every 12 months after treatment. RESULTS: The sensitivity and specificity of serum CA-125 for the diagnosis of endometriosis were 61.1% and 87.5% respectively. Elevated CA-125 (>35 U/ml) was noted in 65/75 cases (86.70%) with advanced endometriosis, but in only 15/56 patients (26.8%) with minimal and mild endometriosis. Although there were significantly higher CA-125 levels in unmarried women, and a negative correlation (r=-0.1970, p=0.0284) between CA-125 and parity, there was no statistical difference in incidence of endometriosis by the status of marriage or parity. Ten women with advanced endometriosis were found with persistent endometriosis by laparoscopy during danazol treatment, even though they tested with normal CA-125 levels (<35 U/ml) at that time. Fifteen patients had elevated CA-125 levels before and one year after therapy, and were confirmed with recurrence of endometriosis by laparoscopy. Nine women with elevated CA-125 levels before treatment, were found without recurrence of endometriosis and had normal CA-125 levels one year after therapy. CONCLUSION: For endometriosis, CA-125 is a valuable adjuvant in the follow-up of recurrence in patients with advanced endometriosis and initially elevated CA-125 levels. It is not an effective screening tool for patients with dysmenorrhea, or for monitoring therapy. There was no significant correlation between the development of endometriosis and reproductive factors.

Adolescent↗
PubMed1997

Classification of endometriosis.

Classification systems for endometriosis continue to evolve. Past systems have been modeled primarily after those in use for grading malignant disease. Unfortunately, classification methods that attempted to quantitate the severity of disease have suffered from only modest predictability in determining outcome. The 1985 revised American Fertility Society classification system is limited by scoring arbitrariness, potential for observational error, limited reproductivity, failure to consider lesion morphologic type and a particularly poor correlation with pelvic pain. These shortcomings are being presently addressed.

Data Collection↗
PubMed2001

Assessing potential risk factors for child malnutrition in rural Kerala, India.

Studies indicate that 42-57 per cent of all child deaths in developing countries are due to the potentiating effects of malnutrition on infectious disease, of which over three-quarters can be attributed to mild-to-moderate malnutrition. Risk factors for underweight status in children under 3 years of age were assessed in Kerala, India. Mothers of 34 children weighing below -1 SD for their age and 59 children weighing more than 1 SD for their age, were interviewed for information about maternal health, child feeding patterns, and sibling gender and age data. Statistical analysis showed that current maternal weight (odds ratio = 8.25, p = 0.0009), current maternal body mass index (OR = 4.55, p = 0.03), infant birth weight (OR = 4.87, p = 0.01) and excessive maternal vomiting in pregnancy (OR = 4.48, p = 0.04) were significant risk factors for current child underweight status. Based on this observed relationship of maternal nutritional factors with child weight-for-age status, further studies on interventions to address the health problems of adolescent girls and all women of reproductive age in Kerala are suggested, in addition to continuing the emphasis in current rural health and nutrition programs for pregnant and lactating mothers.

Adult↗
PubMed1993

Psychologic distress during menopause: associations across the reproductive life cycle.

OBJECTIVE: To determine if women with high psychologic distress attending a menopause clinic report more previous psychiatric disorders (especially depression), or psychologic distress associated with oral contraceptive use and reproductive cycle events than women with low psychologic distress attending the clinic. METHOD: Consecutive women attending a university hospital menopause clinic were administered the Brief Symptom Inventory (BSI). Women with high psychologic distress (who met case severity on the BSI general severity index) were compared to a similar number of the lowest scoring clinic women on their reports of previous psychiatric diagnoses and treatment, and depression or distress related to oral contraceptive use, the premenstrual period, or associated with pregnancy. RESULTS: The forty-four women with high psychologic distress were significantly more likely than the forty-two menopause clinic patients with low psychologic distress to report a past psychiatric diagnosis (usually depression) (p = 0.001), requiring anti-depressant treatment (p = 0.002), oral contraceptive dysphoria (p = 0.004), dysphoric premenstrual syndrome (p = 0.000), postnatal blues (p = 0.02) and postpartum depression (p = 0.004). CONCLUSIONS: Although the halo effect of current distress or retrospective reporting may have biased these results, the similarity of ratings in the two groups on physical symptoms in menopause and psychologic symptoms during pregnancy makes this less likely. These findings corroborate other recent studies showing that women who suffer from affective disorders following one reproductive event are more vulnerable to recurrences associated with others. Clinicians should inquire about possible relationships between previous depression or psychologic distress and reproductive cycle events as it may help predict women who are vulnerable to affective disorders and psychological distress at these critical times.

