Effects of dexamethasone, progesterone, and testosterone on IOP and GAGs in the rabbit eye

The effects of steroids on intraocular pressure and on aqueous outflow pathway (AOP) and adjacent anterior segment tissue glycosaminoglycans (GAGs) were studied in New Zealand Red rabbits treated for 4 wk with dexamethasone, hydroxymethyl-progesterone and methyl-testosterone. Only topical administration of dexamethasone resulted in a significant increase in intraocular pressure. The eyes were labeled in vitro for 1 hr with GAG precursors, [3H]-glucosamine and [35S]-sulfate, and maintained as whole organ cultures. The GAGs were biochemically isolated, fractionated by gel filtration chromatography and subjected to selective GAG degradative procedures. The total content of hyaluronic acid and chondroitin sulfate was analyzed by high performance liquid chromatography. In dexamethasone-treated eyes, the total content of hyaluronic acid was decreased in the AOP, although the specific activity of [3H]-glucosamine did not change. The total content of chondroitin sulfate was increased in the AOP and iris-ciliary body, while the specific activity of the [35S]-label was decreased in the AOP, iris-ciliary body, and sclera. The changes in the AOP GAGs in dexamethasone-treated eyes may be important factors for the development of dexamethasone-induced ocular hypertension in the rabbit.

Microbiological and histological findings in the fallopian tubes of women using various contraceptive methods

The oviducts of seventy-three women undergoing sterilization by partial salpingectomy were submitted for microbiological and histologic studies. Twenty women were intrauterine device users, twenty-five women were oral contraceptive pill users and twenty-eight women used natural or barrier methods of contraception. Among intrauterine device users, there was an excess of mild and severe acute inflammatory histologic changes involving both the lumen and the tubal mucosa. Five of the eight intrauterine device users with acute inflammatory change had sterile tubal cultures.

The postcoital test as a predictor of pregnancy among 355 infertile couples

Late follicular phase postcoital tests in 355 infertile couples (selected to exclude severe defects in ovulation, seminal or tubal function) were scored for mucus characteristics and sperm motility. Cervical mucus characteristics were associated with postcoital sperm motility (P less than 0.001) but not with pregnancy. Postcoital sperm motility in cervical mucus was strongly associated with total motile sperm count per ejaculate (F = 5.38, P less than 0.001). Postcoital sperm motility was a weak predictor of pregnancy when more than five motile sperm were observed per high power microscopic field. When the log rank tests for postcoital sperm motility were repeated in groups with low (less than 10 million) and high (10 million or more) total motile sperm count per ejaculate, the association between postcoital sperm motility and pregnancy was not statistically significant. Regression analysis controlling for other potential predictors revealed no independent association between postcoital sperm motility and the later occurrence of pregnancy in this group of infertile couples.

Hypersensitivity reaction to doxorubicin

A 42-year-old woman with synovial sarcoma developed a skin flare during doxorubicin therapy. With a subsequent dose, erythema, urticaria, and asthma occurred, despite pretreatment with antihistamines. Skin flares occur in about three percent of patients receiving doxorubicin. Rarely, generalized urticaria, angioneurotic edema, or anaphylaxis occur. Local reactions may represent molecular extravasation through vessels, or histamine release from mast cells or basophils. Generalized reactions may involve alternative complement-activation pathways. Pretreatment with antihistamines or corticosteroids sometimes is helpful in preventing recurrences.

A proportional hazards analysis of the clinical characteristics of infertile couples

Evaluated were methods of ordering the many possible predictors of infertility outcome. The clinical characteristics of infertile couples were studied with respect to the occurrence of pregnancy during follow-up, by means of the methods of survival analysis. Among 1,297 couples who were infertile for 12 months or more, the cumulative pregnancy rate at 36 months with 95% confidence limits was 49% +/- 4%. The proportional hazards analysis identified three independent predictors of the occurrence of pregnancy from the couple's history (with P values in brackets): a history of pregnancy in the partnership (0.0001); shorter duration of infertility (0.0001); and shorter length of marriage (0.005). The predictors arising from the diagnostic process (with P values in brackets) were: fewer infertility diagnoses (0.0001); a favorable primary clinical diagnosis (0.001); and the presence of any tubal disease, regardless of the primary clinical diagnosis (0.001). The analysis selected an economical set of significant predictor variables and demonstrated that a longer period of contraception was associated with a lower pregnancy rate among infertile couples. Also, three simple questions from the history were nearly equivalent to the entire diagnostic process as predictors of the outcome.

