Evaluation of cycle-to-cycle variation of endometrial responsiveness using transvaginal sonography in women undergoing assisted reproduction

OBJECTIVES

To investigate the variation of endometrial responsiveness between cycles within the same women undergoing assisted reproduction.

METHODS

The sonographic endometrial thickness in ovarian stimulation cycles was compared with that of subsequent natural cycles. One hundred and thirty-six ovarian stimulation cycles of in-vitro fertilization and embryo transfer were evaluated. Women who did not conceive in in-vitro fertilization cycles were subsequently seen in natural cycles (n = 97) or the next in-vitro fertilization cycle (n = 39). Based on a receiver-operating characteristics (ROC) curve using endometrial thickness to predict pregnancy, the first in-vitro fertilization cycles were classified according to the endometrial thickness as optimal (> 8 mm) in 98 cycles, or suboptimal (< or = 8 mm) in 29 cycles. Similarly, spontaneous cycles were classified as suboptimal (< or = 7 mm) in 28 cycles and optimal (> 7 mm) in 69 cycles.

RESULTS

The pregnancy rates were significantly lower (P < 0.05; Fisher's Exact test) in the suboptimal group in both the in-vitro fertilization and frozen embryo transfer cycles. There was a strong correlation (r2 = 0.745) and a significant difference (P < 0.001; Wilcoxon signed rank sum test) between the endometrial thickness of stimulation and natural cycles.

CONCLUSION

It is possible to predict the occurrence of optimal or suboptimal endometrial response in natural cycles of women, after evaluation in stimulated cycles, with a high degree of reliability. Risk of implantation failure can be identified before subsequent treatment cycles and adjuvant therapeutic strategies may be planned to improve the endometrial response before embryo transfer.

A comparison of the prevalence of domestic violence between patients seeking termination of pregnancy and other general gynecology patients

OBJECTIVES

(1) To determine and compare the prevalence of domestic violence among abortion-seeking patients with other general gynecology patients; (2) to see if a follow-up interview 6 weeks after abortion can improve the abuse disclosure rate; (3) to see if the abused victims accept direct referral to their gynecologists/social workers for help.

METHODS

This is a prospective questionnaire survey in a university teaching hospital on patients seeking abortion and an approximately equal number of other general gynecology patients. Participants were interviewed by a designated project nurse in a private setting, using a structured questionnaire (Modified Abuse Assessment Screen Questionnaire) to assess the past and recent history of abuse. The interview was repeated 6 weeks after the abortion for the abortion-seeking group.

RESULTS

Five hundred and one participants were interviewed, including 245 seeking abortion (TOP group) and 256 other general gynecology patients (non-TOP group). The lifetime prevalence of abuse in the TOP group (27.3%) was significantly higher than the non-TOP group (8.2%) (P<0.001). Repeating the interview 6 weeks after the abortion did not increase the disclosure rate. Most abused victims were unwilling to disclose their information of abuse to their gynecologists or social workers at the time of interview.

CONCLUSIONS

Domestic violence is a significant problem among the gynecology patients, particularly those seeking abortion. A single interview prior to abortion is adequately effective for screening. However, the most effective and acceptable way of helping these victims needs to be explored further.

Comparative study of the biological activity of spermatozoa-zona pellucida binding inhibitory factors from human follicular fluid on various sperm function parameters

Previous studies showed that human follicular fluid (hFF) from gonadotrophin stimulated cycles contained two glycoproteins, named as ZIF-1 and ZIF-2, that reduced the zona binding capacity of spermatozoa. The present study showed that the spermatozoa-zona pellucida binding inhibitory activity was also present in hFF from natural cycle. Using the hemizona binding assay, the inhibitory effect of ZIF-1 on the zona binding capacity of spermatozoa was dose-dependent. The effect of ZIF-2 was also dose-dependent, in the range of 10-100 ng/ml. The inhibitory effects of both ZIF-1 and -2 increased with the duration of the spermatozoa-ZIF interaction. The effect of the former was present up to 120 min incubation, whilst that of latter occurred for the first 90 min. The zona binding inhibitory effect of ZIF-1 and -2 was additive when they were used together to treat the spermatozoa. The biological activity of ZIFs on other sperm parameters that might affect spermatozoa-zona pellucida binding was also investigated. ZIF-1 did not affect the acrosomal status of human spermatozoa while ZIF-2 significantly increased the number of acrosome reacted spermatozoa in the range of 0.1-10 microg. However, the increase in the incidence of acrosome-reacted spermatozoa after ZIF-2 treatment could not totally account the inhibitory effect of ZIF-2 on zona binding. Both glycoproteins did not affect the motility of human spermatozoa. Radioactively-labelled ZIFs bound to human spermatozoa. Unlabelled ZIF displaced the bound radioactivity of spermatozoa treated with the corresponding labelled ZIF. These suggested the presence of specific binding sites of ZIFs on human spermatozoa.

