Reaction mechanisms of trans-1,2-dihydroxy-anti-3,4-epoxy-1,2,3,4-tetrahydro-5-methylchrysene with DNA in aqueous solutions

Reactions of trans-1,2-dihydroxy-anti-3,4-epoxy-1,2,3,4-tetrahydro-5-methylchrysene (anti-5-MeCDE) with DNA and the effects of ionic strength on the reaction were studied in aqueous buffer solution (5 mM sodium phosphate, pH 7) by means of absorption and fluorescence spectroscopy. The results are compared with those obtained with the widely studied metabolite model compound trans-7,8-dihydroxy-anti-9,10-epoxy-7,8,9,10-tetrahydrobenzo[a]pyrene (BaPDE). The rate constant of hydrolysis of 5-MeCDE is k = 1.0 X 10(4)/S, which is approximately 35 times smaller than the value of k for BaPDE under similar conditions. As in the case of BaPDE, the rate of reaction of 5-MeCDE is accelerated in the presence of DNA. This effect is attributed to the rapid formation of physical association complexes (binding constant K) and the subsequent slower formation (rate constant k3) of carbocations at DNA binding sites, which in turn decay rapidly via hydrolysis to tetraols (1,2,3,4-tetrahydroxytetrahydro-5-methylchrysene, 5-MeCT) and to covalent adducts. The values of K and k3 are 2800 +/- 300/M and 8.7 X 10(-3)/S respectively, and are reduced to 450 +/- 100/M and 1.8 X 10(-3)/S in the presence of 0.1 M NaCl. The fraction of 5-MeCDE molecules which bind covalently to DNA is, on the other hand, constant under these conditions and lies in the range of 5-8%. Similar values for the covalent binding are observed for BaPDE, even though the physical association constant K is approximately 10 times larger than for 5-MeCDE under similar conditions. This difference in the values of K are attributed to the larger aromatic ring system in BaPDE which allows for a higher interaction of this molecule with the bases of DNA. Finally, the tetraol derived from the hydrolysis of 5-MeCDE also binds non-covalently to DNA, but the value of K is approximately 3 times smaller than for the diol epoxide.

Structural effects in reactivity and adduct formation of polycyclic aromatic epoxide and diol epoxide derivatives with DNA: comparison between 1-oxiranylpyrene and benzo[a]pyrenediol epoxide

Reaction of 1-oxiranylpyrene (1-OP) with DNA and the structures of the covalent and noncovalent complexes formed were studied in aqueous media (5 mM phosphate buffer with 0.1 M NaCl, pH 7) by utilizing the techniques of absorption, fluorescence and linear dichroism spectroscopy in order to gain an understanding of possible structure-activity relationships for polycyclic aromatic hydrocarbon epoxides in tumorigenesis and carcinogenesis, and the results were compared with those obtained for the highly active benzo[a]pyrene diol epoxide (BaPDE). Like BaPDE, 1-OP undergoes acid-catalyzed hydrolysis with the pseudo-first-order rate constant k = 4.6 X 10(-4) s-1 in the absence of DNA, which is about 10 times slower than in the case of BaPDE. In DNA solutions, this hydrolysis is catalyzed by a rapid formation of a physically bound complex of 1-OP-DNA, which subsequently undergoes either (1) hydrolysis to a diol derivative or (2) formation of a covalent adduct of 1-OP-DNA. The same value of the noncovalent binding constant (K = 4000 M-1 is obtained for both 1-OP and for BaPDE, which suggests that the pi-electron interaction between the pyrenyl moiety and the nucleic acid bases is the dominant factor in the formation of the physical complexes and that the two extra OH groups in BaPDE do not play a significant role in determining the value of the physical binding constant.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty four-hour prolactin profiles and prolactin responses to dopamine in long distance running women

Long distance women runners have a high incidence of oligoamenorrhea. In order to study the possible role of PRL in contributing to their menstrual dysfunction, we evaluated PRL secretion in eumenorrheic (n = 7) and oligomenorrheic runners (n = 9) who averaged 25-50 miles/week, as well as nonrunning women (n = 5) during the midfollicular phase of their cycles. Serum estradiol, progesterone, testosterone, FSH, LH, TSH, and T4 were similar among the three groups. The mean 24-h +/- SE PRL concentrations between the three groups: nonrunners, 12.9 +/- 0.6 ng/ml; eumenorrheic runners, 13.5 +/- 0.4 ng/ml; and oligomenorrheic runners, 15.0 +/- 0.8 ng/ml, were not significantly different. A dopamine (DA) infusion, 0.004 micrograms/kg X min, produced physiologic serum DA levels in these subjects. The nadir of serum PRL levels during DA infusion was similar in each group, which argues against an abnormality in dopaminergic tone in the runners with menstrual dysfunction. Our findings of normal 24-h PRL secretion and appropriate PRL responses to DA in women runners with menstrual dysfunction do not support a role for PRL in this disorder.

