[Diagnosis and treatment of polycystic ovary syndrome].

Obesity, ultrasonic ovarian morphology, serum LH levels and LH/FSH ratio are inconstant symptoms of the polycystic ovary syndrome (PCOS) and are thus no longer essential for diagnosis. PCOS is diagnosed today by the finding of chronic anovulation and hyperandrogenism characterized by a high serum level of "free" testoterone. The other causes of hyperandrogenism, as well as anovulations due to hyperprolactinemia, high levels of FSH and abnormal thyroid function have to be ruled out.

[Pre-ovulatory peaks of gonadotropins. Recent data].

From recent data we know that: The duration of the LH peak seems to be more important than its amplitude for the induction of ovulation. Ovulation induction by hCG is not physiological; the absence of an FSH surge, and the long duration of LH activity would contribute to some of the luteal phase abnormalities. Recombinant hLH, on the other hand could give better results provided its action last about 48 hours.

[The biological activity of luteinizing hormone (LH)].

In vitro bioassay (BIO) is a very specific and sensitive method for determining levels of luteinizing hormone (LH). It provides a means of evaluating the values obtained with routine radioimmunoassays (RIA). Serum levels with bioassay are higher than those obtained with radioimmunoassay.

[Functional hypothalamic amenorrheas. II. Clinical aspects].

The most important causes of the functional hypothalamic amenorrhea (FHA), that are psychological stress, physical stress and weight loss, are associated with a decrease of the frequency of the LH secretory pulses and with a state of hypercortisolism. The slowing down of the LH pulse frequency is difficult to demonstrate in clinical practice. The classical symptoms of FHA which are low gonadotropin levels, and hypogonadism are not very specific.

[Functional hypothalamic amenorrheas. I. Physiopathology].

Functional hypothalamic amenorrhea are very probably due to a decrease of the frequency of the secretory pulses of LH, ie of GnRH. This decrease could be the consequence of a chronic hypersecretion of the corticotropin releasing hormone (CRH). CRH seems to act on the hypotalamic pulse generator of GnRH through the effect of the endogenous opioid peptides of the central nervous system.

[The corpus luteum and progesterone secretion].

The pulsatility of LH secretion has been known only since 1970. The pulsatility of progesterone secretion has now also been shown. The frequency and amplitude of these pulses vary during the three phases of the luteal period.

[Premature failure of the ovaries].

The premature ovarian failure syndrome has been reviewed on the basis of existing data. The frequency, clinical picture and diagnostic procedures of premature ovarian failure are discussed. The disorder is characterized by secondary amenorrhea with constant estrogen deficiency and elevated gonadotropin levels in the post-menopausal range.

[Risk factors in cancer of the endometrium].

The authors evaluate the incidence of the main risk factors in endometrial cancer by comparing a continuous series of 101 patients with a matched reference series. Among these factors, obesity and multiparity are significantly more frequent in patients with endometrial cancer. All of these risk factors are related to a hyperestrogen level.

[Value and indications for nipple stimulation in obstetrics].

The authors have evaluated the effect of stimulation of the breast on uterine tone in a series of 25 patients at term where induction of labour was indicated for obstetric reasons. In 64% of cases breast stimulation carried out for 30 minutes was followed by uterine contractions. In 20% of these cases the authors found that the uterus contracted strongly and in two patients so strongly as to cause fetal heart slowing.

[Interpretation of the blood level of a steroid].

The authors define the conditions under which the steroid circulate in the blood : free, bound to albumin or bound to their specific binding proteins. Based on the physiology of steroids, the authors try to define the value of the serum levels in the evaluation of steroid production and, more particularly, the variations in this production. The biological activity seems to be directly related to the free circulating fraction.

[Cytological detection of cancer of the cervix uteri].

In spite of the apparent simplicity in detection of dysplasias (cervical intraepithelial neoplasias or CIN I, II, or III) and cancer of the cervix, numerous epidemiologic, biochemical, cytologic and socioeconomic problems are involved. The purpose of this early detection is unquestionably sound, even if the efficiency seems not to achieve high levels in accordance to expectations concerning results and if the cost of reiterated cervical and vaginal scraping smears seems exorbitant. The financial constraints and some cost-effectiveness analyses have promulgated use of longer intervals between cytologic exams (Pap tests).

[The effects of the pulsatile administration of naloxone on the secretion of gonadotrophins in a case of hypothalamo-hypophyseal amenorrhea].

