Blood Group Serology and "Race": Looking Back to Move Forward

Less than a decade after the discovery of the ABO antigens as a Mendelian inherited trait, blood group antigen frequencies were first used to define racial groups. This approach, known as seroanthropology, was the basis for collecting large amounts of blood group frequency data in different populations and was also sometimes used for racist purposes. Ultimately, population geneticists used these data to disprove race as a biological construct. Through understanding the history of seroanthropology, and recognizing the harms of its lingering presence, healthcare providers can better practice race-conscious, as opposed to race-based, transfusion medicine.

A comparison of overtime patrol stops made inside and out of cluster identified hotspots

OBJECTIVE

The annual rate of impaired driving crashes in the United States has remained nearly constant over the last decade. While engineers, educators, enforcement, and emergency response personnel have worked diligently in their combined efforts to reduce the loss of life, there is still significant progress to be made. One area of recent interest is the use of data driven enforcement. The basis for data driven enforcement is the use of statistical clustering to identify geographic areas that represent the location of problem identification for various criminal or traffic offenses. In the case of impaired driving fatalities, the clustering represents locations with high rates of impaired driving crashes. Law enforcement officers and supervisors may allocate resources towards more specifically and efficiently addressing problem areas.

METHODS

While data driven enforcement has been proven to be an effective tool in addressing crime and traffic safety problems, it has been a slow process for agencies to adopt data driven techniques. This study aims to explore the difference in traffic stops made inside and outside of hotspot identified areas. The study uses data from the Stark County Operating a Vehicle Impaired Task Force between 2013 and 2014.

RESULTS

The analysis determined that stop occurring in hotspot defined areas are more likely to result in impaired driving arrests and seatbelt citations. Additionally it is found that the average cost of impaired driving arrests is significantly cheaper for stops occurring inside of hotspot areas.

CONCLUSION

Clustering as a means of directing law enforcement efforts are a way to increase the productivity and benefits of law enforcement agencies with limited finances or personnel. From this study it is seen that traffic stops made within defined cluster or hot spot areas are more effective in resulting in OVI arrests.

A comparison of contributing effects on 2-vehicle alcohol-related crashes between impaired and nonimpaired operators

OBJECTIVE

Driving under the influence of alcohol is a crime that places the lives of all motorists in danger. Though it is a largely preventable act, impaired driving has accounted for 31 to 38% of fatal crashes across the country over the last decade. When an impaired operator crashes his or her vehicle, there is often a second unit, of which the operator is not impaired, involved in the crash.

METHODS

This research looks at approximately 14,000 2-unit crashes involving an impaired operator in the State of Ohio from 2008 through 2012. The research is focused on determining the effects of crash and operator characteristics in 2-unit alcohol-related crashes through the use of 2 mixed logit models.

RESULTS

It is found that several factors have similar effects on the injury severities of both the impaired and nonimpaired operators, including head-on crashes, the use of seat belts, and the deployment of airbags. There are, however, several factors that affect the 2 operators differently. It is found that the impaired operator's injury severity is based on the type and, more important, the size of the vehicle he or she is driving, the roadway geometry, and the speed of the vehicle driven by the nonimpaired operator. The nonimpaired operator is equally affected by the speed of the impaired vehicle as much as his or her own speed, and the nonimpaired operator's injury severity is virtually independent of the type of vehicle being driven.

CONCLUSIONS

Researchers may disseminate the results to community groups such as Mothers Against Drunk Driving and Safe Communities to increase awareness of the dangers of drunk driving in an effort to reduce the number of alcohol-related crashes.

The origin of the medical research grant in the United States: the Rockefeller Foundation and the NIH Extramural Funding Program

The establishment of National Institutes of Health (NIH) extramural grants in the second half of the twentieth century marked a signal shift in support for medical research in the United States and created an influential model for the rest of the world. A similar landmark development occurred in the first half of the twentieth century with the creation of the Rockefeller Foundation and its funding programs for medical research. The programs and support of the foundation had a dramatic impact on medical research in the United States and globally. This paper examines early connections between these two developments. The NIH grants have usually been seen as having their roots primarily in the government programs of the Second World War. This article finds direct and indirect influence by the Rockefeller Foundation, as well as parallel developments in these two monumental programs of support for medical research.

An investigation into motorcycle crashes in work zones

OBJECTIVE

There were 454 motorcycle crashes in work zones within the state of Ohio between January 2006 and July 2012. Pavement degradation derived from work zones tend to have a hazardous effect on motorcycles and their safe passage. The objective of this study is to research the work zones where motorcycle crashes have taken place in order to determine any contributing factors.

METHODS

This study incorporates the collection of motorcycle crash data, including construction documents associated with the work zones in which the crashes occurred. Crash documents from the Ohio Department of Public safety and the Ohio Department of Transportation are used to identify the initial factors to be studied.