The effect of estrogen on monoamine systems in the fetal rat brain

The effect of a pharmacologic dose of estrogen on brain monoamine systems in the rat fetus was determined using a semiquantitative measure of histofluorescence. Pregnant rats received a subcutaneous injection of cottonseed oil alone or estradiol (E2) in cottonseed oil just before the monoamine systems began to develop. The fetuses were delivered abdominally and killed on day 22 of gestation. A study of four major monoamine areas of the brain with a glyoxilic acid preparation showed that intrauterine exposure to E2 has a significant effect on the monoamine organization of the fetal hypothalamus. No treatment effects were noted in the areas of locus coeruleus, substantia nigra and corpus striatum. The litter sizes of the E2-treated rats and the body weights of the fetuses were much lower than those of the control group. The effect of E2 on monoamine distribution in the fetal hypothalamus may explain the reported disturbances of reproductive function and sexual behavior seen after perinatal exposure to high doses of estrogen in humans.

The diurnal variations of serum prolactin levels before and during pregnancy in normal and hyperprolactinemic patients

The pattern of 24-hour secretion of prolactin was evaluated in three normal pregnant subjects at the tenth, twenty-fourth, and thirty-sixth gestational week. A similar study was performed in three hyperprolactinemic subjects throughout the course of their gestations. The findings confirm the progressive rise in serum concentrations of prolactin throughout pregnancy in normal subjects, with a tendency to blunting of the ratio of the nighttime mean to the daytime mean ( meanss / meansa ) as pregnancy progresses. One hyperprolactinemic subject (nontumoral) followed this pattern but demonstrated blunting initially and throughout pregnancy. The other two hyperprolactinemic subjects (one tumoral and one nontumoral) demonstrated an unexpected response in that they remained unresponsive to the increasing concentrations of estradiol throughout pregnancy.

Peripheral circulatory response to feeding in newborn low-birth-weight infants

The effect of feeding on calf blood flow (CBF) was investigated in 27 preterm and 10 term small-for-gestational-age (SGA) neonates using the venous occlusion plethysmographic method pre- and postprandially. Blood pressure and heart rate were simultaneously monitored. Feeding consisted of commercially prepared formula with average amounts of 20 ml/kg for preterm and 30 ml/kg for term SGA infants. As a group, the preterm neonates showed no significant CBF changes 1/2 h postprandially from the control value of 8.4 +/- 2.6 ml/min/100 ml (mean +/- SD). Although the difference was not statistically significant, 10 of the 27 preterm infants showed a mean CBF decrease of 9% and 17 showed no change to a slight increase immediately postprandially. These changes were followed by a 35% mean increment in CBF of all preterm infants at 2-2 1/2 h postprandially. CBF decreased in term SGA infants by 40% at 1/2 h postprandially from a control flow of 8.6 +/- 2.9 ml/min/100 ml (p less than 0.01). CBF returned to the control level 1-1 1/2 h postprandially and superseded the control value by 16% at 2-2 1/2 h. Peripheral vascular resistance varied inversely with CBF. Blood pressure and heart rate showed no significant changes. These observations indicated that unlike term infants, most preterm infants manifest no significant immediate peripheral vascular response to feeding before the onset of a hyperdynamic circulatory state. This difference was related to gestational age rather than to birth weight as term SGA infants responded like term appropriate-for-gestational-age infants. The possible mechanisms involved in these CBF changes with feeding are discussed.

Hypergonadotropic hypogonadism

Etiologic factors in hypergonadotropic hypogonadism are discussed. On the basis of these data a classification system is proposed for women with hypergonadotropic hypogonadism to be used in future investigations of the natural history of this disorder. The classification system can also be used in attempts at therapeutic intervention in these women. Recommendations for clinical management and future studies of women with hypergonadotropic hypogonadism are provided.

