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PubMed1998

The use of two estrogen preparations (a combined contraceptive pill versus conjugated estrogen cream) intravaginally to treat urogenital symptoms in postmenopausal Thai women: a comparative study.

OBJECTIVE: To determine whether the combined contraceptive pill used intravaginally was as effective as the standard conjugated estrogen cream for the treatment of urogenital symptoms in postmenopausal Thai women. SUBJECTS AND METHODS: In a randomized clinical trial, 40 postmenopausal women with urogenital symptoms were randomly allocated to two treatment groups for 8 weeks. The first group (n = 20) received a combined contraceptive pill by the vaginal route, one tablet per week at bedtime for 8 weeks. Each tablet contained 250 microg levonorgestrel plus 30 microg ethinyl estradiol. The second group (n = 20) was given 1 gm of an intravaginal conjugated estrogen cream at bedtime, three times in the first week, twice in the second week, and then once a week for the next 6 weeks (1 gram of conjugated estrogen cream contained 0.625 mg conjugated equine estrogens). Subjects were questioned about their urogenital symptoms, and vaginal cytologic smears, vaginal bacterial cultures, and urine cultures were performed before treatment and after 2, 4, and 8 weeks of therapy. RESULTS: The vaginal pH and the proportion of the fecal type bacteria decreased in both groups, with no statistically significant difference between the groups. The karyopyknotic index and the maturation index were improved during treatment in both groups. An increase in the proportion of lactobacilli were recorded in both groups after therapy, with no significant difference between the two groups. No significant changes were observed in urinary bacteria. The therapy (combined contraceptive pill and estrogen cream) had a marked effect on urogenital symptoms (vaginal dryness, dyspareunia, urinary frequency, and urinary urgency), with impressive improvement comparably in both groups. CONCLUSIONS: A combined contraceptive tablet administered vaginally once a week can alleviate urogenital symptoms in Thai postmenopausal women as effectively as the vaginal estrogen cream. However, the pills are much less expensive and are easily obtained in developing countries.

Administration, Intravaginal↗
PubMed1998

Postpartum cardiac failure in Sudanese-Sahelian Africa: clinical prevalence in western Niger.

Postpartum cardiac failure (PPCF) is the most frequent clinical form of heart failure in hospitalized women in Sudanese-Sahelian Africa. We have previously studied this disease in a hospital setting. Although the incidence is relatively high in rural areas, no systematic field study has been carried out. In this report, we describe a retrospective study conducted in the western part of Niger in July-August 1991. Sixty-two villages were visited and a thorough search for patients was initiated (from a population of 79,941 inhabitants, 19,941 females 14-40 years of age, corrected census of 1988). Twenty-eight patients from 27 villages were included. The subject patients were those presenting with predefined symptoms (dyspnea and cough) and physical signs (edema of the legs) of congestive heart failure during the six-month period following delivery. Apart from arterial hypertension and previous PPCF, diagnosis of another cardiac disease was an exclusion criterion. The prevalence of PPCF was 1.40 per 1,000 females of child-bearing age. The clinical profiles of these cases were in accordance with those of a previous study in 1989 carried out at Niamey Hospital. These results were a mean +/- SD age of 28 +/- 7 years, multiparity (mean = 4 children), poor socioeconomic status, postpartum ablutions with hot water, and a high sodium intake. This is the first study on the clinical prevalence of PPCF in a Sudanese/Sahelian population living in a rural area.

Adolescent↗
PubMed1976

Lymphocyte transformation in newborns, women and those who had used oral contraceptives.

Lymphocyte transformation, utilizing the mitotic index parameter has been assessed in newborns' cord blood, adults and women who had been on oral contraceptives and their babies. The results show that the newborns' cord blood response is significantly higher to PHA when compared with the respective adults' response. No significant difference was observed between the women taking oral contraceptives and their respective controls.

Adult↗
PubMed1995

Infertility due to antisperm antibodies.

