Relapsing polychondritis associated with subclinical Sjögren's syndrome and phlegmon of the neck

A 25-year-old woman, diagnosed with Sjögren's syndrome at age 20, presented with painful edema of her left neck. Three days later, she additionally complained of bilateral auricular pain, and her nasal cartilage was tender to palpation. She was diagnosed as having phlegmon on the basis of her neck findings. Anti-human cartilage antibodies were demonstrated by indirect immunofluorescence, and the diagnosis of relapsing polychondritis was established. The patient was administered antibiotics and a non-steroidal anti-inflammatory drug, and her symptoms gradually improved. Relapsing polychondritis is one of the possible complications of autoimmune diseases, and infection might be a precipitating factor for this disease.

1α,25-Dihydroxyvitamin D(3) down-regulates pleiotrophin messenger RNA expression in osteoblast-like cells

Pleiotrophin (PTN)[heparin-binding-growth-associated molecule (HB-GAM), heparin-binding neurite-promoting factor (HBNF)] is a recently identified polypeptide that stimulates growth of fibroblasts and enhances neurite extension. PTN is expressed in many tissues but relatively high level of expression has been observed in brain and bone. We examined hormonal regulation of PTN mRNA expression in several osteoblast-like cell lines including MC3T3-E1 and ROS17/2.8. The levels of PTN mRNA in these cells was significantly reduced by treatment with 10(-8) M: 1α,25-dihydroxyvitamin D(3) (1,25(OH)(2)D(3)) for 24 h. However, PTN mRNA levels were increased when the non-osteoblastic cell line, ROS 25/1, was treated with 1,25(OH)(2)D(3). These effects were observed in a dose-dependent manner in a dose range between 10(-11) M: to 10(-8) M: . This effect was specific to 1,25(OH)(2)D(3), since PTN mRNA levels were not affected by other steroids such as retinoic acid and dexamethasone in MC3T3-E1 or ROS17/2.8 cells. Similar 1,25(OH)(2)D(3) down-regulation of PTN mRNA was also observed in primary cultures of osteoblast-enriched fetal rat calvaria cells as well as cultures of MC3T3-E1 and ROS17/2.8 cells. These observations suggest that PTN expression in osteoblasts is regulated by the calcitropic hormone, 1,25(OH)(2)D(3), and that PTN may play a role in vitamin D-dependent regulation of bone metabolism.

Mouse primary osteoblasts express vitamin D3 25-hydroxylase mRNA and convert 1 alpha-hydroxyvitamin D3 into 1 alpha,25-dihydroxyvitamin D3

We examined whether 1 alpha-hydroxyvitamin D3 (1 alpha(OH)D3) is metabolized into 1 alpha,25-dihydroxyvitamin D3 (1 alpha,25(OH)2D3) in bone. Northern blot analysis indicated that the expression of vitamin D3 25-hydroxylase mRNA was highest in the liver, followed by the duodenum, calvaria, lung, kidney, skin and long bone, and lowest in the spleen. Of the bone cell fractions isolated from fetal mouse calvaria by a sequential enzymatic digestion, fraction 3, which consisted of mostly osteoblastic cells, showed the highest expression of vitamin D3 25-hydroxylase mRNA. When either cultured bone cells of fraction 3 or mouse calvaria were incubated with [3H]-1 alpha (OH)D3, a radioactive peak which comigrated at the same position as authentic 1 alpha,25(OH)2D3 was found on an HPLC chromatogram. The radioactive fraction obtained from the conditioned media of fetal mouse calvaria was tentatively identified as 1 alpha,25(OH)2D3 by cochromatography with authentic 1 alpha,25(OH)2D3 on three different HPLC systems and a thermal isomerization analysis. These results indicate that 1 alpha(OH)D3 is hydroxylated at the 25-position in bones, resulting in the local synthesis of 1 alpha,25(OH)2D3 from 1 alpha(OH)D3 in the skeletal tissues.