Serum lipoprotein responses during active and stable weight reduction in reproductive obese females

An increase in high density lipoprotein-cholesterol (HDL-C) and a reduction in low density lipoprotein-cholesterol (LDL-C) accompany weight reduction in obese males. In contrast, obese females have had variable responses in these two lipoproteins after weight reduction. To evaluate the effects of weight reduction in obese women, 15 morbidly obese eugonadotropic women of reproductive age had serum lipids and lipoproteins measured before and after achieving a stable and reduced weight by either diet and/or a gastric stapling procedure. Total testosterone (T), free testosterone (free T), and testosterone-binding globulin serum concentrations were also determined before and after achieving a stable reduced weight to assess the role of androgens in modulating any lipoprotein changes. In 10 subjects, lipid analysis was also performed during active weight loss. Total serum triglycerides fell from 106 +/- 53 to 76 +/- 30 mg/dl during active weight loss (P less than 0.025). Total cholesterol, LDL-C, HDL-C, and the LDL-C to HDL-C ratio did not change. In contrast, after achieving a stable reduced weight (mean weight reduction, 25.9 +/- 6.7 kg), HDL-C rose from 24 +/- 8 to 32 +/- 9 mg/dl (P less than 0.005). This was accompanied by a reduction in LDL-C from 145 +/- 23 to 135 +/- 30 mg/dl (P less than 0.01) and in the LDL-C to HDL-C ratio from 6.7 +/- 2.6 to 4.8 +/- 1.9 (P less than 0.001). Total triglycerides and total cholesterol were unchanged. After obtaining a stable reduced weight, testosterone-binding globulin increased and free T fell, but no significant correlation existed between the changes in androgens and the changes in lipoprotein responses. Thus, in morbidly obese women, weight reduction increases HDL-C and lowers LDL-C serum concentrations. The reduction in the LDL-C to HDL-C ratio suggests that weight loss may favorably reduce the risk of coronary artery disease in these patients. A concurrent reduction of free T with weight loss does not appear to be a major controlling influence in these lipoprotein alterations.

Bromocriptine associated with symptom exacerbation during neuroleptic treatment of schizoaffective schizophrenia

Bromocriptine is a dopamine agonist with potential mental side effects. The authors report a case involving a patient with neuroleptic-induced remission of psychiatric symptoms in whom bromocriptine was associated with temporary exacerbation of schizophrenic symptoms. Other treatment approaches than bromocriptine are suggested for amenorrhea-galactorrhea induced by neuroleptic medication. The use of bromocriptine requires monitoring for changes in mental status.

Massive edema of the ovary and virilization

Endocrine studies of a virilized adolescent patient with massive ovarian edema are reported. The histologic features of the affected ovary consisted of diffuse edematous stroma with scattered islands of lutein-like cells and no evidence of recent ovulation. Plasma concentrations of progesterone and 17-hydroxyprogesterone (17-OHP) in the peripheral and left ovarian veins and their ovarian-peripheral vein gradients were above the range observed during normal follicular phase. The considerable increase in the ovarian vein concentrations of both steroids observed after adrenocorticotropic hormone administration was noteworthy as a direct effect of this hormone on the ovarian synthesis of steroids has not previously been observed. Peripheral vein levels of testosterone (T) were increased. The secretion of T by the ovary was demonstrated by its elevated levels in the ovarian vein and in the ovarian-peripheral vein gradient. Unexpectedly, the levels of androstenedione in the ovarian vein were normal, suggesting an alteration in the ovarian biosynthetic pathway for the production of T. Similar findings have been observed in hirsute women with hyperthecosis ovarii. After surgery, the peripheral vein levels of 17-OHP and T returned to normal, pointing toward the ovary as their source of excess. The data indicate that stromal luteinization of the massive ovarian edema may lead to changes in normal ovarian steroidogenesis that would be responsible for the clinical manifestations of this disorder.

M13 vectors for selective cloning of sequences specifying initiation of DNA synthesis on single-stranded templates

M13 cloning vectors have been developed for the selection of DNA sequences capable of directing initiation of DNA synthesis on single-stranded templates. These vectors are derived from viable M13 mutants containing large deletions in the region of the complementary strand origin. The deletion mutants are defective in the conversion of viral single strands to the duplex replicative form (SS leads to RF) both in vivo and in vitro, give a reduced phage yield and form turbid plaques. A receptor site for foreign single strand initiation determinants has been introduced into the mutants by the insertion of EcoRI linker sequences at the deletion sites. Specific cloned sequences from bacteriophage G4 RF and from Co1E1 DNA restore a clear plaque type and normal phage growth. Selection of clear-plaque isolates obtained by transfection with RF from one of these vectors, M13 delta E101, carrying inserted Co1E1 HaeIII fragments resulted in the selective cloning of one specific fragment, the HaeIII-E fragment. Insertion of either the H or L strand of the HaeIII-E fragment into the M13 delta E101 viral strand gives a clear plaque phenotype, indicating the presence of initiation determinants on both the H- and L-strands of the Co1E1 HaeIII-E fragment. These cloning vectors provide a new means for the functional dissection of replication origins and for the identification of DNA sequences that determine the enzymatic mechanism of discontinuous synthesis along the length of the bacterial chromosome. The ability to assess initiation capability on the basis of plaque morphology also provides a means for rapid genetic analysis of initiation determinants.