Immunoinfertility is an important problem, involving a significant number of infertile couples. Although the presence of antibodies on sperm has better prognostic value than those in serum or seminal plasma, it may not be the sole authentic evidence of immunoinfertility. Infertility from antisperm antibodies is likely only when they bind to a relevant sperm antigen involved in a specific fertility function. The variance in functional deficits seen in immunologic infertility is most likely related to antibodies directed at different sperm antigens or different class, subclass, or isotypes. Antibodies to FA-1 seem to be of significant importance in human immunoinfertility. In approaching couples with infertility, a high index of suspicion for antibodies is necessary to avoid misdiagnosis. In the optimal situation, all semen analyses should be screened for sperm-bound antibodies, but if this is impractical, testing should be performed on high-risk individuals (Table I). In couples in which the man has sperm-bound antibodies, and in whom there is no identifiable female factor, treatment should be instituted. Most treatments for immunoinfertility have been disappointing because of poor results, adverse effects, or high cost. Corticosteroid therapy has shown some promise in published reports (mostly poorly designed studies), but increase in pregnancy rate is modest and adverse effects may be significant. In our opinion, informed consent should be documented prior to institution of corticosteroid therapy, and subjects should be closely monitored. Advanced reproductive technologies offer a higher safety profile, and, with increasing technology, higher pregnancy rates. We recommend progressing from "low-tech" procedures, such as IUI and reserving the higher level procedures, such as IVF and ICSI, for those couples in whom pregnancy does not occur. The highest level reproductive technologies give the best current prospects for pregnancy in patients with this difficult problem but also are invasive and costly. It is hoped that further work in the laboratory will give rise to newer, safer, and less expensive effective treatments in the very near future.

Antigens, Surface↗
PubMed2003

Relationships between time estimation, memory, attention, and processing speed in patients with severe traumatic brain injury.

The present experiment was aimed at investigating the effects of memory and attention deficits and of information processing slowing on time estimation in patients with severe traumatic brain injury (TBI). Patients with TBI and normal control subjects reproduced and produced durations (5, 14, 38s) in both a control counting condition and in a concurrent reading condition. They also performed finger-tapping tasks at a free rate and at a 1s rate. Both groups were assessed on processing speed using a reaction-time task, and on memory and attention using a battery of neuropsychological tests. The results showed that time estimation was not less accurate in patients with TBI than in control subjects on the reproduction task or on the production task performed either in the control counting condition or in the concurrent reading condition. Conversely, duration judgments were more variable in patients with TBI than in control subjects on both tasks in both conditions. The results also showed that TBI patients exhibited slower reaction-times, and poorer working and episodic memory scores than control subjects. Most importantly, the variability index in the duration reproduction task was related to both working memory scores and processing speed measures, whereas the variability index in the duration production task was only related with the processing speed measures. The temporal performance pattern in TBI patients does not appear to reflect specific deficits in timing, but rather overall problems in attention, working memory, and processing speed mechanisms.

Adult↗
PubMed2006

Cognitive assessment in Chinese patients with aneurysmal subarachnoid hemorrhage.

A subgroup of patients who survive aneurysmal subarachnoid hemorrhage (SAH) may have significant cognitive deficits. The aim of the current study was to determine the efficiency of cognitive tests and frequency of cognitive impairments associated with aneurysmal SAH in Chinese. A series of 116 patients with aneurysmal SAH were assessed before surgery. Only 37 patients have completed all tests. The other 79 patients had discontinued because of their clinical conditions, recurring severe headaches, refusing or misunderstanding due to low education. We found that one or more cognitive functions were impaired in 70.3% of the 37 patients, SAH patients were especially impaired in functions that are related to visual reproduction, verbal fluency, and executive functions. The results suggest that the patients have impressive cognitive deficits after aneurysmal SAH. A battery of appropriate cognitive tests should be developed for use by doctors and nurses.