Transfer of two embryos instead of three will not compromise pregnancy rate but will reduce multiple pregnancy rate in an assisted reproduction unit

OBJECTIVE

To compare the pregnancy rates and multiple pregnancy rates of cycles initiated in 1998 and in 1999, during which 3 and 2 embryos were advised to be replaced, respectively.

STUDY DESIGN

A retrospective study

RESULTS

There were no differences between 1998 and 1999 in the pregnancy rate per cycle started or per transfer, implantation rate and the multiple pregnancy rates, despite a significantly lower number of embryos replaced in 1999. A significantly higher implantation rate was found in cycles with frozen embryos than those without. Using logistic regression analysis, the chance of pregnancy was significantly improved only by the presence of frozen embryos in the fresh cycles with an odds ratio of 2.0 (95% confidence interval: 1.3-3.0) whereas the chance of multiple pregnancy was significantly increased by replacing 3 embryos instead of 2 (odds ratio: 2.1, 95% confidence interval: 1.1-4.2).

CONCLUSION

Patients should be advised to have 2 embryos replaced without jeopardizing the pregnancy rates in the fresh cycles. The risk of multiple pregnancy is significantly increased when 3 embryos are transferred instead of 2.

Pharmacokinetic study of all-trans-retinoyl-beta-D-glucuronide in Sprague-Dawley rats after single and multiple intravenous administration(s)

All-trans-retinoyl-beta-D-glucuronide (RAG) is an endogenous active metabolite of all-trans-retinoic acid (ATRA). In the present study, the pharmacokinetics of RAG was examined after the administration of a single intravenous does (5, 10, or 15 micromol/kg) and of multiple daily intravenous doses (5 micromol/kg) to rats for 8 days. The plasma concentrations of RAG and ATRA were measured by a reverse-phase HPLC method. A rapid distribution phase of approximately 1 h was observed in all of the rats after single or multiple doses. Thereafter, RAG was eliminated through a first-order process, in accord with a typical two-compartment first order pharmacokinetic profile. After single intravenous doses, the AUC of RAG increased proportionally with the dose and the clearance remained unchanged within the tested doses. There was no statistical significant difference in distribution rate constants from central compartment to peripheral compartment (K(12)) and from peripheral compartment to central compartment (K(21)) between different doses. However, as the dose increased from 5 micromol/kg to 10 micromol/kg, the volume of distribution at the steady state (V(ss)) and the volume of peripheral compartment (V(p)) decreased significantly (p < 0.05) from 1.290 +/- 0.269, 0.928 +/- 0.232. L/kg to 0.961 +/- 0.149, 0.647 +/- 0.107 L/kg, respectively. V(ss) and V(p) at a dose of 15 micromol/kg (0.924 +/- 0.187, 0.698 +/- 0.165 L/kg) were not significantly different from that at 10 micromol/kg. Thus, RAG might saturate the tissue-binding sites at higher doses. ATRA was detected as a metabolite of RAG at low levels (usually < 0.05 microM) only in the first 2 h after intravenous administration. RAG clearly was not extensively hydrolyzed to ATRA in our study. After multiple daily intravenous administration of RAG, the clearance (Cl) and the elimination rate constant (K(10)) remained unchanged (p > 0.05), indicating that long-term daily administration of RAG did not induce its accelerated metabolism. However, K(12), V(p), and V(ss) declined significantly (p < 0.05) from 1.67 +/- 0.54 h(-1), 0.928 +/- 0.232 L/kg, and 1.290 +/- 0.269 L/kg to 0.96 +/- 0.48 h(-1), 0.494 +/- 0.147 L/kg, and 0.818 +/- 0.187 L/kg, respectively. Therefore, long-term daily dosing of RAG seemed to decrease its distribution profile. Although the AUC of RAG did not change significantly after multiple dosing, the AUC of ATRA after RAG dosing significantly declined (p < 0.05) from 0.032 +/- 0.019 microM x h to 0.010 +/- 0.006 microM x h. The decline in the AUC of ATRA might reflect an increase in its uptake by tissue and/or in its metabolism. Because enhanced clearance is not associated with RAG after multiple administrations, RAG could be considered as an alternate to ATRA in appropriate clinical applications.