RESULTS

Construction documents associated with 183 of the crashes are able to be retrieved. From these documents, the frequency of associated crashes and rates of fatalities per work type are able to be determined.

CONCLUSIONS

It is found that work types that take place on lower functional class roadways, such as sewer repair, are found to have higher fatality rates. In contrast, those work zones on higher functional class roadways often incorporate speed calming measures and have a clear division between the traveled way and the actual construction work.

A comparison of contributing factors between alcohol related single vehicle motorcycle and car crashes

INTRODUCTION

Alcohol related crashes have accounted for approximately 35% of fatal crashes per year since 1994 nationwide, with approximately 30% involving impairment over the legal blood alcohol content limit of 0.08%. Educational campaigns and law enforcement efforts are two components of multi-faceted programs aimed toward reducing impaired driving. It is crucial that further research be conducted to guide the implementation of enforcement and educational programs.

METHOD

This research attempts to provide such guidance by examining differences in alcohol-involved crashes involving motorcycles and passenger cars. Prior safety research has shown that motorcyclists follow a significantly different culture than the average passenger car operator. These cultural differences may be reflected by differences in the contributing factors affecting crashes and the severity of the resulting injuries sustained by the driver or motorcyclist. This research is focused on single-vehicle crashes only, in order to isolate modal effects from the contribution of additional vehicles. The crash data provided for this study are from the Ohio Department of Public Safety from 2009 through 2012.

RESULTS

The injury severity data are analysed through the development of two mixed logit models, one for motorcyclists and one for passenger car drivers. The models quantify the effects of various factors, including horizontal curves, speeds, seatbelt use, and helmet use, which indicate that the required motor skills and balance needed for proper motorcycle operation compounded with a lack of mechanical protection make motorcyclists more prone to severe injuries, particularly on curves and in collisions with roadside objects.

PRACTICAL APPLICATIONS

The findings of this study have been incorporated into combined motorcycle and sober driving educational safety campaigns. The results have shown to be favorable in supporting national campaign messages with local justification and backing.

Examination of factors determining fault in two-vehicle motorcycle crashes

Motorcycle crashes frequently involve a combination of high-risk behaviors by the motorcyclist or the other crash-involved driver. Such behaviors may include riding or driving without appropriate licensure or while under the influence of alcohol, as well as deciding not to use a safety device such as a helmet or safety belt. Given that these factors frequently occur in combination with one another, it is difficult to untangle the specific effects of individual factors leading up to the crash outcome. This study assesses how various rider-, driver-, and other crash-specific factors contribute to at-fault status in two-vehicle motorcycle crashes, as well as how these same factors affect the propensity for other high-risk behaviors. Furthermore, the interrelationships among fault status and these other behaviors are also examined using a multivariate probit model. This model is developed using police-reported crash data for the years 2006-2010 from the State of Ohio. The results show that younger motorcyclists are more likely to be at-fault in the event of a collision, as are riders who are under the influence of alcohol, riding without insurance, or not wearing a helmet. Similarly, motorcyclists were less likely to be at-fault when the other driver was of younger age or was driving under the influence of alcohol, without insurance, or not wearing their safety belt. Crash-involved parties who engaged in one high-risk behavior were more likely to engage in other such behaviors, as well, and this finding was consistent for both motorcyclists and drivers. The results of this study suggest that educational and enforcement strategies aimed at addressing any one of these behaviors are likely to have tangential impacts on the other behaviors, as well.

Mixed logit analysis of bicyclist injury severity resulting from motor vehicle crashes at intersection and non-intersection locations

Standard multinomial logit (MNL) and mixed logit (MXL) models are developed to estimate the degree of influence that bicyclist, driver, motor vehicle, geometric, environmental, and crash type characteristics have on bicyclist injury severity, classified as property damage only, possible, nonincapacitating or severe (i.e., incapacitating or fatal) injury. This study is based on 10,029 bicycleinvolved crashes that occurred in the State of Ohio from 2002 to 2008. Results of likelihood ratio tests reveal that some of the factors affecting bicyclist injury severity at intersection and non-intersection locations are substantively different and using a common model to jointly estimate impacts on severity at both types of locations may result in biased or inconsistent estimates. Consequently, separate models are developed to independently assess the impacts of various factors on the degree of bicyclist injury severity resulting from crashes at intersection and non-intersection locations. Several covariates are found to have similar impacts on injury severity at both intersection and non-intersection locations. Conversely, six variables were found to significantly influence injury severity at intersection locations but not non-intersection locations while four variables influenced bicyclist injury severity only at non-intersection locations. In crashes occurring at intersection locations, the likelihood of severe bicyclist injury increases by 14.8 percent if the bicyclist is not wearing a helmet, 82.2 percent if the motorist is under the influence of alcohol, 141.3 percent if the crash-involved motor vehicle is a van, 40.6 percent if the motor vehicle strikes the side of the bicycle, and 182.6 percent if the crash occurs on a horizontal curve with a grade. Results from non-intersection locations show the likelihood of severe injuries increases by 374.5 percent if the bicyclist is under the influence of drugs, 150.1 percent if the motorist is under the influence of alcohol, 53.5 percent if the motor vehicle strikes the side of the bicycle and 99.9 percent if the crash-involved motor vehicle is a heavy-duty truck.