Evidence for the uptake of a vitamin D analogue (OCT) by a human carcinoma and its effect of suppressing the transcription of parathyroid hormone-related peptide gene in vivo

The present study was undertaken to clarify the pharmacokinetics of 22-oxa-1,25-dihydroxyvitamin D3 (22-oxa-1,25-(OH)2D3, OCT), a vitamin D3 analogue with little calcemic activity, and its effect on the transcription of parathyroid hormone-related peptide (PTHRP) gene in nude mice bearing a human carcinoma (FA-6) associated with humoral hypercalcemia. FA-6 tumor expressed vitamin D receptor (VDR) mRNA, and its nuclear extract contained a specific and saturable 1,25-(OH)2D3 binding activity. Although [3H]OCT administered intravenously into FA-6 tumor-bearing nude mice was cleared from the circulation more rapidly than [3H]1,25-(OH)2D3, the uptake of [3H]OCT into the tumor tissue, relative to the radioactivity in the circulation, was greater than that of [3H]1,25-(OH)2D3. Intravenous or oral administration of OCT reduced the steady-state levels of PTHRP mRNA in FA-6 tumor, and nuclear run-off assays demonstrated that the effect of OCT on PTHRP gene expression occurred at a transcriptional level. RNase mapping analysis revealed that both upstream and downstream promoters of the human PTHRP gene were down-regulated by OCT. Finally, OCT exerted a preventive as well as therapeutic effect on cancer-associated hypercalcemia with a marked prolongation of the survival time in tumor-bearing animals. These results suggest that OCT is effectively taken up by a VDR-positive human carcinoma in vivo and has a therapeutic potential for cancer-associated hypercalcemia through suppression of PTHRP gene transcription.

Dexamethasone enhancement of betaglycan (TGF-beta type III receptor) gene expression in osteoblast-like cells

Betaglycan (type III transforming growth factor-beta (TGF-beta) receptor) is a cell surface heparan/chondroitin sulfate proteoglycan that binds TGF-beta via its core protein and is abundantly expressed in osteoblastic cells. A previous report (Centrella et al., Mol. Cell. Biol. 11, 4490-4496, 1991) showed post-translational enhancement by glucocorticoid of TGF-beta binding to betaglycan. Upon the availability of the betaglycan cDNA, we investigated the effects of a glucocorticoid analogue, dexamethasone, on the regulation of betaglycan expression in osteoblast-like cells. Betaglycan mRNA was expressed as an approximately 6-kb band in MC3T3-E1 cells. The betaglycan mRNA level was enhanced severalfold by dexamethasone in these cells. The effect of dexamethasone on the betaglycan mRNA level was observed within 9 h and was sustained at least up to 48 h. The dexamethasone effect was dose-dependent, with a saturation concentration at 10(-7) M. Among the steroid hormones examined, dexamethasone exhibited the most potent effect on betaglycan mRNA expression, while retinoic acid also enhanced it moderately. Dexamethasone enhancement of betaglycan mRNA expression was blocked by actinomycin D, but it was not blocked by cycloheximide. Cross-linking experiments showed that dexamethasone treatment increased the binding of radiolabeled TGF-beta 1 to betaglycan, but did not affect binding to the type II receptor. A similar dexamethasone enhancement of betaglycan mRNA expression was also observed in a preosteoblast-like cell line, RCT1. These results suggest that dexamethasone enhances betaglycan expression at least in part via transcriptional events in osteoblasts and this would be one of the target points of glucocorticoid regulation of bone metabolism.

Anomaly of venous system in congenital occipital dermal sinus

We report two cases of congenital occipital dermal sinus in which elongation of the vein of Galen, elevation of the straight sinus, division of the superior sagittal sinus, elevation of the confluence of sinuses, elevation of transverse sinus and narrowing of the torcular angle were observed in the venous phase of cerebral angiography. Enhanced computed tomography (CT) revealed enlargement of the supracerebellar cistern, elevation of the straight sinus and of the confluence of sinuses, but no evidence of intracranial lesions. In order to study the relationship between anomalies in the dural venous sinuses and congenital occipital dermal sinus, we examined both cases from an embryological viewpoint.