Temporal effect of human oviductal cell and its derived embryotrophic factors on mouse embryo development

Mouse embryos at different stages of development were cocultured with human oviduct cells or cultured in the presence of oviduct-derived embryotrophic factor-1, -2, and -3 (ETF-1, -2, and -3) for various amounts of time within the preimplantation period. Cocultures that included the period from 48 to 72 h post-hCG stimulated cell division and increased the cell numbers in the inner cell mass (ICM) of the exposed blastocyst. Exposure of embryos to oviductal cells from 96 to 120 h post-hCG increased the cell number in the trophectoderm (TE), blastocyst size, hatching rate, attachment, and in vitro spreading of the blastocyst. ETF-1 and ETF-2 affected embryos between 48 and 72 h post-hCG by increasing the number of cells in the ICM. In contrast, ETF-3 had a more profound effect on embryos that were exposed from 96 to 120 h post-hCG, where it mostly affected the development of TE cells, leading to higher hatching rate. Human oviductal cells improved mouse embryo development partly by the production of high molecular weight embryotrophic factors. These factors had differential effects on mouse embryo development.

Ultrasound-guided embryo transfer: a prospective randomized controlled trial

BACKGROUND

Recent reports suggested that ultrasound guidance during embryo transfer might improve the pregnancy rate.

METHODS

A prospective randomized controlled trial was performed to compare embryo transfer under ultrasound guidance versus the clinical touch method. A total of 800 embryo transfers was studied; 400 were randomized to ultrasound-guided transfers and 400 were randomized to the clinical touch group. Of these, 441 were fresh cycles and 359 were frozen-thawed cycles.

RESULTS

The clinical pregnancy rate was 26.0% in the ultrasound-guided group and 22.5% in the clinical touch group; the difference was not statistically significant. The ongoing pregnancy rate was 23.5% in the ultrasound-guided group compared with 19.0% in the clinical touch group and the difference was again not statistically significant. The implantation rate was slightly higher in the ultrasound-guided group (15.3%) than the clinical touch group (12.0%) (P = 0.048). There were no differences in the incidences of ectopic pregnancy, miscarriage and multiple pregnancy between the two groups.

CONCLUSIONS

A significant improvement in implantation rate was observed following the use of ultrasound guidance during embryo transfer. The extent of improvement in the pregnancy rate may depend on the specific techniques and methods of embryo transfer used in individual centres.

Effect of cetrimide and ascorbic acid on in vitro human skin permeation of haloperidol

Permeation of haloperidol through the human skin in vitro was studied with two enhancers, cetrimide and ascorbic acid, at various concentrations. Amber glass Franz-type diffusion cells were used for the permeation studies and haloperidol was made soluble in aqueous solution with the aid of lactic acid. Donor solutions were prepared by adding excess of haloperidol to 0.03% (v/v) lactic acid solution with or without enhancers at concentrations 0.1, 0.3 and 0.6% (w/v) and stirred for 36 h at 32 degrees C before filtering. Ascorbic acid gradually increased the solubility of the haloperidol from that of the control where as cetrimide did not show any effect. Cetrimide concentration dependent increase in the permeability coefficient of haloperidol was observed. Mechanism of enhancement by cetrimide was probed with the diffusion profile kinetics and Fourier transform infrared (FT-IR) spectroscopy. Cetrimide was found to increase the thermodynamic activity of the drug in the skin. IR spectra of the stratum corneum treated with cetrimide showed time-dependent decrease in the intensity of the spectrum and dose-dependent decrease of lipid band but no change in the protein conformation. Cetrimide appears to interact with both the dermal keratin and lipids and this interaction was found to be irreversible. Ascorbic acid although increased the flux of haloperidol to the same extent at all concentrations from that of the control, decreased the permeability coefficient and enhancer index in a concentration dependent manner and this is due to the increased solubility of the drug in the vehicle. Both the enhancers did not change the lag time from that of the control.