Aged↗
PubMedDate not supplied

Evaluation of tumor necrosis factor alpha production in ex vivo short term cultured whole blood from women with polycystic ovary syndrome.

In mammals, the pleiotropic biological functions of tumor necrosis factor alpha (TNF-alpha) may include important effects on human reproductive physiology. Thus, chronic anovulation, oligo or amenorrhea, infertility, hyperandrogenism, obesity, insulin resistance and increased TNFalpha serum levels have been observed in women affected by polycystic ovary syndrome (PCOS). Whole blood short - term cell cultures (WBSC) are simple systems where the capacity to produce TNF-alpha by circulating leukocytes, mainly of the macrophage/monocyte lineage, can be accurately quantified. Given the relevance of monocytes/macrophages in the production of TNF-alpha, in this study, in a control-case approach, WBSC from women with PCOS were analyzed in their basal and lipolysaccharide (LPS)- stimulated capacity to produce the cytokine. These measurements did not correlate with the increased serum levels of the cytokine and the normal levels of cortisol, found in PCOS women. Increased serum TNF-alpha levels in PCOS women correlated positively with body mass index and negatively with insulin sensitivity. In spite of the increased serum TNF-alpha levels in PCOS women, basal and LPS stimulated production of the cytokine, by the ex vivo WBSC from these patients, were within normal values.

Adolescent↗
PubMed1987

Inverse seasonal relationship between melatonin and ovarian activity in humans in a region with a strong seasonal contrast in luminosity.

The effects of season on the activity of the pituitary-ovarian axis and the pineal gland were studied in 11 women by serum and urinary melatonin determinations and in 21 women by measurements of the serum concentrations of anterior pituitary and ovarian hormones during the dark and light seasons. A melatonin index was determined by integration of the area below the curve of serum melatonin concentrations during 24-h periods in both seasons. During the dark season, the daytime 12-h melatonin index and daytime urinary melatonin excretion were significantly higher than during the light season. In addition, the duration of the nocturnal melatonin pulse (serum melatonin levels, greater than 65 pmol/L) was lengthened during this season, whereas the mean serum estradiol concentration was significantly decreased at the time of ovulation and during the luteal phase of the cycle, indicating lowered ovarian activity. Luteal phase gonadotropin concentrations were increased during the dark season, which was also characterized by increased sex hormone-binding globulin (SHBG) and decreased free testosterone concentrations and free androgen indices (ratio of testosterone to SHBG X 700) throughout the menstrual cycle. The dark season was thus characterized by increased melatonin secretion and decreased ovarian and androgenic activities. In summary, we characterized two season-dependent hormonal phenomena. Although we did not prove any cause and effect association between melatonin and anterior pituitary-ovarian hormones, the inverse seasonal relationship in pineal gland and ovarian secretion suggests that melatonin is causally related to reproduction in humans.

Adult↗
PubMed1995

Risk assessment and other screening options for gonorrhoea and chlamydial infections in women attending rural Tanzanian antenatal clinics.

Sexually transmitted diseases (STDs) are a major cause of morbidity and mortality in developing countries and may play a key role in enhancing the heterosexual transmission of human immunodeficiency virus (HIV). Treatment of STDs is one of the most cost-effective of all health interventions in developing countries; however, STDs among women in rural populations have received little attention. In this study, we report that prevalences of STDs among 964 women attending antenatal clinics in a rural area of the United Republic of Tanzania. A total of 378 (39%) of these women were infected with at least one STD pathogen, 97 (10%) had syphilis, and 81 (8%) has Neisseria gonorrhoeae (NG) and/or Chlamydia trachomatis (CT) infection. The recommended syndromic approach to screening for NG/CT infection, based on reported genital symptoms, had a low sensitivity (43%) and failed to discriminate between infected and uninfected women. A risk score approach that we developed, based on sociodemographic and other factors associated with NG/CT infection, had a higher sensitivity and lower cost per true case treated than other approaches, although its positive predictive value was only about 20%.