Possible involvement of leukotrienes in human luteal function

The present study was undertaken to assess the ability of human corpora lutea to produce leukotriene B4 (LTB4). The maximum capacity of luteal cells to secrete progesterone was attained on day 4, and both the basal production and the responsiveness to hCG decreased thereafter. In contrast, the production of LTB4 by cultured luteal cells was significantly reduced on day 4, but increased thereafter. The basal concentration of LTB4 produced by luteal cells varied from 75 to 590 pg/10(5) cells/2 days. LTB4 production appeared to decrease concomitantly with increased-progesterone production in cultured luteal cells. Exposure to hCG decreased significantly LTB4 production by cultured luteal cells on day 4. An inhibitor of the lipoxygenase pathway, nordihydroguaiaretic acid (NDGA), inhibited LTB4 production in a dose-dependent manner. However, NDGA did not affect basal progesterone production by the cultured luteal cells. A significant inverse relationship existed between the accumulation rates of progesterone and LTB4 in the luteal cells. Furthermore, the addition of LTB4 inhibited progesterone production in a dose-dependent manner in both the presence and absence of hCG. In conclusion, LTB4 could be synthesized by human corpora lutea in vitro, and correlated inversely with the secretion rates of progesterone. These data suggest that LTB4 produced locally in the corpus luteum may be an important regulator in human luteal regression.

[A case of subarachnoid hemorrhage with sick sinus and advanced AV block]

A 35-year-old man was hospitalized after a sudden onset of transient syncopal attack without accompanying complaints of headache or nausea. He was slightly disorientated but neurologically normal. He had a blood pressure of 150/90mmHg and a pulse rate of 40/min. An ECG showed marked sinus brady-cardia with ventricular escaped rhythm followed by advanced atrioventricular (AV) block. Some components of conducted ventricular beats showed aberration. There was no significant ST or T wave abnormality in normally captured QRS components except for prominent T in leads II, III and aVF. At first, we thought that he might require temporary pacing because of Adams-Stokes attack. However, after administration of atropine sulfate, the ECG returned to normal sinus rhythm with heart rate of 88/min. Then he began to complain of headache followed by a convulsive seizure. A CT scan and angiogram revealed a ruptured aneurysm at the top of the basilar artery, which was successfully clipped. A wide spectrum of ECG changes can be demonstrated in practically all patients with subarachnoid hemorrhage (SAH). Prolonged QT interval, ST-T changes, U wave, sinus tachycardia, or ventricular premature complex are the common abnormalities probably caused by increased circulating catecholamine. As bradyarrhythmia in patients with SAH is an uncommon finding, its mechanism has not yet been defined. Transient sinus bradycardia with advanced AV block in this patient might have been caused not by elevated intracranial pressure (Cushing phenomenon) but by drastic discharge of the parasympathetic nerve. This case serves to illustrate the vigilance required in determining whether abnormalities of cardiac rhythm are instrumental in causing neurological symptoms and signs or a disorder of cerebral function.

Capsular and thalamic infarction caused by tentorial herniation subsequent to head trauma

Five patients (4 male and 1 female) were observed to have capsular and thalamic infarction ascribed to descending transtentorial herniation (DTH) caused by head injury. A lucid interval immediately after the trauma and the presence of an epidural hematoma (EDH) characterized all five cases. At the time of hospitalization consciousness was seriously impaired and signs of cerebral herniation were apparent. Two to four days after the trauma, low attenuation in the computed tomography (CT) images pinpointed intracerebral damage in the anterolateral part of the thalamus and in the internal capsule on the same side as that of the EDH in three patients, and in the other two patients bilateral thalamic and capsular damage was noted. The low attenuation implicated the perforating arteries, that is the anterior thalamoperforating and anterior choroidal arteries, suggesting infarcted regions caused by occlusion of these arteries. Findings in the present study suggest that arterial occlusion in closed head injury may result from DTH. Moreover, infarction may be attributed to the delayed effects of injury.