Arnault Tzanck, MD (1886-1954)

Arnault Tzanck's name is attached to an apparatus he invented that was widely used for transfusing blood in France between the wars, as well a simple test he devised using the microscopic analysis of scrapings from skin cancer lesions, different ganglia, and some forms of dermatitis especially pemphigus. The Tzanck smear is still widely used as a test for herpes, among other diseases. He also experimented with different methods of preserving blood and blood substitutes. Tzanck's most lasting contribution was in the organization of blood transfusion in France that eventually resulted in the creation of the Centre National de Transfusion Sanguine (National Blood Transfusion Center), which was established in 1949 with Tzanck as its first director. In the process, Tzanck educated a whole generation of serologists and immunologists, including Jean Dausset, Marcel Bessis, and Jean Pierre Soulier.

Blood transfusions in the early years of AIDS in sub-Saharan Africa

Blood transfusions transmit HIV more effectively than other means, yet there has been little examination of their role in the origins and early course of AIDS in sub-Saharan Africa. We review historical data in archives, government reports, and medical literature from African and European sources documenting the introduction, establishment, use, and growth of blood transfusions in sub-Saharan Africa. These data allow estimation of the geographic diffusion and growth of blood transfusions between 1940 and 1990. By 1955, 19 African colonies and countries reported transfusion programs-with national rates of 718 to 1372 per 100 000 by 1964, and urban rates similar to those in developed countries. We estimated 1 million transfusions per year in sub-Saharan Africa by 1970 and 2 million per year by the 1980s, indicating that transfusions were widely used throughout sub-Saharan Africa during the crucial period of 1950-1970, when all epidemic strains of HIV first emerged in this region.

Blood transfusion between the wars

This article examines the introduction of blood transfusion into general practice from the end of the First World War to the Second World War. Developments during most of this period were not the result of new discoveries but rather the spread of ideas and the establishment of donor organizations to secure an adequate blood supply. The identification, testing, and organization of potential donors were done in a wide variety of settings that reflected differences in political and cultural experiences. At the end of the 1930s, with war approaching, the resolution of problems with storage of blood and the discovery of new techniques for separating and storing plasma dramatically changed transfusion practice. Thus, the innovations of the Second World War were very much based on the development of broad donor organizations plus the new technical discoveries that had occurred during the interwar period.

Blood transfusion in peace and war, 1900-1918

The practice of blood transfusion became commonplace in the first half of the twentieth century, a time that coincided with the practice of war on a hitherto unprecedented scale. A close examination of the process reveals that it was not a simple one of war acting as a stimulus to scientific and medical discovery. Most innovations had their origins in the United States before the war, whose main effect was to diffuse and perfect transfusion through greatly increased use of the technique. The result was that in less than twenty years blood transfusion changed from being a medical curiosity and procedure of last resort to a practical and relatively simple treatment that demonstrated its value in saving thousands of lives.

The history of research on blood group genetics: initial discovery and diffusion

During the 1920s and 1930s the resting of blood groups for large numbers of people became a very common practice. Although much of this was to ensure compatibility for blood transfusion, over 1,000 articles were published with results of tests on over 1.3 million people to answer more theoretical, scientific questions. The motivation for much of this research was the possible link between the well established hereditary blood types and other possible inherited traits. Because the existence of the blood groups was a rather sudden discovery, the record of this publication offers an excellent case study of the diffusion of new scientific knowledge. Differences in the beginning of blood group research from country to country reveal some important influences of social setting on the spread and application of the new discoveries.

[Additive therapy in ovulation induction with clomiphene]

Between 1977 and 1981 1319 patients consulted our hospital with the problem of sterility. 763 women became pregnant, 200 were treated with clomiphen . In 69 cases we used a combination with other agents, because ovulation could not be induced with clomiphen alone. 7 times we combined clomiphen with HCG, in 7 other cases with Prednisolon . Ovulation and pregnancy occurred subsequent to a treatment with Estradiolvalerianate -Norgestrel and clomiphen in 15 patients, in 32 patients after administration of a combination of clomiphen and Bromocriptine. The inadequate cervical mucus which may develop in patients during clomiphen therapy was treated with an additional low dose of ethinylestradiol. Our retrospective study confirms the value of a combination therapy in the treatment of anovulation and sterility.