Adolescent↗
PubMed2004

Demographic trends and biological status of historic populations from Central Poland: the Ostrów Lednicki microregion.

The microregion of Ostrów Lednicki in the province of Wielkopolska was the center of the formation of the Polish State in Early Middle Ages. The analysis of skeletal remains and parish records from the region documented the biological status of inhabitants and its changes over a millennium. The study material comprised 424 human skeletons from an Early Medieval burial ground on Lake Lednica, records of 2,704 deaths from the registers of the Roman Catholic parish of Dziekanowice, made between 1818-1903, data on the deaths of 929,192 inhabitants of rural areas all over the province Wielkopolska obtained from Prussian statistical materials for the years 1865-1900, and comparative data from the literature. Assuming both a stationary population model and a stable population model with nonzero natural increase, parameters of life tables and measures of opportunity for natural selection (Crow's index I(m), potential gross reproductive rate R(pot), and the biological state index I(bs)) were calculated for the Early Middle Ages and for the two periods of the 19th century which were characterized by different laws of land ownership and thus different rural economies. In the first period, peasants were tenants, whereas in the second, they were given freehold of the land they cultivated. Causes of death were also analyzed. A distinct increase in longevity from the early Middle Ages to the end of the 19th and the beginning of the 20th century was found. This was related to a higher level of demographic development in the parish of Dziekanowice during the 19th century, which was achieved earlier than in other areas of Poland. This was confirmed by genetic measures: coefficients of exogamy and coefficients of kinship. The reasons were related to the historical prominence of this region and to its proximity to the first two capitals of the Polish state, Gniezno and Poznań.

Age Factors↗
PubMed2005

[Analysis of reproductive parameters of urban and rural population of Chuvashia].

Genetic and demographic characteristics for urban and rural population of the Chuvash Republic (Chuvashes and Russians) were calculated based on 1122 questionnaires. The sibship sizes for Chuvashes were 2.05 (urban) and 2.78 (rural). For Russians these indices were 1.75 (urban) and 2.00 (rural), respectively. Crow's index and its components were I(m) = 0.04; I(f) = 0.18; and I(tot) = 0.22 for urban, and I(m) = 0.07; I(f) = 0.27; and I(tot) = 0.36 for rural Chuvashes, respectively; and I(m) = 0.04; I(f) = 0.30; and I(tot) = 0.36 for urban, and I(m) = 0.03; I(f) = 0.29; and I(tot) = 0.33 for rural Russians, respectively.

Ethnicity↗
PubMed2006

Prostaglandins in health and disease: an overview.

OBJECTIVES: Prostaglandins are a group of biologically active compounds that play major roles in human physiology in both health and disease. They function in many different ways and in all major organs. This article reviews the basic physiology of prostaglandins and their application to specific effects on these systems in normal and abnormal clinical states. The critical therapeutic implications of the use of nonsteroidal antiinflammatory drugs in altering organ homeostasis are also examined. METHODS: References were taken from Medline, Embase, and Index Medicus from 1966 to September 2005. A search was done with keywords, including prostaglandins, nonsteroidal antiinflammatory drugs, inflammation, arachidonic acid, Cox-1 (cyclooxygenase-1), and Cox-2 (cyclooxygenase-2). RESULTS: There was a close correlation and predictability between basic prostaglandin physiology and the anticipated effects of these compounds on the heart, lungs, kidneys, gastrointestinal tract, bones and joints, brain, and male and female reproductive systems. These effects are organ and tissue specific. Despite these findings, unexplained and sometimes paradoxical physiologic responses were identified. A prime example of this is the role of prostaglandins in bone metabolism demonstrating both stimulatory and inhibitory effects. In addition all NSAIDs have the potential to impair the normal physiologic effects of prostaglandins depending primarily on the specific organ and the clinical setting. CONCLUSIONS: Prostaglandins are regulatory compounds that play important roles in many physiologic processes in the human body. An understanding of the basic science of prostaglandins is valuable in anticipating the organ-specific biologic effects of these unique compounds in health and disease. However, at selected sites and under different physiologic conditions, unexplained and sometimes paradoxical effects are generated. Impairment of their regulatory functions can lead to significant short- or long-term organ dysfunction.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1997

Fertility options after vasectomy: a cost-effectiveness analysis.