[Possible involvement of leukotriene B4 on human luteal function: special reference to determination of leukotriene B4 produced by cultured luteal cells]

The present study was undertaken to determine the production of leukotriene B4 (LTB4) by cultured human luteal cells in the mid-luteal phase using a reverse phase column (C8). The luteal cells were cultured with or without hCG at 100 ng/ml for 8 days. In the preliminary experiment, methods for extracting culture media samples were assessed prior to radioimmunoassay. Reverse phase column C8, but not C18, made possible the determination of LTB4 produced by human luteal cells. Progesterone (P) production by cultured luteal cells reached its maximum on day 4 following exposure to hCG, and then declined gradually. The concentrations of LTB4 produced by luteal cells varied from 100 to 500 pg/10(5) cells/2 days. However, exposure to hCG did not affect LTB4 production by cultured luteal cells. The level of LTB4 in culture medium (115.0 +/- 37.8 pg/10(5) cells/2 days) was reduced on day 4, but increased thereafter. LTB4 production appeared to decrease concomitantly with increased P production of cultured luteal cells. In conclusion, cultured luteal cells produced considerable amounts of LTB4 throughout the entire culture period. These results suggest that lipoxygenase activity of luteal cells may be closely related to steroidogenic potential.

The effects of lipoxygenase products on progesterone and prostaglandin production by human corpora lutea

The present study was undertaken to assess the effects of the products of the lipoxygenase pathway on steroidogenesis and the production of prostaglandins (PGs) by human corpora lutea in the midluteal phase. In the first experiment luteal cells were cultured with 5-hydroxyeicosatetraenoic acid (5-HETE) at 10, 100, 500, or 1000 ng/mL in the presence or absence of hCG at 100 ng/mL for 10 days. The addition of 5-HETE dose-dependently inhibited progesterone (P) production by the cultural luteal cells. P production stimulated by exposure to hCG was also reduced significantly in response to 5-HETE. However, 5-HETE had no effect on the production of 6-keto-PGF1 alpha, PGF2 alpha, or PGE2 by cultured luteal cells at any point during the culture period. In the second experiment the reaction products of soybean lipoxidase of arachidonic acid (AA-LIP) were added to cultured luteal cells. Treatment with either AA or LIP alone had no effect on basal P production. The addition of AA-LIP at all concentrations tested reduced P production by cultured luteal cells in the presence or absence of hCG. AA-LIP significantly reduced basal 6-keto-PGF1 alpha secretion in cultured luteal cells on day 2. Although the stimulatory effect of AA on luteal PGE2 production was maintained throughout the entire culture period, the lipoxygenase products of AA did not affect AA-stimulated PGE2 production by cultured luteal cell. These results suggest that the products of the lipoxygenase pathway may be important in the involution of human corpora lutea.

[Effects of 5-hydroxyeicosatetraenoic acid (5-HETE) on progesterone and prostaglandin production by human corpora lutea]