[Molecular-biological studies of the cervical secretion with one-dimensional electrophoresis]

In the present study the polypeptide composition of cervical mucus was analysed during the human menstrual cycle. Changes in the polypeptide profile as displayed by a very sensitive silverstaining method were consistent with cycle dependent variations in observed rheological properties of the mucus and activities (concentrations) of luteinising hormone (LH) (from comparatively analysed blood). It could be shown that whereas three main polypeptide components of the mucus (50 kd [kilodalton], 14 kd, 12 kd) remained constant the amount and intensity of other polypeptides increased towards midcycle (ovulation) and diminished on the days after ovulation. A 25 kd polypeptide (being a main component on the days before ovulation) disappeared at midcycle (on the day of ovulation). On the same day a new main peptide (8 kd) was observed, which was decreasing (in favour of the 25 kd peptide) on the days after ovulation. It is postulated that the described shift in the polypeptide pattern of the cervical mucus may be a result of the degradation of the light chain of IgG at midcycle.

[Clinical experiences with the prolactin-inhibiting serotonin antagonist metergoline]

20 puerperal women who did not wish to breast feed their infants were treated with the serotonin antagonist metergoline. In 19 cases effective suppression of puerperal lactation was achieved by the administration of metergoline without the side effects or signs of intolerance. Of 9 women with hyperprolactinaemic amenorrhoea treated with metergoline the raised prolactin level was lowered, followed by menstruation in 7 patients. Ovulation even occurred in 5 of these women. One patient had to discontinue therapy due to intolerance. in normoprolactinaemic amenorrhoea regular menstruation reappeared in 4 out of 5 women; 2 patients even ovulated.

[The incidence of congenital abnormalities following gestagen administration in early pregnancy (author's transl)]

198 women who had been trying for years to have a baby were submitted to a trial of prophylactic allyloestrenol therapy in an attempt to lower the incidence of spontaneous abortion. Allyloestrenol (Gestanon) was given at a dosage of 10 mg daily until the 8th week of pregnancy; the dosage was then stepped up to 15 to 20 mg daily until the 12th week of pregnancy and then rapidly tailed off. A decrease in the miscarriage rate was seen only in the group of women in whom treatment had been commenced immediately following ovulation (27 women: 1 miscarriage). If therapy was initiated only after the first missed period then it was without effect (161 women: 23 miscarriages). There were 4 cases of severe congenital abnormality; 3 of these cases arose in the group given allyloestrenol immediately after ovulation (with a drastic reduction in miscarriage rate). The results are discussed. They speak against a cytotoxic effect of the gestagen. It appears likely that the lowering in miscarriage rate occurs at the expense of a failure to prevent the nidation of abnormal fetuses who would normally be aborted.

[Clinical experience with danazol treatment of endometriosis and mastopathy]

26 women presenting with internal and external endometriosis and 27 women with chronic cystic mastopathy and mastodyny received 400 mg danazol-a 17-ethinyltestosterone derivate-daily for 3 to 6 months. Before, during and after completion of treatment clinical and endocrinological investigation as well haematological examinations and determinations of blood and urinary chemistry were carried out. In cases of mastopathy plate thermography and mammography were performed; in endometriosis the diagnosis was verified by laparoscopy or-tomy. An improvement in, or disappearance of dysmenorrhoea and pelvic pain was observed in the endometriosis group. At laparoscopy or -tomy a decrease in, but not a complete disappearance of endometriotic foci was seen. A most favourable effect of danazol was seen in mastodyny. A change in plate thermographic or mammographic findings was observed on only a few patients. A significant fall in 17 beta-oestradiol after one month and a slight decrease in basal LH levels (statistical trend) were observed. FSH and HPRL levels were not significantly affected. Ovulation was mostly suppressed, but serum progesterone values were found several times to be in the range characteristic of severe luteal insufficiency (100 to 1500 pg/ml). Hence, not only amenorrhoea, but also breakthrough bleeding occurred. The observed side affects can be ascribed to anabolic (weight gain), androgenic (acne, hirsutism) and hypoestronic (atrophic vaginitis, hot flushes, restlessness) symptomatology.