Pilot study on the use of sublingual misoprostol for medical abortion

A new route of sublingual administration of misoprostol was used by 25 women with first trimester, non-viable intrauterine gestation and by 18 women requesting mid-trimester termination of pregnancy. Twenty-three women (92%, 95% CI 75, 98) with first trimester, non-viable gestation had complete abortion after sublingual misoprostol. All women (100%, 95% CI 82, 100) requesting second trimester abortion aborted, and the median induction-to-abortion interval was 11.6 h. Our preliminary results on sublingual misoprostol show that it is a promising method for medical abortion. Prospective randomized studies are required to compare its efficacy and side effects with vaginal misoprostol and to work out the dosage and dosing interval.

Colour Doppler analysis of peri-implantation utero-ovarian haemodynamics in women with excessively high oestradiol concentrations after ovarian stimulation

BACKGROUND

Gonadotrophins are used in many assisted reproduction units to achieve a better success rate by increasing the number of replaced embryos. However, high oestradiol concentrations are associated with altered physiological functions and its complications. We investigated whether high oestradiol concentrations (> or =20 000 pmol/l) after ovarian stimulation in infertile women would affect the uterine haemodynamics at the time of embryo transfer.

METHODS

Colour Doppler indices of utero-ovarian arteries and endometrial colour signals were measured. Fifty-eight women undergoing ovarian stimulation for IVF were classified according to serum oestradiol concentrations on the day of human chorionic gonadotrophin injection into moderate responders (oestradiol <20 000 pmol/l; n = 39) and high responders (oestradiol > or =20 000 pmol/l; n = 19).

RESULTS

Haemodynamic parameters were significantly lower in high responders; the uterine arterial pulsatility index (PI) and resistance index (RI) were (median; range) 1.87 (0.84-2.82) and 0.79 (0.57-0.90) respectively; ovarian artery PI was 0.57 (0.40-1.12) and RI was 0.43 (0.33-0.64). In moderate responders the uterine PI and RI were 2.63 (1.46-5.92) and 0.88 (0.77-1.10) respectively. Ovarian PI was 0.81 (0.32-3.72) and RI was 0.55 (0.23-0.97). The number of women showing endometrial colour signals was significantly lower in high responders (63%) than in moderate responders (92%) (P < 0.05). A further increase in oestradiol (> or =25 000 pmol/l; n = 8) showed significantly (P = 0.03) fewer endometrial colour signals [1.5 (0-8)] compared with moderate responders [4 (0-14)].

CONCLUSION

Despite low uterine PI and RI, the endometrial blood flow in high responders appears to be impaired. This may contribute to the decline in implantation efficiency noted in high responders.

Use of gonadotrophin releasing hormone (GnRH) antagonist (cetrotide) during ovarian stimulation for in-vitro fertilization treatment: multiple doses and single dose

OBJECTIVES

To report preliminary experience in using the GnRH antagonist (Cetrotide) and to compare the multiple dose and single dose protocols.

METHODS

Fifteen patients received multiple doses and another 10 patients received the single dose protocol of GnRH antagonist during ovarian stimulation for IVF treatment. Outcome measures included the duration/dosage of gonadotrophin and number of oocytes aspirated.

RESULTS

All patients had successful oocyte retrieval after the hCG injection. The single dose group had a significantly shorter duration of gonadotrophin but fewer frozen embryos than the multiple dose group.

CONCLUSIONS

Both protocols were effective in preventing premature LH surges. The stimulation regimen was simplified by reducing the total treatment period, the dosage and duration of gonadotrophin. There may be differences in ovarian responses between the two protocols.

Vero cells, but not oviductal cells, increase the hatching frequency and total cell count of mouse blastocysts partly by changing energy substrate concentrations in culture medium

PURPOSE

To investigate the embryotrophic mechanisms of Vero and oviductal cells coculture.