The present study was undertaken to assess the effects of 5-hydroxyeicosatetraenoic acid (5-HETE) on steroidogenesis and prostaglandin (PG) production in cultured luteal cells derived from human corpora lutea in the mid-luteal phase. The luteal cells were cultured with 5-HETE at 10, 100, 500, or 1,000 ng/ml in the absence or presence of hCG at 100 ng/ml for 10 days. The addition of 5-HETE to the culture media did not affect growth curves of cultured luteal cells. 5-HETE significantly inhibited progesterone (P) production by cultured luteal cells in a dose-related fashion on day 2. P production stimulated by exposure to hCG was also reduced significantly in response to 5-HETE. The addition of 5-HETE did not affect estradiol production by cultured luteal cells. The production of 6-keto-PGF1 alpha by cultured luteal cells in the presence of 5-HETE was slightly but not significantly less than that observed in the absence of 5-HETE. However, 5-HETE affects neither PGF2 alpha nor PGE2 production by cultured luteal cells throughout the culture period. The present study demonstrates that 5-HETE inhibits P production in cultured luteal cells by a mechanism(s) other than through PG production. These data suggest the involvement of a lipoxygenase pathway in the synthesis of P and 6-keto-PGF1 alpha of luteal cells.

[Postoperative intracranial pressure in severe cases with hypertensive intracerebral hematoma]

The relationship between the postoperative ICP and the size of hematoma on CT scan and the time of operation was studied to evaluate their influence on the therapeutic results in the severe cases with hypertensive intracerebral hematoma. Twenty one patients of putaminal hemorrhage with severe neurological deficit (semicoma) were studied. ICP was monitored continuously by the Subdural balloon method after craniotomy to remove the hematoma. The relationship between the postoperative ICP level (High ICP: above 40 mmHg, Moderate ICP: 40-20 mmHg, Low ICP: below 20 mmHg), the size of hematoma estimated from CTscan (Large: more than 80 ml, Medium: less than 80 ml), the time from onset to removing hematoma and the therapeutic results were evaluated. The outcome six months after onset was determined according to the Glasgow Outcome Scale. Of 6 cases with Medium hematoma operated on within 8 hours, Low ICP was found in 5 cases (83%) and Moderate ICP was in one case (17%). Of 6 cases with Medium hematoma operated on after 8 hours, High and Moderate ICP were found in 3 cases (50%), respectively. In the cases with Large hematoma, Low ICP was not observed, but High ICP was found in 4 of 7 cases operated on within 8 hours (57.1%) and the other three indicated Moderate ICP (42.9%). High ICP was found in two cases with Large hematoma operated on after 8 hours (100%). The outcome of High ICP cases was severe disability in 4 cases, vegetative state in one and dead in 4, and that of Moderate ICP cases was moderate disability in 3 cases and severe disability in 4.(ABSTRACT TRUNCATED AT 250 WORDS)

[Role of endosalpinx in the oviductal environment]

The oviducal fluid and serum samples from rabbits were obtained daily during estrus and pseudopregnancy and were analyzed for electrolytes, steroid hormones and prostaglandins (PGs). The oviducal fluid volume reached its maximum (1.72 +/- 0.39 ml/day) 48 hours after hCG exposure and then declined gradually. Although the ratios of Na+/K+ and Ca++/Mg++ in the oviducal fluid did not change substantially throughout the observation period, the levels of K+ in the oviducal fluid were consistently 2.5 times greater than those in the serum. The concentrations of progesterone in the oviducal fluid were significantly smaller than those found in the serum. The levels of estradiol in the oviducal fluid were consistently elevated above the serum levels. The concentrations of PGF2 alpha in the oviducal fluid increased rapidly following ovulation and reached levels that were 10-14 times greater than those found in the estrus, whereas PGF2 alpha levels in the serum did not change significantly during the observation period. A significant difference between PGF2 alpha/PGE2 in the oviducal fluids (3.66 +/- 0.72) and serum (0.25 +/- 0.11) was observed at 24 hours after hCG. A surface morphologic study revealed a decrease in the number of ciliated cells, and an increase and expansion of secretory cells after hCG administration. The qualitative and qualitative differences between the oviducal fluid and serum suggest the involvement of secretory cells in the microenvironment for fertilization and preimplantation embryonic development.