[Hypophyseal reaction state during oral contraceptiva (author's transl)]

In 5 normocyclic women, firstly taking a conventional oral contraceptive, Neogynon (50 mcg EE + 250 mcg levo-norgestrel) for 6 months, the levels of LH, 17 beta-E2 and progesterone did not rise after changeover to a dose-reduced pill, Microgynon 30 (30 mcg EE + 150 mcg levo-norgestrel). This fact indicates maintained central suppression. Examination of the hypothalamic-hypophyseal axis by the Gn-RH test (50 mcg) with Microgynon 30 showed negative results during the first treatment cycle in 13 out of 18 women. In the 6th treatment cycle only 7 Gn-RH non-reactive women were observed and after stimulation with 100 mcg Gn-RH only 5 women remained with negative Gn-RH tests. Of the 20 women who took conventional oral contraceptives over a period of 6 months to 6 years (7 took Eugynon: 50 mcg EE + 500 mcg D,L-norgestrel, 5 Lyndiol: 75 mcg mestranol + 2.5 mg lynoestrenol, 8 Neogynon, only one from the Neogynon group showed a positive result. On the other hand there was a positive reaction in 4 out of 7 women using the two step dose-reduced preparation Sequilar (11 tablets of 50 mcg EE + 50 mct levo-norgestrel and 10 tablets of 50 mcg EE + 125 mcg levo-norgestrel).

[The efficacy of gestoden (delta 15-d-norgestrel) as ovulation inhibitor (author's transl)]

Two single-phase combined low-dosage oral contraceptive preparations were tested with respect to their effects on functional parameters of the menstrual cycle. Twenty young women with a normal biphasic menstrual cycle took part in this random study. Evaluation of cervical function, consistency and crystallisation ability of the cervical mucous and of the karyopyknosis index as well as radioimmunoassay of the serum levels of LH, FSH, HPRL, 17-beta-oestradiol and progesterone were carried out consecutively as from the 8th day over the duration of one control cycle and one in which contraceptive as administered. Preparation I (SH D 356 A) contained 75 micrograms delta 15-d-norgestrel (Gestoden) + 30 micrograms ethinyloestradiol. Whilst preparation II (SH D 356 B) contained 75 micrograms d-norgestrel + 30 micrograms ethinyloestradiol. Both substances successfully inhibited ovulation, whereby the former achieved a markedly greater suppression of function with regard to all parameters and, yet good menstrual cycle control was maintained. Hence, gestoden enables the content of active components in oral contraceptives to be reduced even further without detracting from the safety of the technique.

[Intrauterine contraception with copper-T 200 device- a retrospective analysis of 334 cases (author's transl)]

A review is given of the findings obtained in 334 women in whom a Cu-T 200 intrauterine device had been inserted at least two years previously and regular follow-up examinations were subsequently undertaken. The most frequent indications were an expressed preference for IUD on the patient's part (38.3%), poor tolerance to the "pill" (24.8%) and so-called "pill fatigue" (11.1%). Varicose veins led to IUD preference in 8.1% and thromboembolic disease in 6.-%. The failure rate - with 12 pregnancies - was 3.6%, all within 6 months of insertion of the device. Half of the pregnancies went to full term and resulted in the birth of mature, healthy babies. The most frequent complication were menstrual disturbances (20.1%). pain (19.5%), cervicitis (18.3%), and adnexitis (13.8%), necessitating removal of the device in 5.7%, 4.2%, 5.1%, and 0.6% of all cases for the afore-mentioned reasons, respectively. These rates are relatively high. The expulsion rate of 2.7% was relatively low, however. Further analysis of the complications led to the observation that menorrhagia was relatively common in nulliparae and in women with retroversion of the uterus, whereas the pre-insertion finding of a pressure-sensitive uterus with a normal ESR, led in a significantly higher percentage of cases to pain and adnexitis. The diagnosis by vaginal probe of a reduced uterine length led to faulty positioning and an increased tendency to pain in a significantly higher number of cases. The fact that only 56.6% of all women tolerated intrauterine contraception well and remained totally symptom-free supports th view held by us that even today the "pill" remains the contraceptive of choice and should be recommended as such.

[Timing of ovulation in clomiphene-induced cycles (author's transl)]

214 menstrual cycles, induced by clomiphene in 121 women desiring a family but manifesting disturbances of cycle, type WHO II (1976) were investigated with regard to pattern of cervical function. 184 were ovulatory cycles. The time of ovulation was predictable within a range of two days in 58.7% of cases by means of the cervical score, consisting of the dilatation of the cervical os, the degree of transparency, the quantity and the consistency of the cervical mucus. The occurence of the "LH peak" and the rise in basal body temperature (BBT) were set in relation to this. In 41.3% of cycles the cervical score, influenced by the antioestrogenic effect of clomiphene, gave only insufficient evidence. In subsequent treatment cycles the cervical function, in relation to the individual case and the inducible quality of the cycle, showed a similar response rate as in the first treatment cycle. Our results suggest that, after examination of the first clomiphene-induced cycle by the combined means of cervical score and hormoneanalytic methods, patients with a positive cervical response, can be investigated by any interested doctor, even if he doesn't have a laboratory at his disposal, in order to assess the timing of ovulation for therapeutic measures.

