Clitoral vascularization and sexual behavior in young patients treated with drospirenone-ethinyl estradiol or contraceptive vaginal ring: a prospective, randomized, pilot study

INTRODUCTION

Oral contraceptives (OC) are effective for birth control and have good cycle control and tolerability. However, the hormonal components could modify mood and libido.

AIM

The aim of this study is to evaluate the genital vascular effects and sexual behavior of an OC containing 30 μg ethinyl estradiol and 3 mg drospirenone in comparison with a flexible combined contraceptive vaginal ring.

METHODS

Forty women underwent a sonographic assessment of the clitoral anatomy and vascularization and were administered the McCoy Female Sexuality Questionnaire (MFSQ) and the Beck's Depression Inventory questionnaire (BDI). Estradiol, androstenedione, testosterone, and SHBG were assayed. Free Androgen Index (FAI) and Free Estrogen Index (FEI) were calculated. The patients were randomly submitted to OC (group I; n = 21) or vaginal ring (group II; n = 19).

MAIN OUTCOME MEASURES

Ultrasonographic clitoral volume, pulsatility index (PI) of dorsal clitoral arteries, MFSQ, BDI, and hormonal and biochemical assays were analyzed.

RESULTS

After therapy, the testosterone levels were reduced in both groups, whereas estradiol decreased only in group I women. The SHBG increased in all the subjects, and both FAI and FEI decreased. The clitoral volume decreased in all the women. The PI of the dorsal clitoral artery increased only in patients on OC. The hormonal contraception was associated, in both studied groups, with a significant decrease of the two-factor Italian MFSQ score, which was more marked in OC users. In group I subjects, there was a reduction of the number of intercourse/week and a reduction of orgasm frequency during intercourse. The pain during intercourse worsened after OC use. The vaginal ring users reported a vaginal wetness.

CONCLUSIONS

Six-month treatment with hormonal contraception is associated with a diminished MFSQ score. However, the frequency of sexual intercourse and orgasm was reduced only by the use of OC. The OC use was associated with increased pain during intercourse.

Use of a preventive sling surgery for the simultaneous correction of latent stress urinary incontinence during the cystocele repair: two year follow-up

AIM

The aim of this paper was to assess the feasibility and utility of adding a preventive trans obturatory tape (TOT) during the same intervention for anterior prolapse repair, in patients with masked urinary incontinence and massive cystocele.

METHODS

A retrospective trial was conducted in a Tertiary care University Hospital. Ninety-nine women with a massive cystocele (Ba ≥2 cm of pelvic organ prolapse quantification) and an occult stress urinary incontinence were recruited from 2004 to 2010: 53 women were subjected to an anterior fascial reconstruction alone while 46 underwent the same intervention with the addition of TOT. Patients were also asked to rate their overall quality of life, using the International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms Quality Of Life (ICIQ-LUTSqol). All patients were assessed at one, six, twelve and twenty-four months of follow-up. Statistical analysis was performed with SPSS 15.0 software; SPSS inc., Chicago IL, USA was performed using the Chi-square test with Fisher's post-hoc correction.

RESULTS

At 24 month follow-up the rate of appearance of stress urinary incontinence at the urogynecological examination, was higher in the group without TOT (81% vs. 19%, P=0.004). In terms of overall quality of life, significantly higher rates of satisfaction have been reported by the group treated with additional TOT (P=0.006).

CONCLUSION

The addition of TOT during the anterior prolapse correction seems to give a greater durability to the correction, resulting, in the long term, in a lower rate of urinary symptoms onset (first latency) and in a better quality of life compared to the traditional anterior colporrhaphy alone.

Clitoral changes, sexuality, and body image during the menstrual cycle: a pilot study

INTRODUCTION

A relationship between sexual function and all body image variables has been reported. However, there are no studies analyzing the relationship between menstrual cycle, body image, and sexuality.

AIM

To evaluate clitoral changes, sexual behavior, and perceived body image during the menstrual cycle.

METHODS

Twenty-four women underwent ultrasonographic (US) clitoral measurements, color Doppler evaluation of the clitoral artery, and hormonal testing. In addition, they were administered the McCoy Female Sexuality Questionnaire (MFSQ), the Stunkard Figure Rating Scale (FRS), and the Beck's Depression Inventory questionnaire (BDI).

MAIN OUTCOME MEASURES

The main outcome measures were clitoral volume, clitoral artery pulsatility index (PI), the MFSQ, the FRS, and the BDI.

RESULTS

The subjects had a mean age of 29.3 ± 4.5 years and a mean body mass index (kg/m(2)  = BMI) of 21.2 ± 2.0. US and color Doppler assessments showed significant increase in clitoral body volume (P = 0.039) and a decrease in the PI (P = 0.027) of the clitoral artery during the periovulatory phase of the menstrual cycle. These changes were significantly and positively correlated with estradiol levels (P = 0.009 and P = 0.017, respectively). The two-factor Italian MFSQ for sexuality and partnership was similar in all the phases of the cycle. The number of intercourses/week slightly increased in the periovulatory phase. The mean BDI was normal in all women and did not change during the cycle. The FRS showed no difference in all examined parameters during the three phases of the menstrual cycle.