Clinical factors affecting pregnancy rates among infertile couples

In a follow-up study of 1297 couples registered at a Nova Scotia infertility clinic with a complaint of infertility of at least 12 months' duration, the cumulative pregnancy rate at 36 months, with 95% confidence limits, was found to be 49 +/- 4%. The predictors of pregnancy by univariate analysis were a favourable primary clinical diagnosis (p less than 0.001), a duration of infertility of less than 3 years (p less than 0.001), a single diagnosis for the infertility (p less than 0.001), a previous pregnancy in the partnership (p = 0.001) and a length of marriage of less than 4 years (p = 0.002). Proportional hazards analysis confirmed these variables as predictors of pregnancy. The highest cumulative pregnancy rates after 12 and 36 months of follow-up were observed in cases of ovulation deficiency, and the lowest were seen in cases of tubal defects. However, before the process of diagnosing infertility begins, useful prognostic information can be determined from the length of marriage, the duration of infertility and the partnership's history of previous pregnancy.

Aqueous outflow pathway complex carbohydrate synthesis in vitro

A technique is described for examining the in vitro synthesis of glycosaminoglycans and glycoproteins in the aqueous outflow pathway (AOP). New Zealand red rabbit eyes were maintained at near-physiologic conditions and were infused by anterior chamber exchange with 30 muCi [3H] glucosamine and 100 muCi [35S] sulfate. At 0.5, 1.0, and 2.0 hours, the anterior segment tissues were dissected, isolated, and fractionated by gel filtration chromatography on Sephadex G-50 columns. The elution profiles demonstrated an increase of labeled material with time in the glycosaminoglycan (GAG) fractions and in the glycopeptide fractions. The relative rate of synthesis of labeled material was: central cornea greater than peripheral cornea greater than iris-ciliary body greater than AOP greater than anterior sclera. In order to characterize the profiles of each tissue, the isolated material was analyzed for hexosamine, hexuronic acid, and sulfate. The AOP cells synthesized a heterogenous mixture of GAGs and glycoproteins which biochemically appeared to be distinct from other anterior segment tissues. In addition, the percent distribution of GAG polymers in each tissue was determined by selective GAG degradative procedures and by gel filtration chromatography. The AOP cells synthesized four types of GAGs, and the percent distribution of the labeled GAGs was different from the other tissues. The present results suggest that this technique may provide a well-controlled method to probe the metabolic activity of complex carbohydrates in the AOP and in the anterior segment.

Treatment-independent pregnancy among infertile couples

We analyzed a two- to seven-year follow-up of 1145 infertile couples to determine the frequency of pregnancy occurring independently of treatment. Pregnancy occurred in 246 of 597 treated couples (41 per cent) and in 191 of 548 untreated couples (35 per cent). Thirty-one per cent of the pregnancies in treated couples occurred more than 3 months after the last medical treatment or more than 12 months after adnexal surgery. These pregnancies plus the 191 pregnancies in untreated couples constituted the category of "treatment-independent pregnancies" and accounted for 61 per cent of all pregnancies; for 44 per cent of those among couples with ovulation deficiency; for 61 per cent of those in couples with endometriosis, tubal defects, or seminal deficiencies; and for 96 per cent of those in couples with cervical factors or idiopathic infertility. We conclude that the potential for a spontaneous cure of infertility is high, that treatment for many classes of infertility should be evaluated by randomized clinical trials, and that in such trials random assignment of subjects to untreated control groups would be ethically acceptable.

Spontaneous hepatic hemorrhage during pregnancy

Spontaneous rupture of the liver during pregnancy seems to represent an extreme vascular complication of toxemia. The very high mortality rate has generally been attributable to uncontrolled hemorrhage. However, control of the hemorrhage may not be sufficient to achieve recovery. Hepatic dysfunction may proceed to necrosis associated with multiple organ failure, even after successful hemostasis. Although ligation of the hepatic artery has been successful in controlling hemorrhage in hepatic trauma, this maneuver may contribute to injury in patients with this lesion in whom there is a preexisting hepatic abnormality. In this brief review, the relationship of the underlying pathology to a variety of therapeutic measures in the context of a catastrophic complication of pregnancy are discussed.

Age-related changes in the cerebrospinal fluid outflow glycosaminoglycans

The glycosaminoglycan distribution patterns of the cerebrospinal fluid (CSF) outflow pathway, dura mater and cerebral cortex of young New Zealand red rabbits and 1-, 3- and 12-week-old C-57 mice were identified by analyses of the glycosaminoglycan moieties and by the use of zone electrophoresis. The glycosaminoglycans were identified by specific degradation procedures, i.e., hyaluronate lyase, chondroitin ABC lyase, endo-beta-D-galactosidase and nitrous acid treatment. The CSF outflow pathway and dura mater glycosaminoglycan components were primarily hyaluronic acid and chondroitin sulfate-dermatan sulfate, whereas the cerebral cortex glycosaminoglycan components were hyaluronic acid, chondroitin sulfate-dermatan sulfate, keratan sulfate and heparan sulfate. The glycosaminoglycan components of the dura mater and cerebral cortex decreased and those of the CSF outflow pathway increased as a function of age. These results demonstrate the feasibility of analyses of the CSF outflow pathway glycosaminoglycan components and suggest that topographical changes in the glycosaminoglycan distribution profiles may contribute to the pattern of cerebrospinal fluid outflow.