Adult↗
PubMed1979

[Determination of estradiol-17 beta receptors in tumorous breast tissue as an index of the hormonal dependence of the tumor].

To judge the hormone-dependence of mammary tumors the technic of tissue sections was employed, which were examined for the presence of oestradiol-17 beta receptors. Under examination were 192 patients, 78 of them being in their reproductive age and 14 menopausal patients. Oestradiol-17 beta receptors were found in the tumor material from 42.7% of patients.

Adult↗
PubMed1987

Body fat, menarche, fitness and fertility.

Many well-trained athletes, ballet dancers and women who diet excessively have secondary or primary amenorrhoea. Less extensive training or weight loss may result in anovulatory menstrual cycles, or a shortened luteal phase. These disruptions of reproductive ability are due to hypothalamic dysfunction, which is correlated with weight loss or excessive leanness. It is proposed that these associations are causal and that the high percentage of body fat (26-28%) in the mature human female may influence reproduction directly. Four mechanisms are known: (i) adipose tissue converts androgens to oestrogen by aromatization. Body fat is thus a significant extragonadal source of oestrogen; (ii) body weight, hence fatness, influences the direction of oestrogen metabolism to more potent or less potent forms; leaner women make more catechol oestrogens, the less potent form; (iii) obese women and young, fat girls have a diminished capacity for oestrogen to bind sex-hormone-binding-globulin; (iv) adipose tissue can store steroid hormones. An indirect mechanism may be signals of abnormal control of temperature and changes in energy metabolism, which accompany excessive leanness. The hypothalamic reproductive dysfunction results in abnormal gonadotrophin secretion: there is an age inappropriate secretory pattern of luteinizing hormone (LH) and follicle stimulating hormone (FSH), resembling that of prepubertal children. The secretion of LH and the responses to LHRH are reduced in direct correlation with the amount of weight loss. Other evidence from non-athletic and athletic women and mammals is presented in support of the hypothesis that a particular, minimum ratio of fat to lean mass is normally necessary for menarche (approximately 17% fat/body wt) and the maintenance of female reproductive ability (approximately 22% fat/body wt). Nomograms are given for the prediction of these critical weights for height from a fatness index; these weights are useful clinically in the evaluation of nutritional amenorrhoea and the restoration of fertility in underweight women. Evidence is presented that undernutrition and hard physical work can affect the natural fertility of populations, by the delay of menarche, a longer period of adolescent subfecundity, a longer birth interval and an earlier age of menopause. Data from a study of the long-term reproductive health of 2622 former college athletes compared with 2766 non-athletes show that the former college athletes had a significantly lower lifetime occurrence of breast cancer and cancers of the reproductive system, and a lower lifetime occurrence of benign tumours of these tissues, compared with the non-athletes.(ABSTRACT TRUNCATED AT 400 WORDS)

Adipose Tissue↗
PubMed2005

Relationship between reactive oxygen species production and lipid peroxidation in human sperm suspensions and their association with sperm function.

OBJECTIVES: To investigate if reactive oxygen species (ROS) production by human sperm suspensions could predict oxidative stress manifest as lipid peroxidation and if lipid peroxidation was a useful predictor of human sperm function. DESIGN: Laboratory study. SETTING: Research laboratory associated with reproductive medicine clinic. PATIENT(S): Eighty-three couples under evaluation for IVF donated the surplus from a diagnostic semen sample. INTERVENTION(S): Cells were separated from seminal plasma on a 30% Percoll gradient. MAIN OUTCOME MEASURE(S): Reactive oxygen species production, lipid peroxidation, sperm motility measured by computer-assisted semen analysis and ability of the sperm to acrosome react. RESULT(S): Forty-four samples exhibited ROS production < or =20 000 relative light units (rlu)/s/10(8) sperm and lipid peroxidation < or =40 nmol malondialdehyde/10(8) sperm. The remainder fell into two distinct groups; both exhibited a linear relationship between lipid peroxidation and ROS production but of markedly differing slopes. Abstinence time had no effect. Lipid peroxidation was a good predictor of sperm motility and their ability to acrosome react. CONCLUSION(S): Reactive oxygen species production in sperm suspensions is an index of overall oxidative stress experienced by sperm, but sperm divide into two classes of ability to resist oxidative stress. Lipid peroxidation should be investigated as a clinical test of sperm function.