Evidence that chorion-decidual prolactin release is calcium dependent

The regulation of PRL release from chorion-decidual explants was evaluated in organ cultures. Agents previously shown to stimulate pituitary release in vitro (TRH, theophylline, estradiol, and vasoactive intestinal polypeptide) were all without effect on chorion-decidual PRL release. Media free of calcium, however, resulted in 44% decreased chorion-decidual PRL release. Conversely, 2.5 mM CaCl2 produced a 64% increase in PRL release (P less than 0.01). Also, calcium chelation with EGTA (0.125-1.0 mM) produced a dose-related decrease in chorion-decidual PRL release. This decrease was greatest at 1.0 mM (P less than 0.01), being 56% of control. In contrast, the calcium-calmodulin complex inhibitor trifluoperazine (10 micrometers) did not significantly alter chorion-decidual PRL release. These studies and previous report in the literature suggest that different control mechanisms govern pituitary and chorion-decidual PRL release; however, an exception appears to be a common role for calcium.

Viable deletions of the M13 complementary strand origin

The single-stranded DNA of bacteriophage M13 is converted to a duplex replicative form by a mechanism involving RNA-primed initiation at a single unique site on the viral DNA. The DNA sequence that specifies the RNA primer is contained largely within one of two adjacent hairpin structures protected from DNase degradation by RNA polymerase. We have used in vitro techniques to construct a series of M13 mutants having deletions in the region of the complementary strand origin. Deletions of the duplex replicative form DNA range in size from 54 to 201 base pairs. The largest deletions remove both of the RNA polymerase-protected hairpins and the entire sequence specifying the primer RNA. Mutants lacking one or both hairpins form faint plaques, give reduced phage yields, and show a lag in phage production of >30 min. The rate of conversion of the single-stranded viral DNA to the parental replicative form is reduced both in vivo and in vitro. These results indicate that both the RNA polymerase-protected hairpins and the RNA primer-coding sequence are important, but not essential, for replication. Other sequences within the origin region, or possibly elsewhere in the genome, may play a role in complementary strand initiation in these mutant phages. The M13 viral strand is initiated by extension of the 3' terminus generated by site-specific nicking of the viral strand of the replicative form DNA by the M13 gene II protein. This specific nicking site is retained in all of the M13 deletion mutants. Deletion end points do not extend into a 13-nucleotide sequence preceding the viral strand nicking site. We propose that a sequence including these 13 nucleotides is required for gene II protein action at this site.

Hirsutism: implications, etiology, and management

Hirsutism usually results from a subtle excess of androgens. As such, it is a clue to possible endocrine disturbance in addition to presenting cosmetic problems. We use the term hirsutism to mean male-pattern hirsutism--excessive growth of hair in areas where female subjects normally have considerably less than male subjects. An elevation of the plasma free (unbound) testosterone level is the single most consistent endocrinologic finding in hirsutism. The plasma free testosterone level is sometimes elevated when the total level of plasma testosterone is normal because testosterone-estradiol--binding globulin (TEBG) levels are often depressed in hirsute women. Frequent blood sampling is sometimes necessary to demonstrate subtle hyperandrogenic states since androgen levels in the blood are pulsatile and seemingly reflect episodic ovarian and adrenal secretion. The source of hyperandrogenemia can usually be determined from dexamethasone suppression testing. Those patients whose plasma free androgen levels do not suppress normally usually have functional ovarian hyperandrogenism (polycystic ovary syndrome variants). Very high plasma androgen levels or evidence of hypercortisolism, which is not normally suppressible by dexamethasone, should lead to the search for a tumor or Cushing's syndrome. Those patients in whom hyperandrogenemia is suppressed normally by dexamethasone have a form of the adrenogenital syndrome, a prolactinoma, obesity, or idiopathic hyperandrogenemia. In such patients, glucocorticoid therapy may reduce hirsutism and acne and normalize menses. The treatment of hirsutism resulting from functional ovarian hyperandrogenism is not as satisfactory; estrogen-progestin treatment is the most useful adjunct to cosmetic approaches to hirsutism in this country. However, other manifestations of polycystic ovary syndrome, such as infertility, may take precedence over hirsutism when an optimal therapeutic program is designed for many patients.