[Treatment of infertile couples--an interdisciplinary task (author's transl)]

The results obtained by closest cooperation between gynaecologist and andrologist in the treatment of sterile marriages are reported. 127 couples were treated over a period of 20 months. Almost 100% of the males and 60% of the females were sub- or infertile. Treatment of both partners was meticulously coordinated in order to increase the success ratio. Interdisciplinary cooperation seemed to be advantageous particularly in homologous insemination. 23 pregnancies were achieved, i.e. 18.1%, despite the unpromising nature of this negatively selected material.

[Contraception in preclimacteric women with special regard to oral contraceptives (author's transl)]

During a period of 9 years 143 women at an age over 40 attended for the first time the I. University Clinic of Gynecology and Obstetrics in Vienna for receiving contraceptive treatment. 71 women (49.6%) received oral contraceptives wiD was inplanted because of either internal contraindications of oral contraceptives (mainly high risk for thrombosis) or negation by the patient. 16 patients were sterilised, mostly with the laparascope. The main side effects in the patients receiving oral contraceptives were nervosity, impairment of libido and complaints in the lower extremities. 60.5% of all women over the age of 40 using oral contraception didn't show any complaints. On the basis of the own results and the reports in literature the advantages and disadvantages of oral contraception in comparison with mechanical devices are discussed.

[Hormonal and functional parameters in hyperprolactinaemia (author's transl)]

58 women with raised serum prolactin levels and normal hypophyseal-X-ray parameters were subdivided into three groups according to the serum prolactin level (16 to 40, 41 to 80, greater than 80 ng/ml). In addition to the determination of LH, FSH, oestradiol, progesterone and testosterone in the serum and thyroid diagnostic procedures the following hormonal tests were performed: 1. response to gestagen; 2. response to clomiphene; 3. Gn-RH-test for hypophyseal function; 4. ovarian response to administered gonadotropins (only in cases with prolactin levels greater than 80 ng/ml). The grade of menstrual cycle disorders depends on the severity of the observed hyperprolactinaemia. Slight disorders like luteal phase insufficiency, anovulatory cycle and oligomenorrhoea are associated with low- or medium-grade hyperprolactinaemia. Mainly secondary, but also primary amenorrhoea is found in cases with higher serum prolactin levels (greater than 80 ng/ml). In these cases the hypophyseal response to Gn-RH is frequently found (61%) to be negative and, moreover, the ovarian response to administered gonadotropins seems to be diminished. Increasing HPRL levels often appear to be associated with a negative response to the other above-mentioned tests.

[Hormonal and functional parameters in hyperprolactinaemia (author's transl)]

58 women with raised serum prolactin levels and normal hypophyseal X-ray parameters were subdivided into three groups according to the serum prolactin level (16 to 40, 41 to 80, greater than 80 ng/ml). In addition to the determination of LH, FSH, oestradiol, progesterone and testosterone in the serum and thyroid diagnostic procedures the following hormonal tests were performed: 1. response to gestagen; 2. response to clomiphene; 3. Gn-RH-test for hypophyseal function; 4. ovarian response to administered gonadotropins (only in cases with prolactin levels administered gonadotropins (only in cases with prolactin levels greater than 80 ng/ml). The grade of menstrual cycle disorders depends on the severity of the observed hyperprolactinaemia. Slight disorders like luteal phase insufficiency, anovulatory cycle and oligomenorrhoea are associated with low- or medium-grade hyperprolactinaemia. Mainly secondary, but also primary amenorrhoea is found in cases with higher serum prolactin levels (greater than 80 ng/ml). In these cases the hypophyseal response to Gn-RH is frequently found (61%) to be negative and, moreover, the ovarian response to administered gonadotropins seems to be diminished. Increasing HPRL levels often appear to be associated with a negative response to the other above-mentioned tests.

[Results of a long-term clomiphene citrate therapy in women with normogonadotropic menstrual disturbanes (author's transl)]

A total of 72 pregnancies was achieved in 59 women with menstrual cycle disturbances (WHO Type II) by administration of clomiphene. 27 of these pregnancies (34.7%) occurred only after more than three courses of cloimphene. A secondary classification of the patients was based on the symptomatic severity of the menstrual disturbance. Clomiphene (100 mg) was administered on the fifth day after the onset of menstruation for five days, whereby in one or two cases up to 19 courses had to be given. The group consisted of women who had rejected HMG-HCG therapy because of the possibility of multiple pregnancy. 59 pregnancies went to full term; 2 tubal pregnancies and 11 cases of miscarriage were recorded. The commencement of pregnancy was evaluated and the time of ovulation and the length of the luteal phase determined in women requiring up to three courses of clomiphene and those requiring over three courses. The investigation demonstrates that clomiphene therapy can be successful even after more than six courses of the drug. Side effects are minimal.

