Spontaneous luteinizing hormone (LH) surges are associated with more rapidly increasing estradiol (E2) and follicle stimulating hormone (FSH) in in vitro fertilization and embryo transfer

In a retrospective analysis of 64 patients stimulated with human menopausal gonadotropin (hMG) and/or pure follicle stimulating hormone (FSH); 35 cycles with spontaneous luteinizing hormone (LH) surges were compared with 29 control cycles with respect to serum FSH and estradiol (E2) levels drawn on the day prior to and the day of human chorionic gonadotropin (hCG), approximately 16 hr after gonadotropin stimulation. FSH decreased significantly (P less than 0.05) in control cycles where two or more preovulatory oocytes (preovs) were obtained, in contrast to cycles with a spontaneous LH surge, where FSH increased irrespective of the number of preovs. The E2 increase in the LH surge cycles was significantly higher (P less than 0.05) than in the control cycles. However, the increase in E2 did not correlate with the change in FSH levels or with the number of preovs.

Distribution of T cell subsets in follicular fluid

Examination of follicular fluid (FF) from in vitro fertilization patients revealed a significant difference in concentrations of lymphocytes and T cell subpopulations with increased oocyte maturation. A total of 111 follicles containing 82 oocytes were aspirated from 10 patients undergoing laparoscopic oocyte retrieval. FF from 61.3% of the follicles was classified as clear and 38.7% as bloody, based on gross and microscopic appearance. A mean of 1.78 X 10(6) lymphocytes/ml was obtained from peripheral blood (PB) as compared to 2.14 X 10(5) and 2.79 X 10(5) lymphocytes/ml for clear and bloody FF, respectively. There were 6.3 X 10(5) T4 and 3.7 X 10(5) T8 lymphocytes in PB, resulting in a T4/T8 ratio of 1.72, which is not significantly different from that of the general population. The mean concentration of FF T4 and T8 lymphocytes decreased with increased oocyte maturation; the T8 reduction was statistically significant (P less than 0.05). The proportion of T4 to T8 lymphocytes in FF remained unchanged and was unaffected by maturity of the oocyte. Although estradiol (E2) did not vary with oocyte maturity, progesterone (P) increased and E2/P decreased. There was no correlation between E2 or P levels and distribution of T cells. Fertilization rates were higher in more mature oocytes, but there was no correlation between fertilization and E2, P, E2/P, or T cell subpopulations. It remains to be determined what factors result in the decrease in lymphocytes with increased oocyte maturity and the observed difference in FF T4/T8 compared to PB.

The value of basal and/or stimulated serum gonadotropin levels in prediction of stimulation response and in vitro fertilization outcome

The purpose of this study was to determine whether basal or stimulated (or both) serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) on day 3 of the cycle before administration of exogenous gonadotropins can predict stimulation response and in vitro fertilization (IVF) outcome. Eighty consecutive new patients underwent a gonadotropin-releasing hormone (GnRH) stimulation test on the morning of cycle day 3. All patients underwent the same stimulation protocol consisting of a combination of FSH and human menopausal gonadotropin (hMG). Paired discriminant analysis of FSH0 (at 0 minutes from GnRH injection) and LH0 revealed seven distinct groups of patients with statistically significant differences among the means: groups 1, 2, and 3 (26.25%) with higher means FSH0:LH0; group 4 (40%) with mean FSH0:LH0 (both levels less than 10 mIU/ml) of 1:1, and groups 5, 6, and 7 (33.75%) with higher mean LH0:FSH0. Canonical discriminant analysis of both basal and stimulated serum FSH and LH levels confirmed the seven groups and did not add to the information from analysis of FSH0 and LH0 only. Serum estradiol (E2) response during stimulation, as well as the number of preovulatory oocytes aspirated and transferred, was highest in the groups with a higher mean LH0:FSH0, intermediate in the group with mean FSH0:LH0 of 1:1, and lowest in the group with a higher mean FSH0:LH0. No pregnancy occurred in the higher FSH:LH groups. It is concluded that basal serum gonadotropin levels can distinguish different populations of IVF patients who tend to behave differently in terms of E2 response, oocytes obtained and transferred, and pregnancy rates and outcome.