Hormonal screening of hyperestrogenic, elderly, obese females for a granulosa cell tumor

Two elderly, obese, postmenopausal patients demonstrated, for their age, inappropriate estrogen stimulation, elevated serum concentrations of estrone (E1) and estradiol (E2) and low serum concentrations of gonadotrophins. Hormonal evaluations before and after hysterectomy and bilateral salpingo-oophorectomy are reported. The first patient represents the eighth reported case of a granulosa cell tumor with documented preoperative and postoperative estrogen serum concentrations. Though the second patient had no evidence of an ovarian neoplasm, she demonstrates the complexity of attempting to preoperatively diagnose an early granulosa cell tumor in the elderly, obese female by hormonal profiles. The contribution of gonadotrophins and estrogens in making this diagnosis is discussed.

Lack of predictive indices in kernicterus: a comparison of clinical and pathologic factors in infants with or without kernicterus

A review of 398 neonatal autopsies at Downstate Medical Center revealed 27 cases of kernicterus during the seven-year period from 1971 through 1977. With the current intensive care of the sick newborn, kernicterus continues to occur, mainly in premature infants with relatively low levels of serum bilirubin (mean of 11.5 mg/100 ml). To understand the factors contributing to the development of kernicterus, clinical and pathologic findings in 27 infants with kernicterus were compared to 103 "control" infants with retrospectively. Birth weight, gestational age, sex, and Apgar scores were comparable in both groups. The duration of survival was significantly shorter in infants with kernicterus than in the control infants. The clinical signs and symptoms of kernicterus were nonspecific and the premortem diagnosis of kernicterus was not suspected in most of the cases. There were no significant differences in the peak serum bilirubin values, incidence of hypothermia, hypoglycemia, convulsions, anemia, infection, use of phototherapy, transfusion and exchange transfusion in the two groups. Serum albumin values and bilirubin binding capacity measured by 2-(4-hydroxybenzeneazo)benzoic acid were significantly lower in the kernicteric group although the bilirubin-albumin molar ratio was equal in both groups. The incidences of severe acidosis and hypoxic encephalopathy were significantly higher in the kernicteric infants. In this study, acidosis, hypoxia, hypoalbuminemia, and low bilirubin binding capacity were seen more often in kernicteric infants than in control infants. However, analysis of previously suggested risk factors failed to identify any single factor or combination of factors which could be predictive to the development of kernicterus.

High frequency mechanical ventilation in severe hyaline membrane disease an alternative treatment?

Twenty-four preterm infants with respiratory failure from severe hyaline membrane disease (HMD) received mechanical ventilation at high respiratory frequencies. The average birthweight of the infants was 1244 +/- 301 g, and 7 babies weighed less than 1000 g. The average gestational age was 30 +/- 2 weeks, and 6 infants were born at 28 weeks or less. The method of ventilation included (1) respiratory frequencies of 60--110/min, sometimes with brief manual ventilation at more rapid rates, (2) peak inflation pressures (PIP) of less than 35 cm H2O, (3) inspiratory durations of 0.15--0.25 sec, (4) positive end-expiratory pressure (PEEP) of 4--9 cm H2O, and (5) weaning from mechanical ventilation by reducing tidal volume until peak inflation pressure (PIP) reached 20--25 cm H2O, whereupon respiratory frequency was decreased. PaCO2 was kept at 30--40 torr and PaO2 at 60--80 torr. Of the infants, 22 survived (92%) with few major complications.

The effect of ampicillin on oral contraceptive effectiveness

The effectiveness of oral contraceptives with concomitant use of ampicillin has been questioned. Eleven volunteer subjects were studied during 2 consecutive menstrual cycles; they were given Demulen with placebo or ampicillin during each of the cycles. Serum estradiol (E2), progesterone (P4), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were evaluated on days 13 and 19 of each cycle. Testosterone-binding globulin (TeBG) capacity and ferning of cervical mucus were evaluated on day 13 of each cycle. Subjective symptoms were recorded. All cycles appeared to be anovulatory. Steroid suppression was present in 10 of 11 patients during both cycles. Estrogen-dependent TeBG was not affected by ampicillin. It is possible that cervical mucus ferning was improved by concurrent ampicillin administration. Ampicillin appears unlikely to diminish the effectiveness of the oral contraceptive studied.