Acrosome Reaction↗
PubMed1996

Ultrasound studies of vascular and morphological changes in the human uterus after a positive self-test for the urinary luteinizing hormone surge.

The aim of the study reported here was to establish complementary data for changes in uterine size, echogenicity and vascularity during the menstrual cycle relative to a positive self-test for urinary luteinizing hormone (LH) and day 1 of next menses. Thirteen volunteers (aged 23-32 years) with apparently regular menstrual cycles were recruited from the nursing staff. The plan was to examine all women by transvaginal ultrasonography with colour Doppler imaging on day 11 of the menstrual cycle. A urinary LH self-test was to be used daily until a positive result was obtained and the women were to be re-scanned daily until the dominant follicle had ruptured. All women were then to be scanned at least every 48 h (within +/- 2 h of the same time of day) until day 6 of the next menstrual cycle. Matched samples of peripheral blood were taken at the time of each scan for hormone analysis. The main outcome measures were the times of follicular rupture, a positive test result for urinary LH and the start of menses, uterine volume, cavity length, endometrial thickness and grade, pulsatility index (PI), and time-averaged and peak systolic maximum velocities in uterine and radial arteries and in subendometrial vessels. Nine women fulfilled the criteria for an ovulatory cycle, and seven provided data over the complete study. The principal changes relative to a positive urinary LH test were (i) a continued rise in endometrial thickness to days 3 and 4 (this index then remained relatively constant, but the layered appearance was lost) and (ii) a gradual decrease in the uterine arterial PI. There was a significant rise in uterine volume, cavity length and uterine arterial PI around the time of the next menses, and a fall in endometrial thickness and blood velocity in the uterine and radial arteries and subendometrial vessels. The data may have implications for the assessment of reproductive status and the design of future studies on disorders of implantation or menstruation.

Adult↗
PubMed1988

Clinical value of prolactin bioassay in euprolactinemic reproductive disorders.

To examine the disparity between clinical presentation and prolactin (PRL) measured by radioimmunoassay (RIA), serum samples from 128 patients with galactorrhea and/or reproductive disorders were evaluated by RIA for immunoassayable PRL (RIA-PRL) and by Nb2 lymphoma cell proliferation assay for bioassayable PRL (bioassay-PRL). One hundred fifteen patients had normal RIA-PRL and 13 patients had high RIA-PRL (greater than 25 ng/ml). Twenty patients had galactorrhea, two of whom had hyperprolactinemia. The reproductive disorders in female patients included infertility, amenorrhea, oligomenorrhea, irregular menstrual cycles, and luteal phase defects. Six oligospermic males also were studied. Twenty-three male and female volunteers with no evidence of reproductive disorders served as controls. Appropriate comparisons showed that PRL bioassay/RIA ratio, an index of agreement between the two assay systems, did not differ for the various patient groups compared with controls. It is concluded that Nb2 lymphoma bioassay does not provide additional diagnostic value to RIA in defining the cause of euprolactinemic galactorrhea and/or reproductive disorders.

Biological Assay↗
PubMed2006

[Effects of Ailing Granule on immuno-reconstruction in HIV/AIDS patients].