Use of plasma volume substitutes and plasma in developing countries

Plasma and plasma substitutes are used in the treatment of various conditions such as haemorrhage and shock. This article examines the role of crystalloids, artificial colloids, human plasma, human albumin, and plasma protein fraction, in the treatment of such patients, with particular reference to peripheral health facilities in developing countries.It is concluded that 0.9% saline, together with 5-6% dextrose, is of particular importance in this situation since it is easy to produce locally, is stable at high temperatures, and has a low cost/benefit ratio. The second priority is to ensure the availability of a limited quantity of one or more colloid plasma substitutes. In the field of plasma, fresh frozen or fresh liquid plasma is most useful for the treatment of various haemostatic derangements and follow-up treatment of severe burns, since it contains the widest spectrum of therapeutically useful components and can be produced locally with an acceptable degree of difficulty.The treatment of severe diarrhoea with special alkaline electrolyte solutions and oral rehydration solutions is also outlined.

A comparison of estrogen use by women with endometrial cancer, gynecologic disorders, and other illnesses

Exogenous estrogen use was determined by interview in 206 endometrial cancer patients, 191 women with nonmalignant gynecologic disorders, and 199 women with other illnesses. Separate comparisons of these patients with gynecologic and other illness control subjects provided estimates of the risk of endometrial cancer among estrogen users, adjusted for the effects of confounding variables, of 1.5 (95% confidence limits 0.9 and 2.7) and 4.8 (2.7 and 8.4), respectively. In both comparisons, risk increased with increasing duration of use; regardless of duration of use, risks were higher among users of estrogen within 12 months of diagnosis than among past users. The effects of bias, including surveillance bias, on the results were considered and it was concluded that the true risk was not less than the case/gynecologic control estimate and was likely to approach the case/other control estimate.

FSH and testosterone effects in seminiferous tubules of immature hypophysectomized rats

The effects of follicle-stimulating hormone (FSH) and testosterone on the development of the cytosolic germ cell adenylate cyclase and germ cell morphology in rats hypophysectomized at 29 days of age were studied. Following hypophysectomy, the adenylate cyclase content fell to marginal levels and germ cell development ceased at the late pachytene stage. Testosterone treatment led to a moderate increase in the cytosolic enzyme content and to progression of spermatid cell development to stages 8-12. FSH treatment with doses of 80-100 micrograms/day restored enzyme content to levels seen in control rats, as well as progression of germ cell development up to stages 15-16, i.e., to the same stages present in age-matched control (sham-operated) rats. The results indicate that in immature rats FSH is essential for spermatid cell maturation as is evidenced by its ability to stimulate the formation of cytosolic germ cell adenylate cyclase to quantitatively normal levels, as well as to stimulate the development of spermatid cells.

Epinephrine plasma thresholds for lipolytic effects in man: measurements of fatty acid transport with [l-13C]palmitic acid

To determine the plasma epinephrine thresholds for its lipolytic effect, 60-min epinephrine infusions at nominal rates of 0.1, 0.5, 1.0, 2.5, and 5.0 micrograms/min were performed in each of four normal young adult men while they also received a simultaneous infusion of [1-13C]palmitic acid to estimate inflow transport of plasma free fatty acids. These 20 infusions resulted in steady-state plasma epinephrine concentrations ranging from 12 to 870 pg/ml. Plasma epinephrine thresholds for changes in blood glucose, lactate, and beta-hydroxybutyrate were in the 150--200-pg/ml range reported by us previously (Clutter, W. E., D. M. Bier, S. D. Shah, and P. E. Cryer. 1980. J. Clin. Invest. 66: 94--101.). Increments in plasma glycerol and free fatty acids and in the inflow and outflow transport of palmitate, however, occurred at lower plasma epinephrine thresholds in the range of 75 to 125 pg/ml. Palmitate clearance was unaffected at any steady-state epinephrine level produced. These data indicate that (a) the lipolytic effects of epinephrine occur at plasma levels approximately threefold basal values and (b) lipolysis is more sensitive than glycogenolysis to increments in plasma epinephrine.