OBJECTIVE: To evaluate cost per delivery using two different initial approaches to the treatment of postvasectomy infertility. DESIGN: Model of expected costs and results in the United States in 1994. SETTING: Men with postvasectomy infertility, evaluated and treated at centers with experience in vasectomy reversal or sperm retrieval and ICSI. PATIENT(S): Men with postvasectomy infertility, with a female partner < or = 39 years of age. INTERVENTION(S): Initial microsurgical vasectomy reversal was compared with retrieved epididymal or testicular sperm. Actual treatment charges, complication rates, and pregnancy and delivery rates obtained in the United States were used for cost per delivery analysis. MAIN OUTCOME MEASURE(S): Cost per delivery, delivery rates. RESULT(S): Cost per delivery with an initial approach of vasectomy reversal was only $25,475. (95% confidence interval $19,609 to $31,339), with a delivery rate of 47%. However, the cost per delivery after sperm retrieval and ICSI was $72,521. (95% confidence interval $63,357 to $81,685), with an average of $73,146 for percutaneous or testicular sperm retrieval and $71,896 for surgical epididymal sperm retrieval. The delivery rate after one cycle of sperm retrieval and ICSI was 33%. CONCLUSION(S): The most cost-effective approach to treatment of postvasectomy infertility is microsurgical vasectomy reversal. This treatment also has the highest chance of resulting in delivery of a child for a single intervention.

Cost-Benefit Analysis↗
PubMedDate not supplied

Mortality of human epidermal keratinocytes in co-culture with oral squamous cell carcinoma cells.

Normal human epidermal keratinocytes (NHEK) died after 5 days of co-culture with an oral carcinoma cell line (HSC-4). However, the HSC-4 cells did not change in either mitotic character or shape. We analyzed the changes in the mitotic activity and DNA synthetic activity of NHEK in co-culture with the HSC-4 cells. The mitotic index of the NHEK decreased gradually with the presence of human beta-defensin-2 (HBD-2) in the media. However, the mitotic index (MI) of the HSC-4 cells did not change. The shape of the NHEK cells did not change during co-culture. The time changes of the labeling index (LI) measured by BrdU incorporation, and the LI decreased in neither NHEK nor in HSC-4 cells in the presence of HBD-2. Moreover, in co-culture with an anti-HBD-2 antibody, the MI of both NHEK and HSC-4 cells did not change. These results indicate that HBD-2 might not lead to apoptosis or necrosis, but rather to cellular reproductive death in NHEK cells. However, HSC-4 cells might be more tolerant of HBD-2, so that HBD-2 does not cause cellular reproductive death. HBD-2 does not diminish the DNA synthesis rate but decreases the mitotic activity in NHEK cells in vitro. HBD-2 diminishes neither the DNA synthesis rate nor the mitotic activity in HSC-4 cells.

Bromodeoxyuridine↗
PubMed2000

Ovarian hyperstimulation syndrome (OHSS): diagnosis and management.

OBJECTIVE: To present our experience and the current knowledge about pathophysiology, diagnosis, and management of the ovarian hyperstimulation syndrome (OHSS). DESIGN: Retrospective study concerning clinical and laboratory findings of severe OHSS. SETTING: General ICU at a maternity-surgical hospital. PATIENTS: Ten patients suffering from severe OHSS. INTERVENTIONS: Supportive and preventive therapeutic measures applied are described. MEASUREMENTS AND RESULTS: Admission and discharge data as well as worst values during disease course were recorded. Clinical and laboratory findings showed third space fluid shift leading to weight gain, generalized tissue edema, ascites, hydrothorax, abdominal distension and pain, chest discomfort, hypovolemia, dehydration, ovaries enlargement, electrolyte disturbances, hypoalbuminemia, high hematocrit, urea, and WBC. CONCLUSIONS: OHSS is an iatrogenic complication of assisted conception of unknown pathogenesis, with potentially life-threatening sequelae due to hemoconcentration such as circulatory shock, ARDS, hepato-renal failure, thromboembolic phenomena, and multi-organ dysfunction syndrome. Gynecologists and intensivists must be aware of the diagnosis and management of the syndrome because of the widely used reproductive techniques for assisted conception.

Adult↗
PubMed1992

Pregnancy and lactation as determinants of bone mineral density in postmenopausal women.