METHODS

Mouse embryos were cultured in Chatot, Ziomek, and Bavister medium (CZB), in modified CZB media (MM) with nutrient concentrations adjusted to that found in conditioned media after different periods of Vero cells or oviductal cells culture, in reconstituted medium (RM) containing the purified > 100-kDa components of Vero cell conditioned medium that had been reconstituted with CZB medium, and cocultured with Vero cells with an interposing membrane.

RESULTS

The blastulation rate was not different among embryos cultured in different Vero-cell-derived MMs. Nine-hour Vero-cell-derived MM significantly increased the total cell number and hatching frequency of the embryos. There was no difference in these parameters with oviductal-cell-derived MMs. The RM of Vero cells did not possess embryotrophic activity. The presence of a porous membrane between Vero cells and embryos did not affect the embryotrophic activity of coculture.

CONCLUSIONS

Vero cells, but not oviductal cells, improved mouse embryo development partly by modifying the energy substrate concentration in culture medium.

Heat-capacity studies of (3)He in (3)He-(4)He mixture films and the coverage dependence of the two-dimensional (3)He Landau Fermi-liquid parameters

The heat capacity of (3)He in (3)He-(4)He mixture films on a nuclepore substrate is reported over the temperature range 90<T<124 mK, for (3)He coverages between 0.05 and 1.4 bulk-density atomic layers, and a (4)He film thickness of 4.33 bulk-density atomic layers. A step structure appears in the specific heat as a function of (3)He coverage. Combining NMR and specific heat data for (3)He atoms on the same substrate and for the same (4)He coverage allows the two-dimensional Landau Fermi-liquid parameters F(A)(0) and F(S)(1) to be extracted as a function of (3)He coverage. We conclude that in the submonalayer (3)He coverage regime p-state pairing is favored.

Mifepristone: a potential postcoital contraceptive

Mifepristone is an orally-active progesterone receptor antagonist. When a single dose of mifepristone is given in the mid- or late follicular phase, it may diminish or inhibit the luteinising hormone (LH) surge. In the early luteal phase, a single dose of mifepristone induces significant changes in the endometrium without affecting the hormonal levels or menstruation. When it is given in the mid-luteal phase, there will also be significant changes in the endometrium and some women may have two episodes of vaginal bleeding. A clinical trial suggests that a single dose of mifepristone in the early luteal phase may be an effective contraceptive agent but the lack of a cheap and easy method to identify the LH surge limits its clinical application. The administration of mifepristone alone or in combination with a prostaglandin does not appear to be an effective form of contraception. When used together with a prostaglandin, it may be an effective method for menstrual regulation but the cost and possible side effects of the prostaglandins limit its use. Mifepristone is a very effective method for emergency contraception. The incidence of side effects was also lower than that of the Yuzpe regimen. Lowering the dose of mifepristone from 600 to 10 mg does not decrease its efficacy but the incidence of delay in onset of the subsequent menses is reduced. Despite its efficacy, the reputation of mifepristone as an abortion pill may limit its access in many countries.

Inhibition of human CYP3A4 activity by grapefruit flavonoids, furanocoumarins and related compounds

PURPOSE

To evaluate the inhibition of CYP3A4 activity in human liver microsomes by flavonoids, furanocoumarins and related compounds and investigate possibly more important and potential inhibitors of CYP3A4 in grapefruit juice.

METHODS

The effects of various flavonoids and furanocoumarin derivatives on CYP3A4 activity in two human liver microsomal samples was determined using quinine as a substrate. All flavonoids and furanocoumarin derivatives were dissolved in DMSO. In all cases, inhibition activities were compared with activities in control incubations containing 0.2% (v/v) DMSO.

RESULTS

The results showed that the inhibition of quinine 3-hydroxylation (CYP3A4 activity) by bergapten (67%), and quercetin (55%) was greater than naringenin (39%) and naringin (6%), at the same inhibitor concentration of 100 M. The results also demonstrated that the furan ring in the furanocoumarins enhanced the inhibitory effect on CYP3A4 activity. Flavonoids with more phenolic hydroxyl (-OH) groups produced stronger inhibition than those with less hydroxyl groups. Of all the chemicals studied, bergapten (5-methoxypsoralen) with the lowest IC50 value (19-36 microM) was the most potent CYP3A4 inhibitor.