Monitoring gonadotropin-stimulated cycles for in vitro fertilization and embryo transfer

One hundred fifty-one cycles stimulated with human menopausal gonadotropin (hMG) and/or follicle-stimulating hormone (FSH) were analyzed retrospectively to determine the relationship of the monitoring parameters used: serum estradiol (E2), transvaginal sonographic follicular size, and peripheral biologic estrogen response, with harvests and pregnancies resulting from in vitro fertilization and embryo transfer. Mean +/- SE serum E2 levels were higher on the day of human chorionic gonadotropin (hCG) administration in the miscarriage group (689.4 +/- 27.5 pg/ml) than in the nonpregnant group (527.7 +/- 25.8 pg/ml) (P = 0.018) and highest in the ongoing pregnancy group (734.6 +/- 66.5 pg/ml) (P = 0.003). When two or more preovulatory oocytes (preovs) were retrieved, the mean E2 levels were higher (622.3 +/- 27.3 pg/ml) than if zero or one preov was retrieved (378.4 +/- 43.5 pg/ml) (P = 0.001). The mean diameter of the two largest follicles at the time of hCG administration was significantly greater (14.7 mm) in the group with two or more preovs retrieved than in the group with zero or one preov (13.3 mm) (P = 0.001). The relative probability of achieving a pregnancy was best predicted by the presence of two follicles greater than or equal to 16 mm in diameter on transvaginal ultrasound examination and was 1.63 times greater than that of all patients in this series.

Beta-human chorionic gonadotropin as a monitor of pregnancy outcome in in vitro fertilization-embryo transfer patients

Serum human chorionic gonadotropin (hCG) was studied to test its predictability of pregnancy outcome in in vitro fertilization (IVF) patients. The mean +/- standard deviation of serum hCG concentration related to the day complete clearance of exogenous hCG was derived from 47 single term pregnancies as a normal range. This range can be used to predict spontaneous abortion (77%), multiple pregnancy (60%), and abortion in multiple-sac pregnancies terminating in the birth of fewer infants than the initial number of sacs (80%). The results also showed that our stimulation protocol did not affect the clearance rate and doubling time of endogenous hCG or implantation time as suggested by the time of endogenous hCG detection and that spontaneous abortion may be due to late implantation.

Mechanisms and factors of early pregnancy wastage in in vitro fertilization-embryo transfer patients

Although the pregnancy rate per transfer of the Norfolk In Vitro Fertilization-Embryo Transfer (IVF-ET) program has been reported as between 25% and 35%, the viable pregnancy rate per transfer is only 15% to 20%. An understanding of the mechanism(s) and etiologic factors of miscarriage among IVF patients might suggest changes that could prevent some early pregnancy wastage. Forty-seven consecutive single pregnancies and 26 miscarriages (October 1985 to November 1986) were included in this study. Factors such as implantation time, date of corpus luteum rescue (CLR), embryo quality, and corpus luteum activity after rescue were studied and compared between term pregnancy and miscarriage groups. Results are discussed in detail in this paper.

The value of in vitro fertilization for the treatment of unexplained infertility

In 54 patients referred with the diagnosis of unexplained infertility (UI), the diagnosis was confirmed in 26 (strict UI) (48%). Minimal abnormalities (MA) were found in 19 (35%); 9 (17%) had gross abnormalities and were excluded from analysis. Fifty patients with tubal infertility were randomly assigned to form a control group. Mean age and type of stimulation did not differ in the two groups. Peak follicular estradiol (E2) and terminal follicular E2 patterns were comparable. There was no difference in the mean number of oocytes retrieved per cycle. However, the control group had significantly more preovulatory oocytes: 3.6 +/- 2.0 standard deviations versus 2.8 +/- 2.1 in the overall UI group (strict UI + MA groups) and 2.7 +/- 2.2 in the strict UI group. Significantly more fertilized oocytes per cycle were obtained in the control group (P less than 0.05). The per-cycle and per-embryo transfer (ET) pregnancy rates were 32.4 and 37.3% in the overall UI group and 24 and 24.5% in the control group. The miscarriage rate was 12% in the strict UI group, 22% in the overall UI group, and 25% in the control group. It is concluded that patients with UI constitute a favorable group for in vitro fertilization and ET.