The relation of pregnancy and breast feeding to bone mineral density of the wrist, radius, hip, and spine was examined in a white, upper middle-class, homogeneous sample of 741 postmenopausal women ranging in age from 60 to 89 years. Number of pregnancies ranged from 0 to 14, with a mean of 2.0 pregnancies and 1.5 live births. Almost two thirds of the women who had had a live birth reported breast feeding. Unadjusted comparisons indicated that bone mineral density of the wrist, radius, and hip increased with increasing numbers of pregnancies, and women who had breast-fed had higher bone mineral densities at these sites. However, after adjustment for age or age and body mass index, these associations were no longer significant. Multiple regression analyses adjusted for age, age at menopause, obesity, cigarette smoking, and estrogen and thiazide use also indicated that number of pregnancies and breast feeding were not significantly associated with bone mineral density at any of the four sites measured. Results of the present study suggest that reproductive history and breast feeding are not long-term determinants of bone mineral density.

Age Factors↗
PubMed2000

Ovarian hyporesponsiveness to follicle stimulating hormone in adolescent girls born small for gestational age.

Girls with reduced prenatal growth are known to have, at birth, a small ovarian fraction of primordial follicles and, in adolescence, a uterus and ovaries of small size. We have now examined whether reduced prenatal growth is also followed by changes in the relationships among FSH, inhibin B and estradiol in adolescent girls. We studied 48 post-menarcheal girls (age 13.6 +/- 1.4 yr) who were either born with an appropriate weight for gestational age (AGA; n=33; mean weight 3.3 Kg) or born small for gestational age (SGA; n=15; mean weight 2.4 Kg). Serum FSH, inhibin B and estradiol concentrations were measured in the early follicular phase (range: day 5 +/- 3). SGA girls had, compared to AGA girls, elevated serum FSH (7.2 +/- 0.7 vs 4.5 +/- 0.3 IU/mL; p=0.0002), similar inhibin B (62.1 +/- 8.1 vs 60.7 +/- 6.5 pg/mL) and lower estradiol concentrations (12.1 +/- 1.5 vs 21.2 +/- 2.4 pg/mL; p=0.02). SGA girls thus displayed, early after menarche, a pattern that points to hyporesponsiveness of the ovarian granulosa cell fraction and that is reminiscent of reproductive aging. In conclusion, the gynecological correlates of prenatal growth restriction are herewith extended to include ovarian hyporesponsiveness to FSH in adolescence.

Adolescent↗
PubMed1999

Serum leptin levels during the menstrual cycle of healthy fertile women.

Leptin is a protein, produced by adipose tissue, which has cytokine and hormonal properties. Serum leptin levels can be considered as a measure of body fat mass, and are involved in regulation of body weight. Previous studies suggest that leptin may have an additional role in reproduction, and there is also evidence for involvement in the hypothalamic-pituitary-gonadal axis. In this study, we investigate the possible changes in serum leptin concentration throughout the menstrual cycle. Samples were collected from apparently healthy, fertile women at different stages in their menstrual cycle, timed precisely according to the luteinising hormone (LH) surge. Mean serum leptin levels were significantly higher in the luteal phase (median 11.4 ng/mL) than in the follicular phase (median 10.0 ng/mL) (P < 0.001). In addition, mean serum leptin levels correlated with body mass index (r = 0.54, P < 0.05), but showed no correlation with luteal-phase progesterone levels. Results showed that levels of serum leptin vary during the menstrual cycle, and add to the mounting evidence that leptin has a role in reproduction. These fluctuations should be taken into account whenever studies are performed using female subjects.

Adult↗
PubMed1999

The role of social desirability, negative affectivity, and female reproductive system symptoms in differences in reporting symptoms by men and women.

52 women and 38 men completed the Inventory of Health Status, Version 2, a measure of somatic health, and the Cornell Medical Index which provided separate scores for somatic and emotional health. The Personal Style Inventory was given, from which measures of Social Desirability and Negative Affectivity were utilized. Multiple regressions were done separately with scores on the Inventory of Health Status and the Cornell Emotional component, and scores on Social Desirability, Negative Affectivity, and sex as predictors. Scores on Social Desirability and Negative Affectivity were forced into the equation first. For the Inventory of Health Status, sex alone contributed significantly to the final equation. For scores on the Cornell Index's emotional component both sex and scores on negative affectivity had significant beta weights. Analysis of items from the Inventory of Health Status was done to examine the role of symptoms pertaining to women's reproductive system, and almost all the items that differed by sex were either clearly or possibly specific female reproductive items, e.g., "Abnormal menstruation." Similar analyses were not possible for the organic component of the Cornell Index, which has different items for reproductive systems of men and women. The complexity of the female reproductive system may play a central role in sex differences in symptom reporting and perhaps of emotional distress, but other interpretations are discussed.

Adult↗