12 mg of Naloxone were given using an intravenous pulsatile pump at the rate of 0.4 mg/minute every 8 minutes over a period of 4 hours in a woman of 28 years of age who had secondary amenorrhea of hypothalamic origin. The levels of L.

[Pregnancy provoked by pulsatile administration of gonadotropin- releasing hormone in 2 women with oligomenorrhea].

Pulsatile administration of gonadotropin releasing hormone (GnRH) at a rythm of 1 microgram/min during 6 minutes every 2 hours restored ovulatory cycles and subsequently pregnancy was obtained in 2 patients who presented with oligomenorrhea and sterility.

[Protein binding of steroids].

The role of protein-binding in the physiology of steroids is of great complexity. The following are envisaged: the types of protein, methods of binding and the affinity of steroids for proteins, and the variations in free fraction according to plasma protein levels; the functions of binding proteins on the activity and clearance of steroids as well as on the peripheral conversion of androgens; the factors which influence variations in binding protein levels and in particular the influence of circulating levels of natural hormones and the influence of hormone treatment.

[Changes in LH, FSH, PRL and estradiol after perfusion with naloxone in normal and amenorrheic women].

Naloxone is antagonistic to endogenous opioids. Giving it shows that these opioids act as controlling mechanisms in the secretion of LH and FSH by the hypothalamic, pituitary system and probably of Gn-RH by the hypothalamus. Endogenous opioids and particularly beta endorphin, which is itself under the control of oestradiol, play an inhibitory role on the secretion of Gn-RH and alter the pulsatile mode of Gn-RH secretion.

[Hemoglobin A1c and its variations in pregnancy].

Variations in haemoglobin A1c were studied at different stages of pregnancy in 306 non-diabetic women, using a specific method. It was found that HbA1c levels progressively decreased during the first 25 weeks of pregnancy, then remained stable. No correlation was noted between carbohydrate metabolis and Hb A1c levels.

[Exfoliatin in neonatal staphylococcal infections].

An outbreak of staphylococcal skin infection in neonates was investigated clinically, bacteriologically and epidemiologically with the following findings: (1) In 8 out of 13 cases, exfoliatin-producing staphylococci were present in the bullae, which is unusual with bullous lesions occurring at other ages; (2) exfoliatin producing staphylococci were present in all children with bullous lesions, as well as in carriers; (3) 39% of the phage II group staphylococci studied produced exfoliatin; (4) purulent lesions due to phage II staphylococci which did not produce exfoliatin were observed. The contaminating agent could be identified in most cases.

[Treatment of menopausal hot flushes with a nonhormonal medication, veralipride].

The value of veralipride in menopausal disorders is no longer questionable and has been documented by a number of studies. The purpose of this paper is to study the clinical effectiveness and to look for the biological consequences of three months therapy with veralipride. To achieve this, a thorough biological study (hematology, glucids, lipids, hepatic and renal function) was done in 21 patients with a menopausal syndrome before and after taking veralipride for three months.

[Maternal glucose tolerance along pregnancy (author's transl)].

The development of the foetal and placental unit induces large changes in maternal glucose tolerance along pregnancy. Oestrogen-induced hyperinsulinism is responsible for facilitated anabolism which take place during the first part of pregnancy. Accelerated catabolism occurring during the second part is due to the direct action of placental hormones, mainly of human placental lactogen.

[Infertility and carbohydrate metabolism. A study of 93 cases (author's transl)].

An oral glucose tolerance test was performed in 93 women with unexplained infertility (sterility or repeated abortions). An abnormal carbohydrate metabolism was found in 1/3 of the cases (32 patients). Advice on diet control, provided to all of these patients, was followed only by 13.

[Maternal glucose tolerance along pregnancy (author's transl)].

The development of the foetal and placental unit induces large changes in maternal glucose tolerance along pregnancy. Oestrogen-induced hyperinsulinism is responsible for facilitated anabolism which take place during the first part of pregnancy. Accelerated catabolism occurring during the second part is due to the direct action of placental hormones, mainly of human placental lactogen.

[Epidural morphine for obstetrical pain relief (author's transl)].

Twenty five healthy pregnant women received an epidural injection (at levels varying from T11-T12 to L3-L4) of morphine (2 or 3 mg in 10 ml of saline solution 9 p. thousand) in order to achieve pain relief for delivery. The degree of dilation never exceeded 5 cm at time of injection.