Vasoactive intestinal polypeptide in tissues of the human female reproductive tract

Vasoactive intestinal peptide (VIP) is a known potent hypotensive and vasodilatory agent. Studies were performed to determine the possible role of VIP in the human menstrual cycle in 44 patients in the reproductive age group, some of whom were using oral contraceptives, three pregnant patients, and four postmenopausal patients. No significant relationship between VIP and menstrual cycle phase was found.

Ovarian hyperandrogenism with normal and abnormal histologic findings of the ovaries

Thirty-one patients with clinical features of polycystic ovary syndrome (PCO) were studied to determine the correlation between biochemical and histologic findings. The biochemical features investigated were the effects of adrenocortical and ovarian suppression by dexamethasone and oral contraceptives (Ovulen) on plasma free androgens. Four patients showed a histologic picture consistent with PCO (Group A), and five had histologically normal ovaries (Group B). The remaining 22 patients had no tissue available for histologic examination (Group C). The baseline values of plasma free testosterone (FTel) were higher and those of testosterone-binding globulin (TeBG) were lower (p less than 0.05) in Group A than in Group B, although plasma total testosterone (T) and the free 17beta-hydroxysteroid androgen index (FHSl) were similar in the two groups. During dexamethasone administration in all study groups, T and FTel fell slightly (17.7% to 33.8%), and FHSl levels decreased moderately (36% to 46.6%); in no case did both indices of free androgen levels fall to the normal range for dexamethasone-suppressed women. However, no change was noted in TeBG in all three groups. On the other hand, Ovulen treatment suppressed T and free androgens to normal in all groups, and raised TeBG more than 350% from the baseline. These data suggest a decrease in androgen production. The effects of dexamethasone and Ovulen on all three groups were similar in percent changes. As Group B patients resemble those of Group A biochemically and clinically, except for possibly being less hyperandrogenic, the concept of ovarian hyperandrogenism should be expanded to include patients with no anatomic ovarian abnormality, particularly in milder cases.

Interfacial behavior of uracil derivatives

The adsorption of a number of methylated uracil derivatives and of 5-fluorouracil has been studied by surface electrochemical methods at a mercury electrode. All derivatives exhibit an initial or dilute adsorption region where they are adsorbed flat on the electrode surface and are bound by pi-electron overlap with the electrode. Uracil, thymine, 1,5-dimethyl-uracil, 5,6-dimethyluracil, 1,5,6-trimethyluracil and 5-fluorouracil undergo a surface reorientation from the initial flat solution activities for each compound. An unsubstituted N(3)-H group is an absolute requirement for a uracil derivative to be capable of adopting the perpendicular surface stance. In the perpendicular orientation the uracil derivative appears to be bound to the electrode primarily via a N(3)-H--(-) electrode bond although a similar but weaker hydrogen bond can be formed via the N(1)-H group for certain compounds.

Pregnancy in a true hermaphrodite

True hermaphroditism is a rare form of intersexuality, and fertility in such an anomaly has been reported only once before in literature. A 19-year-old true hermaphrodite reared as a female with normal secondary sex characteristics and a karyotype of 46,XX was treated by removal of the left ovotestis. The right ovary and other pelvic organs were of a normal female. Ten months after the treatment she became pregnant. The pregnancy was complicated by a premature delivery of a 1500-g male infant that showed no congenital anomalies. Histologic findings of the ovotestis and clinical findings of a true hermaphrodite with pregnancy are presented.

Dysmenorrhea in unicornis with rudimentary uterine cavity

Two adolescents with a rare müllerian anomaly, uterus unicornis with a noncommunicating rudimentary uterine cavity, are presented because of clinical manifestations characterized by dysmenorrhea and pelvic pain requiring multiple hospitalizations and surgical procedures prior to the correct diagnosis. A high index of suspicion and proper diagnostic evaluation are essential for all adolescent patients presenting with dysmenorrhea associated with menarche and subsequent menstruation. The details of 2 cases and their diagnostic and therapeutic emphasis are presented.