The influence of burn trauma on the hypothalamus-pituitary axis in normal female subjects

In 5 severely burned women (greater than 25% TBS, II degrees and III degrees burns) the following hormones were investigated by RIA. (1) LH-releasing hormone test in the initial phase of burn shock with 100 gamma 3 LH-RH. (2). Follow-up controls of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (HPRL), oestradiol (E2), progesterone (P) and testosterone (T) in the catabolic and healing phase of burn disease. All women were before onset of burn trauma regularly ovulating. The following preliminary results can be presented: If the burn trauma occurs in the preovulatory phase of the menstrual cycle, there was no ovulation during the time of observation. As a sign of the normal function of the anterior lobe of the pituitary gland all subjects responded with an increase of plasma LH to the stimulation with LH-releasing hormone. The burn trauma interferes with the female endocrine equilibrium by involving hypothalamic centres. Negative feedback mechanisms by the secretion of adrenal hormones and temporary hyperprolactinemic states as a further result are discussed.

[Prophylactic medication to prevent miscarriage in pregnant women with a history of sterility (author's transl)]

A report is given of the outcome of 451 pregnancies occurring among women who had previously attended the Infertility Clinic. General gestagen therapy was given prophylactically in 129 cases before the appearance of any signs of threatened abortion. Massive gestagen therapy was initiated in 41 cases in response to signs of threatened abortion. Gestagen was not given either prophylactically or therapeutically in the remaining 281 pregnancies. The incidence of abortion was 10.1% in women given prophylactic gestagen, whilst the overall rate of abortion in the entire series of 451 women was 13.3%. It transpired on closer scrutiny of the 129 cases given prophylactic gestagen therapy that the abortion rate was 12.0% in the 108 pregnancies in which prophylactic gestagen therapy had been initiated at the time of the first missed period or later, whereas not one single abortion was registered amongst the 21 women who had been given gestagen therapy in the immediate post-ovulatory phase. It can be concluded that commencement of prophylactic gestagen therapy at the earliest possible moment provides optimum conditions for successful implantation of the fertilized ovum, especially in cases with masked insufficiency of the corpus luteum.

[The place of laparoscopy in the investigation of infertility (author's transl)]

An assessment of the value of hysterosalpingography (HSG) and laparoscopy was made on the basis of a comparison of the respective findings obtained during routine investigation of 105 women attending the Infertility Clinic. The results of the two procedures concurred in 76% of the women; in the remaining cases, apparently normal findings on HSG had to be rectified on the basis of laparoscopic investigation and vice versa. The divergent results are discussed in detail. In particular, intramural obstruction of the tubes diagnosed on HSG often appears to be merely functional and the presence or absence of adhesions in the region of the tubes must be viewed with reservation. HSG and laparoscopy should be considered complementary, not rival procedures.

[Contraceptive efficiency of triphasic inhibitors (author's transl)]

The effects of two newly developed triphasic preparations with a sequence of 6/5/10 and a reduced content of the total dose of oestrogen per cycle on the parameters of cycle function were studied in 10 young women with normal phasic cycles using a randomized trial design. Cervical function, spinnbarkeit and crystallisation of cervical secretion and the karyopyknotic index were monitored and LH,E2 and progesterone levels in serum radioimmunologically determined in a pretreatment control cycle, the immediately following 1st treatment cycle, the 3rd treatment cycle and a subsequent treatment-free cycle. Both preparations brought about suppression of ovulation already in the 1st treatment cycle with the periphery (cervical barrier) greatly reduced but still reactive. The results of the study show that by adapting the ratio of active substances to the phases of the normal cycle, not only good cycle control and tolerance are achieved but also inhibition of ovulation.

[Anti-androgen treatment of acne (author's transl)]

A group of women suffering from acne vulgaris or post-pubertal acne was selected for a trial of anti-androgen treatment on the basis of suspected concomitant endocrine disorder from the case history. A satisfactory response to anti-androgen treatment was obtained in 80% of these subjects. The serum testosterone levels, which were slightly elevated or within the normal range prior to therapy, decreased significantly in response to anti-androgen treatment with an oral contraceptive of the combined type containing cyproterone acetate and ethinyl oestradiol. The highest rate of response was observed in patients with post-pubertal acne resistant to conventional therapy.

[Central and peripheral actions of an oral contraceptive with reduced oestrogen content (author's transl)]

The action spectrum of an oral contraceptive which contained a reduced amount of the oestrogen component (0.04 mg ethinyl-oestradiol and 2.0 mg lynoestrenol) was investigated in 4 volunteer subjects. Serum levels of LH, 17 beta-oestradiol and progesterone were determined by radioimmunoassay and, in addition, the karyopyknotic index and cervical function were studied daily from the 8th day of the cycle. These parameters were determined in a control cycle, in the cycle during administration of the oral contraceptive and in the subsequent treatment-free cycle. Furthermore, the bleeding patterns were studied in 284 treatment cycles of 26 patients. Results of these studies indicate complete contraceptive protection by inhibition of ovulation and by an efficient cervical barrier action already during the first treatment cycle. Withdrawal bleeding was observed 3 to 4 days after ingestion of the last tablet. Spotting was recorded in 11 subjects during the first treatment cycle but was rarely observed during further treatment. Blood loss and bleeding control is comparable to that of other combined oral contraceptives with reduced oestrogen content.

