Growth hormone--non multum sed multa (quality, not quantity).

In view of the recent availability of recombinant human growth hormone (GH) and reports of its ability to augment ovulation induction by exogenous gonadotropins, we have surveyed the reproductive physiological role of GH and the family of polypeptides that mediate its action. The clinical studies using GH to improve ovulation induction, although achieving a significant reduction in exogenous gonadotropin administration, show only minor benefits in terms of attainment of pregnancy. An explanation for this phenomenon is suggested, and we provide guidelines for whom GH should be recommended.

Percutaneous catheter drainage of tubo-ovarian abscesses.

We present the successful treatment of tubo-ovarian abscesses in three young patients by continuous percutaneous drainage, inserted under the guidance of real-time ultrasonography using only local anesthesia. Each patient had been diagnosed laparoscopically as suffering from acute pelvic inflammatory disease, but had formed abscesses despite extensive broad-spectrum antibiotic therapy. One case involved a complication of the ovum pick-up procedure; the woman had tubo-ovarian abscesses with infected hematomas.

Third-trimester uterine rupture after prostaglandin E2 use for labor induction.

Prostaglandin E2 is a powerful oxytoxic agent that reliably initiates labor, even in the presence of an unripened cervix. The very low incidence of obstetric and neonatal side effects contributes to its universal use. Only nine cases of uterine rupture during the third trimester of pregnancy after application of various prostaglandin E2 preparations have been reported in English.

Ectopic pregnancy, the new gynecological epidemic disease: review of the modern work-up and the nonsurgical treatment option.

Over the past few decades, the incidence of ectopic pregnancy has increased almost to the extent of an "epidemic disease." Early diagnosis of tubal pregnancy, with the aid of serum human chorionic gonadotropin, high-resolution ultrasound, and the more liberal use of laparoscopy, has dramatically reduced both maternal mortality and the need for radical surgery. Despite this, women with previous ectopic pregnancies still have reduced fertility potential.

Lack of correlation between hormonal blood levels and endometrial maturation in agonadal women with repeat implantation failure following embryo transfer from donated eggs.

Five women with ovarian failure who repeatedly failed to conceive following embryo transfer from donated eggs underwent endometrial development investigation. One endometrial biopsy was obtained on cycle days 19, 21, and 23 during three consecutive artificially induced cycles. All five patients had only early secretory changes on days 19 and 21.

Conservative treatment of ectopic pregnancy and its effect on corpus luteum activity.

Corpus luteum activity was monitored in 15 women undergoing nonsurgical management of ectopic pregnancy with local methotrexate injection followed by alternating oral methotrexate and citrovorum factor (group A, n = 8) or local methotrexate injection alone (group B, n = 7). All patients initially demonstrated a viable corpus luteum (plasma progesterone ranged from 1.4 to 19 ng/ml).

Uterine rupture at term pregnancy with the use of intracervical prostaglandin E2 gel for induction of labor.

Prostaglandin E2 is a powerful oxytocic agent that reliably initiates labor, even in the presence of an unripe cervix. The low incidence of fetomaternal complication contributes to its universal use. We report a rare case of uterine rupture after intracervical application of prostaglandin E2 gel.

Expression of estradiol and progesterone receptors by histologically normal endometria of women with postmenopausal bleeding.

Estradiol and progesterone receptor levels (RE2, RP) were measured in histologically normal endometria of women with postmenopausal bleeding (PMB) and the results were compared to those in histologically normal endometria of premenopausal and postmenopausal (PM) women and to those in pathological PM endometria. In histologically normal PMB endometria, RP levels were comparable to those in secretory premenopausal endometria and significantly higher than those in PM atrophic endometria. The RP levels in the former group correlated with the respective RE2 levels and the values of the ratio RP/RE2 occupied a mid-zone between those ratio values of normal premenopausal or pathological PM endometria on the one hand and normal PM endometria, on the other hand.

Normal pregnancy complicated by vaginal ectopic trophoblastic implantation; a case report.

We describe a rare case of ectopic placental tissue, presenting as a vaginal tumor during normal intra-uterine pregnancy. Its clinicopathological features, and its possible relation to placental site trophoblastic tumors are discussed. To the best of our knowledge, this is the first case to be reported in the English literature of such a lesion occurring at this site.

Conservative approach to multiple pregnancy with intrauterine fetal death of one or more fetuses.

One of the less common complications of multiple gestation is intrauterine demise of one or more fetuses. Despite the many case reports in the literature, there are no firm guidelines regarding the management of this problem. We herein report the favorable outcome of the conservative approach we chose for managing four patients; two with twins, one with triplets and one with quadruplets (first report in the literature).