[Comparative studies on steroidogenesis and prostaglandins production by luteal cells in newly formed corpora lutea and early pregnancy]

The present study was undertaken to assess the ability of cultured luteal cells from human corpora lutea (CL) in the mid luteal phase and the early pregnancy to secrete steroids and prostaglandins (PGs). Luteal cells responded to hCG with a significant increase (2- to 4-fold) in progesterone (P) production. The addition of hCG to the culture media did not stimulate estradiol (E2) production. In contrast, both P and E2 secretion by luteal cells in early pregnancy were significantly lower than those found in the mid luteal phase. Exposure to hCG did not affect P production by luteal cells in early pregnancy. Arachidonic acid (AA) significantly stimulated PGE2 synthesis by luteal cells in the mid luteal phase in a dose-dependent manner. Both basal PGE2 production and the responsiveness to AA were maintained for the duration of the culture. However, hCG did not affect AA-stimulated PGE2 production. Both PGF2 alpha and 6-keto-PGF1 alpha production abruptly declined as the culture proceeded. PG synthesis by cultured luteal cells in early pregnancy was significantly lower than in the mid luteal phase. The ultrastructural characteristics of luteal cells in early pregnancy, which contained lipid droplets, granular and agranular endoplasmic reticulum and large spherical mitochondria, were maintained after 10 days in culture. The present results demonstrate that P and PGE2 production by cultured luteal cells predominate during the mid luteal phase. These data suggest that PGE2, but not PGF2 alpha, may be involved in the regulation of CL function in the menstrual cycle.

Direct inhibitory ovarian effects of prolactin in the process of ovulation

The present study was designed to determine the effects of prolactin (PRL) on the process of follicle rupture and oocyte maturation using an in vitro perfused rabbit ovary model. In the first experiment ovaries were perfused for 12 hours with or without PRL at 10(2) or 10(3) ng/ml. Ovulation did not occur in any ovaries in the absence of gonadotropin. The majority of follicular oocytes did not progress beyond the germinal vesicle stage following treatment with PRL. The percentage of follicular oocytes which showed evidence of degeneration was also comparable in both groups. The concentrations of progesterone in the perfusate did not differ significantly between PRL-treated and control ovaries. In the second experiment, ovaries were perfused with or without PRL at 10, 10(2), or 10(3) ng/ml. Thirty minutes later 50 IU of human chorionic gonadotropin (hCG) was added to the perfusate of all ovaries. The addition of PRL to the perfusate inhibited hCG-induced ovulation in a dose-related fashion. The degree of ovum maturity and degeneration was comparable in the two groups. PRL did not affect hCG-stimulated progesterone production by the perfused rabbit ovaries. The present study demonstrates that PRL acts directly on the ovary to influence the process of ovulation, resulting in the inhibition of hCG-induced follicle rupture. These data suggest that PRL inhibits ovulation by mechanism(s) independent of ovarian progesterone synthesis.

[Basal encephalocele--a report of two cases and consideration of its pathogenetic classification]

The authors have experienced two cases of basal encephalocele without intra and extra cranial anomalies. We have reviewed previous reported cases and studied, from the view point of developmental pathology, reasons why these cases did not have associated anomalies. In this paper we will report our two cases of basal encephalocele and propose a new classification for it, based upon the developmental pathology of the basal part of the skull and associated anomalies. Case 1. A 32 year old male complained of continuous rhinorrhea for 8 months. Coronal CT scan demonstrated a defect of the right sphenoid and ethmoid bone, and a protrusion of isodensity mass, which was enhanced by administration of metrizamide in the subarachnoid space. During the operation, the protruded mass was removed, and the defects of bone and dura mater were repaired. Postoperative course was uneventful. Case 2. A 33 year old male was referred from the department of otology to the department of neurosurgery, because of rhinorrhea and the presence of brain tissue at the time of nasal operation 3 months before. Coronal CT scan revealed a defect of the left ethmoid bone and a protrusion of isodensity mass in it. RI cisternography clearly demonstrated the leakage of CSF through the left nasal cavity. During the operation, the protruded mass was removed and the bone and dura mater defects were repaired. Postoperative course was uneventful. The common findings of both cases are that they were diagnosed by accident in adulthood cases of rhinorrhea, and midsagittal basal bone structure was preserved without extra and intra cranial anomalies.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of experimental salpingoplasty on fertility in the rabbit]