OBJECTIVE: To explore the possible mechanism of Ailing Granule (AG, a Chinese herbal preparation for nourishing Qi and activating blood circulation) in intervening HIV/AIDS. METHODS: Twenty-one HIV/AIDS patients were orally administered with AG (mainly composed of Fructus Ligustri lucidi, Radix Scutellariae, Radix Astragalus and Eupolyphaga et polyphage) by 20g, twice a day for 4 months. Their symptoms and signs were scored, T cell subgroup (CD3, CD4, CD8) and interleukin-2 (IL-2) were detected with flow-cytometry, and viral load determined with RT-PCR, as well as some indexes for safety evaluation, including ALT, Cr and BW were observed before and after treatment. RESULTS: After treatment, the symptom and sign score of patients lowered, among them the scores of fatigue, anorexia, spontaneous sweating and skin rash reduced with difference statistically (P < 0.05); the total effective rate was 61.9%; CD4 count and IL-2 level increased from 308.29 +/- 150.66/microl and 13.19 +/- 5.93 ng/L to 336.50 +/- 148.94/micro1 and 15.14 +/- 5.14 ng/L respectively( P < 0.05); while the viral load lowered but showed no significant difference. All the indexes of safety measured kept unwavering during treatment(P > 0.05). CONCLUSION: AG could significantly alleviate the symptoms of HIV/AIDS patients, improve their immune function, inhibit HIV reproduction to a certain extent or keep it stable. No obvious toxic or adverse reaction was seen.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Relationship between delay of surgical diagnosis and severity of disease in patients with symptomatic deep infiltrating endometriosis.

We investigated relationships between delay of surgical diagnosis and severity of disease in 95 patients with symptomatic deep infiltrating endometriosis. The delay before surgical diagnosis of deep infiltrating endometriosis was significantly longer for patients with advanced stage IV (revised American Society for Reproductive Medicine [ASRM] score >70) disease than for those with stage I, II, III, or IV (revised ASRM score <or=70) disease.

Adult↗
PubMed2001

Racial differences in sex hormone levels in women approaching the transition to menopause.

OBJECTIVE: Evaluate racial differences in reproducibility of hormone levels over time (estradiol, DHEAS, FSH, and testosterone) while adjusting for covariates previously identified as relevant in the study population. DESIGN: Longitudinal cohort study. SETTING: Healthy, late-reproductive-age women in a community-based sample. PATIENT(S): African American and Caucasian women identified by random digit dialing. INTERVENTION(S): Hormone levels measured in the early follicular phase of the menstrual cycle four times over 9 months. A multivariate, linear mixed model estimated effects on hormone levels of race, age at enrollment, age at menarche, number of pregnancies, current smoking, alcohol consumption, body mass index (BMI), waist/hip ratio (WHR), and menstrual cycle length. MAIN OUTCOME MEASURE(S): Follicular plasma levels of estradiol, FSH, DHEAS, and testosterone. RESULT(S): African American but not Caucasian women had significantly lower levels of estradiol and DHEAS with increasing age. African American but not Caucasian women had significantly decreased levels of estradiol and significantly increased levels of DHEAS with increasing BMI. No racial differences in reproducibility of hormone measures were found. CONCLUSION(S): There are racial differences in associations of hormone levels with age and BMI in late reproductive age women. Further study is needed to replicate these findings and to determine the relationships of these hormonal associations with menopausal symptoms.

Adult↗
PubMed2000

Associations among symptoms of depression and posttraumatic stress disorder and self-reported health in sexually assaulted women.

Symptoms of depression and posttraumatic stress disorder (PTSD) were examined for their association with health status in a sample of sexual assault victims. Hypotheses were that symptoms of each disorder would account for unique variance in health status among individuals exposed to traumatic stressors. Fifty-seven sexually assaulted college women were assessed for prior victimization history, assault characteristics, and depressive and PTSD symptoms. When prior history of sexual victimization, assault severity, and physical reactions during the assault were controlled, hierarchical multiple regression models indicated that symptoms of PTSD and depression were significantly associated with global health perceptions and severity of self-reported health symptoms. Only PTSD symptoms were significantly associated with reproductive health symptoms. The results suggest that both symptoms of PTSD and depression account for the relationship between exposure and health impairment among sexual assault victims.

Adult↗