The efficiency of human reproduction after in vitro fertilization and embryo transfer

Two hundred ninety-seven nonpregnant patients were used to study the possibility of early transient implantation as a parameter of the efficiency of in vitro fertilization (IVF) procedures. Ten patients without embryo transfer (ET) were used as controls. The luteal estradiol, progesterone, and human chorionic gonadotropin were measured by radioimmunoassay (RIA). In 31 cases, a transient elevation of hCG occurred after complete serum clearance of exogenous hCG, suggesting that the transient increase in hCG was of embryonic origin. In addition, five patients were found to have prolonged clearance of hCG, which was due not to individual variation in clearance, but to a minimal production of hCG by trophoblastic tissue. These data suggest that implantations occurred in 12.1% of our so-called "nonpregnant" patients.

Treatment of medulloblastoma with procarbazine, hydroxyurea, and reduced radiation doses to whole brain and spine

Forty-seven patients with medulloblastoma were treated postoperatively with procarbazine, followed by craniospinal radiation therapy in combination with hydroxyurea. The radiation dose to the posterior fossa was 55 Gy; the spinal cord received 25 Gy and the whole brain 25 to 35 Gy (mean 33 Gy). Seventeen tumors recurred. Only one initial recurrence was in the spinal subarachnoid space; 10 (59%) were in the posterior fossa, and four (24%) were supratentorial. The estimated 5-year disease-free survival probability was 55%; the 5-year overall survival rate was 66%. Myelotoxicity occurred in 38% of patients, but in only one case was it severe enough to warrant reducing the total dose of radiation. It was concluded that good-risk medulloblastoma patients may be treated with radiation dosages as low as 25 Gy to the spinal axis and to the whole brain without increasing the risk of recurrence outside the posterior fossa. Chemotherapy with procarbazine followed by radiation therapy and hydroxyurea during radiation therapy was well tolerated and may play a role in reducing radiation dosages outside the posterior fossa.

Follicular fluid estradiol and progesterone are markers of preovulatory oocyte quality

Follicular fluid estradiol (FF E2) and progesterone (P) have previously been shown to vary with the maturation of the follicle. A profile of follicular fluid E2 and P was obtained from follicles of 19 preovulatory oocytes, which resulted in normal term pregnancies from single embryo transfers. A narrow band was defined around the linear regression line E2/P = 1.2 X 10(-2) + 1.57 X 10(-4) E2, r = 0.806, P less than 0.01, when E2/P was plotted versus E2 that included 84.2% of these oocytes. Eleven of the 19 pregnancies were clustered between an E2 of 240 to 460 ng/ml and an E2/P ratio of 0.044 to 0.084. Sixty-eight patients undergoing in vitro fertilization and embryo transfer were studied. A significantly greater number of preovulatory follicles from the fertilized, cleaved, and pregnant group (10 of 40) was found in the cluster than from the fertilized, cleaved, but not pregnant group (4 of 46; P = 0.04) and fertilized but not cleaved group (0 of 13; P = 0.04). Significantly more pregnant patients (14 of 20) had a preovulatory follicle within the band than nonpregnant patients (11 of 36) (P less than .02), as well as in the cluster (10 of 20), compared with 4 of 36, respectively (P less than 0.01). It may be concluded that a range of FF E2 and E2/P values define a stage of maturation that is compatible with successful pregnancies.

Toxicity domain in presynaptically toxic phospholipase A2 of snake venom

About 42 complete amino-acid sequences of phospholipases A2 (phosphatidylcholine 2-acylhydrolase, EC 3.1.1.4) are known, including those of 13 presynaptically toxic enzymes, but the structural features responsible for the neurotoxicity and distinguishing the toxins from the non-neurotoxic enzymes are far from being clear. In this study, we examined the charged-residue distributions and hydrophobic characteristics based on the sequence data and the predicted tertiary structure and proposed a possible toxicity domain. We found that the presynaptically toxic enzymes have three or four more basic amino-acid residues than the non-neurotoxic enzymes at positions 59, 60, 65, 70-73 and 97 or 98. These residues appear to cluster near the surface region at the N-terminal side. The cationic nature of this basic cluster in the toxin is enhanced by the alpha-amino group of the N-terminus and the dipole moment of helices 96-110 and 1-10. Moreover, these toxic-site residues are usually associated with hydrophobic regions at 1-7, 64-81 and 97-109.