The present study was undertaken to determine the functional capacity of oviduct following distal ampullar salpingostomy and tubal anastomosis. In the first experiment using 6 rabbits, the left fimbria of an oviduct and adjoining ampulla were resected, and then the remaining distal ampulla was subjected to cuff salpingostomy. The contralateral oviduct of each rabbit served as a control. Ovulation was induced at 3 weeks after surgery. The mean number of corpora lutea per ovary in the salpingostomy oviduct (5.00 +/- 0.37) did not differ significantly from that observed in the control oviduct (5.17 +/- 0.31). Five of 6 salpingostomy oviducts contained ovulated ova. However, the retrieval rate was significantly (p less than 0.01) reduced in the salpingostomy oviducts (36.7%), as compared to that found in the control oviducts (93.5%). Scanning electron microscopy of the fimbria revealed morphological features of both ciliated and secretory cells that were comparable to those of the contralateral intact fimbria. The second experiment assessed pregnancy outcome following tubal anastomosis in 6 rabbits. Pregnancy was established in both oviducts of all rabbits. The rate of implantation did not differ significantly between anastomosis sides (75.0 +/- 8.9%) and contralateral controls (93.9 +/- 3.9%). The present data demonstrated that fimbriectomized rabbit oviduct can retrieve ovulated ova, albeit less efficiently than normally. However, information that the retrieval rate of ova after salpingostomy is lower than that found in anastomosis also suggests a significant role of fimbria in ovum retrieval.

[A study on transference of cefminox into intrapelvic tissues]

Intravenous administrations of cefminox (CMNX, MT-141) 1 g as both single shot injection and drip infusion were absorbed rapidly. CMNX showed good transference into intrapelvic organs such as uterus, oviduct and ovary, with the tissue/serum ratios of 37.6% for myometrium, 35.1% for endometrium, 41.4% for cervix uteri, 49.5% for portio vaginalis, 54.3% for ovary and 59.7% for oviduct. From these results, usefulness of CMNX in the field of obstetrics and gynecology was confirmed.

[Study on human pituitary gonadotropin synthesis and release in amenorrhea and anovulation by LH-RH two step test]

The pituitary gonadotropin response of synthesis and release to two step stimulation at a 60 minute interval with 100 micrograms of luteinizing hormone-releasing hormone (LH-RH) was studied by radioimmunoassay of hLH and hFSH in the normal menstrual cycle, amenorrhea and anovulation. The definition of delta 1 and delta 2 was as follows: delta 1 = 30 (or 60) min. value-0 min. value. delta 2 = 90 (or 120, 180) min. value-60 min. value. delta 1, delta 2 ratio = delta 2/delta 1. Serum mean levels of hLH in follicular and luteal phase increased after the first injection of LH-RH. The second injection of the hormone induced an increase to above the first peak, indicating the priming effect of the first LH-RH on the second peak. The first peak is presumed to be the pituitary gonadotropin release due to the first injection of LH-RH, and the second peak can be composed in part of hLH newly synthesized by the first LH-RH stimulation. The response of hLH in the ovulatory phase increased after the first administration, but showed no significant peak after the second. The LH-RH two step test in normoestrogenic and PCO type amenorrhea produced two peaks of the mean levels of hLH. In ovarian anovulation, an hLH value higher than the others was detected before the first LH-RH stimulation. The first injection caused an increase in serum hLH but after the second there is no significant peak. In contrast, serum hLH and hFSH values were lower than in the normal menstrual cycle.(ABSTRACT TRUNCATED AT 250 WORDS)