CONCLUSIONS

These results suggest that more than one component present in grapefruit juice may contribute to the inhibitory effect on CYP3A4. Bergapten appears to be a potent inhibitor of CYP3A4, and may therefore be primarily responsible for the effect of grapefruit juice on CYP3A4 activity.

Effects of metformin on ovulation rate, hormonal and metabolic profiles in women with clomiphene-resistant polycystic ovaries: a randomized, double-blinded placebo-controlled trial

BACKGROUND

Metformin, an insulin-sensitizing agent, has been used successfully as the first-line drug to induce ovulation in women with polycystic ovary syndrome. There are, however, very few studies evaluating metformin treatment in women with clomiphene citrate (CC)-resistant polycystic ovaries (PCO).

METHODS

Twenty infertile Chinese women aged <40 years, who had ultrasound features of PCO and remained anovulatory on CC, were randomized by computer using the sealed envelope method to receive placebo or metformin 500 mg three times a day for 3 months. Hormonal and metabolic profiles were determined before the therapy and were repeated after 3 months for women who failed to become pregnant within this period. Clomiphene was then added for one cycle to those women who did not ovulate after taking placebo or metformin alone.

RESULTS

The median ovulation rate in the placebo group was 0% (range: 0--50%) after placebo only and 6.9% (range: 0--50%) after placebo and CC, whereas the corresponding rates in the metformin group were 0% (range: 0--22%) and 0% (range: 0--22%) respectively. There was no improvement in the ovulation rate despite a significant reduction of body mass index, serum testosterone and fasting leptin concentrations in the metformin group.

CONCLUSIONS

Metformin treatment may result in successful ovulation only in certain subgroups of these women.

The use of misoprostol prior to hysteroscopy in postmenopausal women

BACKGROUND

This study examined whether oral misoprostol exerted a cervical priming effect in postmenopausal women prior to hysteroscopy.

METHOD

Thirty-seven patients were randomized to receive either oral misoprostol (400 microg) or placebo (vitamin B(6)) 12 h prior to hysteroscopy. The resistance of the cervix to dilatation was objectively assessed by a cervical tonometer.

RESULTS

The mean baseline cervical dilatation (4.2 mm in misoprostol group versus 4.4 mm in placebo group) was similar between the two groups. The mean cumulative force measured (27.7 N in misoprostol group versus 21.8 N in placebo group) was also comparable. None of the patients suffered from any significant side-effects.

CONCLUSIONS

These data showed that there were no significant benefits from giving misoprostol pre-operatively in postmenopausal women, and it was concluded that oral misoprostol had no significant cervical priming effect in postmenopausal women.

Uncommon hand tumours

This paper presented clinical examples of some rare or uncommon presentations of tumours of the hand, including glomus tumour, intraosseous dermoid, fibrolipoma of the radial nerve, blastomycotic cyst and synovial sarcoma. Each lesion is illustrated by review of case histories, radiological and pathological features.

Current treatment of ganglion of the wrist

Ganglion of the wrist is one of the the most common lesions of the hand. The cause of pain in an occult dorsal wrist ganglion has been linked to compression of the posterior interosseous nerve at the wrist. A case is presented in this paper and the pathoanatomy discussed. Ultrasound-guided aspiration after hyaluronidase instillation provided a useful alternative to surgery with a high success rate. Arthroscopic decompression for dorsal and palmar wrist ganglia offered the patient the benefit of smaller surgical scars and a high success rate. A description of the surgical techniques, pathoanatomy, and early results of the authors and a review of the literature is presented.

Vaginal misoprostol as medical treatment for first trimester spontaneous miscarriage

BACKGROUND

Misoprostol is effective for cervical priming prior to suction evacuation in first trimester pregnancy termination. This is the first randomized study to compare vaginal misoprostol versus expectant treatment in women presenting with spontaneous miscarriage.

METHODS

Sixty women presenting with spontaneous miscarriage were recruited to the study at the Queen Mary Hospital between 1998 and 1999. They were randomized to group 1: misoprostol; and group 2: expectant management. Women in the misoprostol group received vaginal misoprostol 400 microg on days 1, 3 and 5. The expectant group was followed up according to the same schedule. Suction evacuation was performed if there was excessive bleeding or abdominal pain; or if a gestational sac was detected by transvaginal scan on day 15.