Partial gonadotrophin-resistance in pseudohypoparathyroidism

A patient with classical Albright's pseudohypoparathyroidism was investigated because of oligomenorrhoea. Hypo-oestrogenism was associated with elevated basal gonadotrophin values [mean basal serum LH and FSH were 272 +/- 84 (SD) ng/ml and 593 +/- 83 ng/ml, resplectively (normal less than or equal to 220 and less than or equal to 400, respectively)]. The response to gonadotrophin releasing hormone (Gn-RH) was exaggerated, with maximal LH and FSH increments of 1688 and 458 ng/ml, respectively. These results and the findings on ovarian biopsy were compatible with partial ovarian resistance to gonadotrophins. This resistance could be overcome by administration of human menopausal gonadotrophins. This is the first evidence for gonadotrophin resistance in pseudohypoparathyroidism. The plasma cyclic adenosine-3',5'-monophosphate response to glucagon administration by two different protocols was about 70% that of normal control subjects. Other endocrine glands whose responses to hormones are mediated via the adenylate cyclase system evidenced minor abnormalities of questionable significance. This indirect evidence is compatible with a more extensive defect in the adenylate cyclase system in pseudohypoparathyroidism than has hitherto been suspected.

Immunoglobulins, proteinase inhibitors, albumin, and lysozyme in human cervical mucus. I. Communication: hormonal profiles and cervical mucus changes--methods and results

The serum levels of luteinizing hormone (LH), estradiol-17beta, and progesterone were determined simultaneously with the concentrations of immunoglobulin (Ig) G, IgA, C'3, alpha1-antitrypsin, inter-alpha-trypsin inhibitor, alpha1x-antichymotrypsin, albumin, and lysozyme in cervical mucus during nine ovulatory cycles. Spinnbarkeit and ferning were also assessed, and the basal body temperature was measured and recorded during these cycles. The profiles were synchronized according to the LH peak. The midcycle period, characterized by the rapid increase and decline of estrogen and the beginning rise of progesterone, shows a prounced minimum of immunoglobulins, C'3, proteinase inhibitors, albumin, and lysozyme in cervical mucus, which is known to be most receptive to sperm penetration at this time. Although the variation of cervical mucus values is considerable during the early proliferative and the luteal phases, the midcycle values appear to be constantly low, showing slight differences among the profiles of the different parameters. The statistical evaluation and the assessment of the significance of parameters for ovulation detection and the assessment of the fertile period as well as the correlation of these parameters with basal body temperature will be the subject of the second communication of this series.

The effects of dexamethasone on plasma free androgens during the normal menstrual cycle

In order to evaluate the ovarian and adrenal contribution to peripheral plasma concentrations of total testosterone (TTe), indixes of the plasma concentrations of free testosterone (FTeI), free 17 beta-hydroxysteroid androgens (FHSI), and testosterone-binding globulin (TeBG) during the menstrual cycle, women were examined during three normal cycles and three other cycles under dexamethasone (0.5 mg., four times a day) suppression. All study cycles were apparently ovulatory. The mean TTe and FTeI during the midcycle period were significantly higher than during the early follicular (P less than 0.005) and the midluteal periods (P less than 0.01 and P less than 0.001, respectively). During the menstrual cycles under dexamethasone suppression only the difference in TTe and FTeI between the midcycle (37 +/- 12.4 (S.D.) ng. per 100 ml. and 10.5 +/- 4.0 (S.D.), respectively) and the midluteal (26.0 +/- 10.1 (S.D.) ng. per 100 ml and 7.2 +/- 3.2 (S.D.), respectively) periods was significant statistically (P less than 0.05). No significant differences in the mean levels of FHSI and TeBG between three periods within the cycle were noted in either the control or the dexamethasone-treated cycle. When each phase was compared, the mean levels of TTe, FTel, and FSHI were significantly lower in the dexamethasone-treated cycles than in the normal cycles. The data suggest that the level of TeBG is not perceptibly affected by physiologic fluctuation of estrogen levels during the menstrual cycle, and the FHSI levels are stable throughout the ovulatory cycle. Decrease in levels of TTe, FTeI, and FHSI during dexamethasone suppression seems to be due to reduction of androgen production as TeBG, a major determinant of the metabolic clearance rate of androgens, was not affected by dexamethasone.