Evaluation of ketanserin as a tocolytic agent in third trimester pregnant rats.

Ketanserin, as a 5HT2 selective antagonist, was evaluated for its tocolytic effects in pregnant Charles River (CR) rats, at total doses of 1.5 and 3.5 mg/kg IU from day 22 to day 25 of pregnancy.

Ultrasonic validation of residual bladder volume in postvaginal hysterectomy patients.

Transverse and sagittal bladder diameters were measured with real-time ultrasound in 80 patients (100 measurements) during the first 2 days of postvaginal hysterectomy to assess the residual bladder volume and compared with the catheterization volume for the same patients. The sonographic method, with a 97.7% specificity and a negative predictive value of 89.

Placental site trophoblastic tumors (trophoblastic pseudotumors): pathology and clinical importance.

Placental site trophoblastic tumor (PSTT), which can be regarded as a subtype of gestational trophoblastic neoplasia is discussed. The histopathological features include trophoblastic proliferation without the typical organization of the bilamelar cyto and syncytiotrophoblastic villus. Ultrastructural investigation has demonstrated a clone structural relationship between the infiltrating cells and those of the trophoblastic components of the normal human placenta.

Primary paraovarian cystadenocarcinoma: clinical and management aspects and literature review.

Two cases of primary paraovarian-origin serous cystadenocarcinoma, one invasive and one of low malignant potential, are presented. Both were diagnosed in postmenopausal women and were initially treated surgically. As of this writing, both women have survived 48 months past their initial diagnosis and have no clinically detectable disease.

Ultrasonic assessment of the endometrium as a predictor of oestrogen status in amenorrhoeic patients.

Thirty consecutive amenorrhoeic patients were assessed with regard to the following: medical history, physical examination, pelvic ultrasonography, serum levels of 17-beta oestradiol (E2), other relevant serum hormones and the response to a progesterone challenge test. The results showed a correlation coefficient of 71% (P = 0.001) between the E2 levels and the endometrial width and of 52% (P = 0.

Abnormal thyroid function in hyperemesis gravidarum.

Thyroid function was evaluated in 41 consecutive women with hyperemesis gravidarum (HG). In 11, increased free thyroxin concentrations (FT4) were measured. After one week of conservative therapy, 4 patients with persistent emesis were treated with antithyroid agents.

Distribution of total progesterone receptor levels in various segments and tissues of the normal human uterus: the effect of short-term estrogen administration.

Total progesterone receptor levels (TRP) were measured in various tissues and segments of normal human uteri in basal conditions (late proliferative phase, control group, n = 6) and after short term estrogen administration (test group, n = 8). Similar trends of distribution were observed in both groups in basal endometrial TRP levels along the longitudinal axis, i.e.

Distribution of total estradiol receptor levels in various segments and tissues of the normal and pathological human uterus.

Estradiol receptor (RE2) levels were measured in normal (n = 22) and pathological (n = 14) human endometria and in various segments and tissues of the same uteri (n = 8). The highest total estradiol levels (TRE2) were found in midcycle normal cyclic endometria and the lowest in the secretory phase of normal cyclic endometria and in normal postmenopausal endometria (the TRE2 levels in the latter two groups were within similar ranges). The highest nuclear RE2 levels were found in proliferative-phase normal cyclic endometria.

Progesterone challenge test in postmenopausal women with pathological endometrium.

Cytosolic and nuclear progesterone receptor levels (RPC, RPN) were measured in normal and in pathological human endometria after single-dose progesterone injection 1-3 h before tissue collection (test subjects) and the results compared to those obtained in controls (no progesterone treatment). In test cases of late proliferative or midcycle normal endometria and in estrogen-primed normal postmenopausal endometria, RPN levels were higher and RPC levels were lower compared with those obtained in control samples. In test cases of postmenopausal pathological endometria, histologically normal endometria of women with postmenopausal bleeding and in one case of endometrial polyp, RPN levels were also higher and RPC levels lower than those in the respective controls, but the change of distribution of the RP (cytosol/nuclear extract) was significantly lower than in normal endometrium.

Heterotopic pregnancy.

Three cases of heterotopic pregnancy, i.e. combined intra-uterine and extra-uterine pregnancy are reported.

The diagnostic value of laparoscopy in women with chronic pelvic pain.

Laparoscopy was performed in 130 patients with chronic pelvic pain. Laparoscopy confirmed the preoperative diagnosis of pelvic inflammatory disease (PID) in 41 of 63 women with preoperative diagnosis of chronic PID (65%), whereas in 8 (13%), no pathologic findings were revealed. Laparoscopy directed the management in all 67 women who underwent the procedure to establish a diagnosis; in 16 (24%) of these, no pathologic findings were revealed.