Spinal cord proliferative sparganosis in Taiwan: a case report

A 43-year-old woman suffered from low back pain and bilateral footdrop. A cisternal myelogram unexpected revealed multiple filing defects in the spinal canal extending from the lower cervical region to the caudal equina. Diagnostic exploration revealed numerous cystic organisms adhering to the spinal cord and nerve roots. Histopathological examination showed these organisms to be proliferative sparganum cestode larvae. Although these cestode larval infections have been reported a dozen times in humans from various parts of the world, this is probably the first reported case of spinal cord infection.

Liver alcohol and aldehyde dehydrogenase isoenzymes in Chinese

Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) isoenzyme phenotypes were determined in 71 autopsy liver specimens by agarose isoelectric focusing and starch gel electrophoresis, respectively. Ninety percent of the livers examined exhibited a pH-optimum for ethanol oxidation at pH 8.5, instead of 10.5 which is usual among Caucasians. The homozygous ADH2 2-2 phenotype was found to be 59%, and the heterozygous ADH2 2-1 phenotype, 31%. The remaining 10% of the livers, exhibiting a pH-optimum at 10.5, were homozygous ADH2 1-1 phenotype. Accordingly, the gene frequencies of the alleles ADH2(2) and ADH2(1) were calculated to be 0.75 and 0.25, respectively. Fifty-eight percent of the 71 livers examined possessed both the activities of ALDH I and ALDH II isoenzymes, whereas 42% lacked the ALDH I activity. The implications of these distributions of liver ADH and ALDH isoenzyme patterns among Orientals for ethanol elimination, alcohol sensitivity and alcoholism are discussed.

Elevated serum interleukin-2 receptor; increased in vitro immunoglobulin synthesis and lack of response to testosterone-enhanced in vitro interleukin-2 production in ankylosing spondylitis

The pathogenesis of ankylosing spondylitis (AS) remains unknown, although previous studies have strongly suggested that it may result from immunological aberration. To further explore the pathogenetic mechanisms, in vitro syntheses of immunoglobulins and interleukin-2 (IL-2) by peripheral blood mononuclear cells (MNC), and the serum level of the interleukin-2 receptor (IL-2R) were studied in 35 patients with definite AS and in 28 healthy controls. MNC were cultivated in the presence of pokeweed mitogen (PWM) for seven days. Immunoglobulins in the supernatants were measured by rate nephelometer (Immunochemistry System Analyser II, Beckman.) In vitro synthesis of IL-2 was carried out by cultivating MNC in medium only; in medium containing physiological concentration of the male sex hormone i.e., testosterone 500 ng/dl and estradiol 2 ng/dl; and in medium containing physiological concentration of female sex hormone, i.e., testosterone 50 ng/dl and estradiol 20 ng/dl. IL-2 was quantitated using an IL-2-dependent cytotoxic T lymphoid cell line (CTLL). Serum IL-2R was measured using an IL-2R test kit (CELLFREE, T Cell Sciences, Cambridge, MA). The results showed: In vitro synthesis of IgG, IgA and IgM was significantly higher in AS than in controls; In vitro synthesis of IL-2 was significantly enhanced by testosterone in normal control, but not in AS; and Serum IL-2R was significantly elevated in patients with AS. These findings, viewed in conjunction with previous results here, lead to postulation that an inflammatory process, elicited in HLA-B27-positive males and caused by an infectious agent invading via the mucosa may both cause immunological abnormalities and provoke various symptoms and signs of AS.