[Changes in glucose tolerance, serum insulin and blood lipids during contraceptive medication (oestrogen-gestagen) in metabolically-healthy women (author's transl)]

A low-dosage combination type of contraceptive (oestrogen-gestagen) was given to 19 metabolically- healthy women of normal weight over a period of 6 months. Glucose tolerance, serum insulin and serum lipids were measured 1 month before, during and 2 months after medication. There was a slight decrease in the basal insulin values and an opposite trend in the basal blood glucose values, not exceeding 10 mg% in comparison to pretreatment values. The oral glucose tolerance test with a load of 100 g oligosaccharides did not show any statiscally significant changes during the 9 month observation period. The serum insulin curve, however, showed a delayed increase with a tendency to return to original values after medication had stopped. A slight degree of insulin resistance without change in glucose tolerance can, therefore, be assumed. There was a tendency for triglyceride values to increase over the observation period. A trend towards decreased cholesterol, on the other hand, was statistically insignificant. The observed changes were all within the normal range in all cases.

Experimental and clinical data on Cyclabil

The effects of a 2-phase preparation on the parameters of cycle function were studied in 14 normally menstruating women. The preparation, Cyclabil, is administered in a series of 11 tablets with 2.0 mg oestradiol valerate and 10 tablets with 2.0 mg oestradiol valerate in combination with 0.5 mg D,L-norgestrel. The cervical function, the spinnbarkeit of the cervical mucus and its crystallisability and, by means of RIA, FSH, LH, 17beta-oestradiol and the progesterone serum levels were determined continuously in a control cycle before the treatment, in the first and third treatment cycles and in a subsequent control cycle. The results show that no impairment of the normal cycle function were found during cyclical administration of the 2-phase preparation in 13 women. Two pregnancies occurred during the therapy. The process of ovulation was inhibited in one subject during the medication. 20 other women with pronounced premenopausal deficiency symptoms and cycle irregularities were treated with the 2-phase preparation for 6 months. Apart from the good cycle regulation, the deficiency symptoms were eliminated completely in 19 women and almost completely in 1 woman. Checks of the FSH, LH, 17beta-oestradiol and oestrone serum levels conducted at random during a medication cycle showed only a slight influence on the gonadotropin level. During the medication, E2 can be demonstrated in comparison to E1 at a ratio of 1:10.

Bioavailability of natural estrogens in young females with secondary amenorrhea

The bioavailability of 17 beta-estradiol valerate, free 17 beta-estradiol and Premarin was studied in 24 subjects suffering from secondary amenorrhea. 17 beta-estradiol and estrone were determined by specific radioimmunoassay systems. All estrogens were administered as single oral doses. The amounts applied were 2 and 10 mg of 17 beta-estradiol valerate or equivalent amounts of the free estradiol and Premarin, respectively. No elevations of 17 beta-estradiol serum levels were recorded at the lower dosages, whereas the increases of estrone serum levels were approximately tenfold over basal levels. Similar data were recorded in a group of 3 women with normal cycles after the ingestion of 2 mg of 17 beta-estradiol valerate. All subjects responded to the higher doses of estrogens with a moderate increase of 17 beta-estradiol serum levels, but with much higher elevation of estrone levels. These data suggest a rapid conversion of 17 beta-estradiol into estrone. The biological activity of 2 mg 17 beta-estradiol valerate is discussed on grounds of a possible metabolism of estrone sulfate at the target tissues.

[Blood coagulation and fibrinolysis in women receiving estrogen, gestagen and estrogen-gestagen-contraceptives (author's transl)]

Eight femal subjects received a contraceptive with a low estrogen content (Neogynon), the estrogen component (50 mug ethinylestradiol) and consecutively the gestagen component (250 mug D-Norgestrel) of the contraceptive. Each treatment cycle was followed by a control cycle. At various times of the control and therapy cycles several coagulation and fibrinolytic parameters were investigated. Statistical analyses were performed by multivariate two-factorial analysis of variance. Plasminogen exhibities a statistically significant increase during the treatment with ethinylestradiol and the combination of this steroid with D-norgestrel. No significant changes were found for all other parameters, including partial thromboplastin time, fibriogen, factors X, IX, VIII, factor VIII-related antigen, antithrombin III and fibrin(ogen)degradation products.