Endocrinologic characteristics of partial ovarian failure

Three young women with primary ovarian failure, secondary amenorrhea or oligo-ovulation, and normal gonadotropin levels are reported on here. Vaginal cytology and serum estradiol levels indicated the two women to be persistently hypoestrogenic. The third case, who had the Turner phenotype, was hypoestrogenic during anovulatory cycles but occasionally ovulated. Basal serum LH and FSH were normal. All were tested with synthetic LH-releasing hormone and had a brisk response, LH levels rising 51-198 ng/ml above baseline and FSH rising 278-536 ng/ml. Plasma levels of testosterone, dehydroepiandrosterone sulfate, and progesterone were normal. Gonadal dysgenesis was suggested in two on the basis of an abnormal karyotype, and isochromosome of the short arm of X in Case 2, and an isochromosome of the long arm of X in Case 3. The diagnosis of primary hypogonadism was established by laparoscopy and ovarian biopsy. The latter studies revealed small ovaries with a scarcity of primordial and primary follicles, yet with evidence of current or previous follicular activity. The observation that hypoestrogenism was so marked in two of our patients that elevated serum FSH would have been expected, suggests that the presence of a limited number of ovarian follicles suffices to prevent hypergonagotropism in hypoestrogenic women by a mechanism which does not involve elaboration of sex steroids.

Obesity and oligomenorrhea are associated with hyperandrogenism independent of hirsutism

Obesity, oligomenorrhea, and hirsutism are frequently associated with high plasma androgen levels and/or low testosterone-binding globulin (TEBG) levels. Studied have been undertaken to determine the extent to which each of these clinical features may be related to this hormonal profile. Indexes of plasma free (unbound) androgen levels were focused upon because this fraction appears to be the biologically active portion of the plasma androgens. The hormonal profile was normal in women with either obesity or oligomenorrhea alone and abnormal in those with severe hirsutism alone. On striking new finding was that subjects with the combination of obesity and oligomenorrhea had elevated plasma total and free androgens and depressed TEBG even in the absence of hirsutism. Furthermore, the androgen levels were higher in obese oligomenorrheic women with mild hirsutism than in severely hirsute women who were not obese. Plasma estradiol concentrations were normal in these obese women. A simple explanation for elevated free plasma androgen levels in obese women who were oligomenorrheic yet had little if any hirsutism is not possible. The data are compatible with the concept that obesity is a variably expressed manifestation of slightly elevated plasma free androgen levels or that obesity is an incidental finding which somehow blunts the effect of high androgen levels on hair follicles. Regardless of the explanation, oligomenorrheic obese women must be suspected of having high androgen production even in the absence of hirsutism.

Predetermination of ovulation timing by luteinizing hormone assay

A modified rapid,solid-phase radioimmunoassay for serum luteinizing hormone requiring only 1 1/2 hours of incubation is presented. The method has been used to predetermine the time of ovulation in six infertile patients. Its advantages are presented in these cases. The simplicity and accuracy of the method make it practical, and it can serve well in the management of infertility.

Pituitary responses to LRH in the postpartum periods

Pituitary responses to luteinizing-hormone-releasing-hormone (LRH) in the postpartum periods were studied. Following a subcutaneous injection of 100 mug of synthetic LRH to postpartum subjects, no statistically significant changes in the levels of LH and FSH could be demonstrated in five subjects on postpartum day 1 or 3 and the three subjects on postpartum day 8. A normal elevation of LH and FSH following LRH was demonstrated in one subject 36 days post partum. The findings are in agreement with previous studies demonstrating a persistence of pituitary suppression during the early postpartum period. No correlation could be drawn between the pituitary responses to LRH and the plasma levels of estradiol-17 beta and progesterone.

Study on maternal, fetal, and amniotic human prolactin at term

Prolactin present in maternal blood, fetal blood, and amniotic fluid samples obtained simultaneously at term was examined. The relative concentrations of prolactin in maternal and fetal serum samples were found to vary with each individual case. However, amniotic fluid samples contained a much higher level of prolactin than did both maternal and fetal serum samples in every case. After gel filtration, three separate peaks of immunoreactive prolactin were observed, probably representing three different sizes of the hormone molecule. The main component was small prolactin, constituting at least 69% of the total prolactin immunoreactivity in blood samples and 90% in amniotic fluids. Prolactin was found to be very similar in cord venous and arterial sera, both quantitatively and in terms of heterogeneity. There were more noticeable differences in the percentages of medium and small prolactin present in serum samples than in amniotic fluid samples. Big prolactin was present in all samples; its percentage in maternal serum was slightly higher than its percentages in the other samples. These results suggest that: 1) The mother and fetus carry on independent secretion of prolactin during gestation. 2) The size heterogeneity of prolactin in amniotic fluid differs from maternal hPRL to a greater degree than it does from fetal hPRL. 3) The prolactin in amniotic fluid appears to be of fetal origin.