Establishment and characterization of five cell lines derived from human malignant gliomas

We established and characterized five cell lines derived from human malignant gliomas (four glioblastomas multiforme and one highly anaplastic astrocytoma). All cell lines exhibited tumor cell morphology and growth kinetics, and anchorage-independent growth in soft agar. Cytogenetic analysis revealed significant aneuploidy in all five cases as well as clonal chromosomal alterations unique to each cell line. No cell line was tumorigenic in athymic mice. Two of the cell lines were sensitive to carmustine (BCNU) in monolayer and soft-agar cultures. Electron microscopy showed marked variability between cell lines in the number and structure of intracytoplasmic organelles; SF-126 formed collagen fibers in vitro. Immunohistochemical analysis of the surgical specimens showed variable expression of glial fibrillary acidic protein (GFAP) in malignant astrocytes; positive immunostaining for glycoproteins of the extracellular matrix was found predominantly in perivascular regions. In early-passage cultures, only cell line SF-295 expressed GFAP; at establishment, none of the cell lines expressed GFAF or glutamine synthetase. Fibronectin and laminin were expressed by all cell lines in early-passage culture, but expression of these glycoproteins at establishment was variable. Only SF-126 was positively identified by immunostains for procollagen III; this was also the only cell line in which DEAE-cellulose chromatography and SDS-PAGE demonstrated interstitial collagen synthesis. These well-characterized glioma-derived cell lines may now serve as useful tools with which to study the cell biology of gliomas. The synthesis of interstitial collagen by a glioma-derived cell line may suggest a derivation from vascular mesenchymal elements, either reactive or transformed, in the original heterogeneous malignant glioma, rather than from a glial precursor cell.

Clinical aspects with regard to the occurrence of an endogenous luteinizing hormone surge in gonadotropin-induced normal menstrual cycles

A decline in serum E2 the day before laparoscopy indicated that ovulation had occurred in 16 cycles stimulated with exogenous gonadotropins for the purpose of in vitro fertilization (IVF). In contrast to 18 control cycles with rising E2 values after human chorionic gonadotropin (hCG) administration and without evidence of ovulation, the onset of the endogenous luteinizing hormone (LH) surge had been initiated. From this study, it is believed that the onset of an endogenous LH surge can be identified by the terminal preovulatory E2 pattern. Further, the incidence of an endogenous LH surge in gonadotropin-induced menstrual cycles and the present clinical approach of the Norfolk IVF program to this phenomenon are discussed.

The perimenopausal patient in in vitro fertilization: the use of gonadotropin-releasing hormone

The perimenopause, incipient ovarian failure, is a major problem in stimulation failures during an in vitro fertilization program. This must be recognized as not necessarily related to age but also associated with adnexal inflammatory and operative processes. Although ovulation occurs uninterruptedly, the follicle-stimulating hormone in the early follicular phase is elevated and the luteinizing hormone is normal. Characteristically, there is no estradiol response to human menopausal gonadotropin therapy or a rapid response with a premature luteinizing hormone surge. These problems sometimes may be overcome with pulsatile intravenous gonadotropin-releasing hormone therapy, 5 or 10 micrograms/90 or 120 minutes. The major therapeutic problem is in the identification of a luteinizing hormone surge in these patients. Of eight women who were treated, two failed to respond with follicular maturation, three either had no oocytes aspirated from apparently postmature follicles or had postmature oocytes; and one had treatment cancelled due to ovulation. The four latter patients may have failed because of unrecognized ovulation. In the remaining two patients, one oocyte was fertilized and transferred, and one pregnancy occurred.

Retreatment of pediatric brain tumors with radiation and misonidazole. Results of a CCSG/RTOG phase I/II study

Twenty-nine patients with recurrent pediatric brain tumors after full-dose treatment with radiation were retreated with misonidazole (9 gm/m2) and whole-brain irradiation (300 rad X 10). Seventeen of 29 patients (59%) experienced nausea and vomiting with misonidazole administration and 6 patients (21%) developed peripheral neuropathy. Serum levels of misonidazole were similar to those reported for adults. One patient died of trauma shortly after retreatment. For the remaining 28 patients, the median time-to-progression was 5.5 months. Median survival was 13 months. Six patients (21%) developed radiation toxicity, two of whom died from the toxicity. Whereas the results on this study are similar to reported series of patients receiving salvage chemotherapy for recurrent pediatric brain tumors, more effective treatment clearly is needed.

Transplantation of anastomosed vascular allomentum and split thickness autogenous skin grafting for repair of deep electrical burns of the wrist

The use of allomentum to replace automentum or skin flaps in treating 3 patients with severe electrical burns of the wrist is discussed, as are the specific advantages and disadvantages, and the prospects for clinical use of the technique.