RESULTS

Fifty-nine women completed the trial. Those who did not require suction evacuation up to the time of return of normal menstruation were considered to be successful. The incidence of side-effects was comparable between the two groups. Three women in the expectant group and one in the misoprostol group underwent emergency suction evacuation because of excessive bleeding. The mean duration of vaginal bleeding was similar for both groups (14.6 days in the misoprostol group versus 15.0 days in the expectant group). The successful rate in the misoprostol group was significantly higher than that of the expectant group (83.3 versus 48.3%, P < 0.05).

CONCLUSION

We recommend repeated vaginal misoprostol 400 microg given on days 1, 3 and 5 as a treatment option for women with first trimester spontaneous miscarriage.

Local vs systemic corticosteroids in the treatment of carpal tunnel syndrome

The authors compared the effectiveness of low-dose, short-term oral prednisolone vs local methylprednisolone injection in a prospective, double-blinded, parallel treatment study of carpal tunnel syndrome (CTS). A single injection of 15 mg methylprednisolone resulted in significant improvement in global symptom scores over a 12-week period. This study demonstrated the superiority of local steroid injection to oral steroid in the treatment of CTS.

A comparative study of raw and prepared semen samples from two consecutive days

OBJECTIVE

To study and compare raw and prepared semen samples from two consecutive days by conventional sperm parameters, various motility characteristics of spermatozoa determined by computer-aided sperm analysis and calcium ionophore-induced acrosome reaction.

STUDY DESIGN

Semen samples of male partners in couples undergoing 81 cycles of double intrauterine insemination were studied. The first sample was produced after abstinence of 2-7 days and the second, 24 hours after the first. Both samples were processed by isolate sperm separation medium.

RESULTS

Semen volume, sperm concentration and total motile spermatozoa were significantly reduced in day 2 raw and prepared samples, whereas normal morphology, motility characteristics and percentage of acrosome-reacted spermatozoa increased significantly in day 2 inseminated samples as compared to day 1. Oligospermic, asthenospermic and teratozoospermic samples showed a significant improvement in concentration, various motility characteristics and normal morphology of spermatozoa in day 2 samples as compared to day 1.

CONCLUSION

Men with normal samples showed improvements in normal morphology and acrosome-reacted spermatozoa, whereas those with subnormal semen samples from day 1 showed a significant improvement in concentration, various spermatozoal velocities and normal morphology on day 2.

Arsenic compounds induce cytotoxicity and apoptosis in cisplatin-sensitive and -resistant gynecological cancer cell lines

PURPOSE

Arsenic compounds have been found to be effective in the treatment of acute promyelocytic leukemia through the downregulation of bcl-2 expression. Resistant ovarian cancer cells often overexpress bcl-2 or p53 proteins or both. We hypothesized that arsenic compounds, such as As2O3 and As2S3, could also be active against gynecological cancers resistant to conventional chemotherapy.

METHODS

We investigated the effects of these two arsenic compounds in vitro on ovarian cancer cell lines sensitive (OVCAR, GG, JAM) and resistant (CI80-13S) to cisplatin (CDDP) and on human cervical cancer cell lines (HeLa) in comparison with their effects on human fibroblasts (HF). A fluorometric assay based on measurements of fluorescein diacetate (FDA) in cells was used to determine cell viability. Apoptosis was assessed in terms of cell morphology, by flow cytometry and by a DNA fragmentation assay.

RESULTS

Treatment of each cell line with the As2O3 or As2S3 led to a marked dose-dependent decrease in cell growth. The IC50 of the two compounds indicated a significantly greater cytotoxic effect against all the cancer cells tested than against the normal HF. At a clinically achievable concentration (2 microM), As2O3 selectively inhibited the growth and induced apoptosis in CI80-13S, OVCAR and HeLa cells but had no significant apoptotic effect on GG or JAM cells or HF. Following treatment with 5 microM As2S3, the CI80-13S, OVCAR and HeLa cells also exhibited growth inhibition and induction of apoptosis.

CONCLUSIONS

Arsenic compounds (As2O3 and As2S3) can inhibit growth and induce apoptosis in human ovarian and cervical cancer cells at clinically achievable concentrations, indicating that As2O3 and As2S3 could be effective in the treatment of gynecological cancer.