CONCLUSIONS

In young, lean, eumenorrheic Italian women, there is no significant change, during the menstrual cycle, in sexual function, body image perception, and symptoms of depression, as assessed by the two-factor Italian MFSQ for sexuality and partnership, the FRS, and the total BDI score. However, our results suggest that estrogens, influencing clitoral anatomic and vascular changes, may favor genital arousability.

2D and 3D Ultrasound Examination of Labia Minora

The aim of the study was to prospectively evaluate, by using 2D/3D ultrasonography and 3D color Doppler analysis, the morphological and vascular changes in the labia minora during the menstrual cycle of women not sexually aroused. A total of 81 young, healthy eumenorrheic women, in a stable heterosexual relationship (>1 year) and without any sexual dysfunction, underwent 2D/3D ultrasound and color Doppler examination of the labia minora on Days 3-5 and 12-14 of the menstrual cycle. Estradiol serum levels were also evaluated. Estradiol plasma levels increased in the periovulatory phase. The labia minora thickness increased from the follicular (3.8 ± 0.3 mm) to the periovulatory phase (4.6 ± 0.4 mm; p = .005). Furthermore, in the periovulatory phase, the vaginal introitus area and the angles were wider than in the follicular phase. The Pulsatility Index of the posterior labial artery significantly decreased in the periovulatory period. Three-dimensional power Doppler indices of vascularization and blood flow in the labia minora significantly increased in the periovulatory period. The relationship between the different parameters showed that estradiol was positively correlated with labia minora thickness and vaginal introitus area and angles. Furthermore, the circulating levels of estradiol were negatively correlated with posterior labial artery PI and positively correlated with other indices of labia minora vascularization. In conclusion, it seems that estrogen production may influence the anatomic and vascular changes of the labia minora during the menstrual cycle and these changes can be easily identified by ultrasound.

Drospirenone and cardiovascular risk in lean and obese polycystic ovary syndrome patients: a pilot study

OBJECTIVE

We sought to verify if an oral contraceptive (OC) containing drospirenone affects the cardiovascular risk of patients with polycystic ovary syndrome (PCOS).

STUDY DESIGN

A total of 28 women with PCOS (16 lean [group A] and 12 overweight [group B]) were assessed at baseline and after 6 months therapy with an OC. Leptin, homocysteine, endothelin-1, and flow-mediated dilatation of brachial artery were measured.

RESULTS

The brachial artery diameter and the pulsatility index, after the reactive hyperemia, did not change in group A; it improved significantly in group B after 6 months of treatment. At baseline and after therapy the plasma levels of homocysteine and endothelin-1 did not differ among the groups. Leptin was significantly lower at baseline in group A compared to group B.

CONCLUSION

The OC containing drospirenone does not seem to affect the surrogate markers of cardiovascular risk in lean patients with PCOS.

The role of 3-D ultrasonography in the evaluation of menstrual cycle-related vascular modifications of the clitoris. A prospective pilot study

INTRODUCTION

Clitoral functional modifications occur during the menstrual cycle.

AIM

To prospectively evaluate, by the three-dimensional (3-D) Doppler flow analysis, the hemodynamic clitoral blood flow variations during the menstrual cycle. METHODS. Fourteen young (18-35 years), eumenorrheic (menstrual cycle of >25 and <35 days) women in a stable heterosexual relationship (>1 year) and without any sexual dysfunction (as resulted from the two-factor Italian McCoy female sexuality questionnaire > or =35) were submitted, in the early follicular (day 3-5) and in the periovulatory (day 12-14) phases of the menstrual cycle, to bi- and tridimensional ultrasonographic and color Doppler analyses of the clitoral structures. On the same days, the circulating estradiol values were assayed. MAIN OUTCOMES MEASURES. Two-dimensional ultrasonographic evaluation of follicular diameter and color Doppler evaluation of the dorsal clitoral arteries; 3-D power Doppler analysis of the clitoral body volume and of the indices of clitoral vascularization and blood flow; estradiol assay.

RESULTS

The mean virtual organ computer-aided analysis (VOCAL) volume of the clitoral body was lower in the follicular (0.79 +/- 0.19 mL) phase with respect to the periovulatory phase (0.98 +/- 0.22 mL; P < 0.001); the clitoral arteries demonstrated a significant decrease of the pulsatility index (PI) from the follicular (1.75 +/- 0.18) to the periovulatory phase (1.26 +/- 0.21; P = 0.002); the 3-D power Doppler histogram analysis showed significant changes of the indices of vascularization and blood flow (vascularization index [VI] = 2.239 +/- 1.201 vs. 3.302 +/- 1.305, P = 0.001; flow index = 27.290 +/- 2.454 vs. 33.620 +/- 1.712, P < 0.001; vascularization flow index = 0.578 +/- 0.573 vs. 1.091 +/- 0.461; P = 0.001) between the follicular and the periovulatory phase of the menstrual cycle. The relationship between the different parameters evidenced that estradiol is positively correlated with the VOCAL clitoral body volume (r = 0.512; P = 0.033) and inversely correlated with the dorsal clitoral artery PI (r = -497; P = 0.048) and with VI (r = 0.622; P = 0.011).

CONCLUSIONS

During the normal menstrual cycle, the estrogens may, probably, influence the clitoral anatomic and vascular structures and the 3-D ultrasonography may easily and precisely demonstrate these modifications.

Periovulatory morphometric and vascular modifications of the clitoris in young adult and middle-aged women. A pilot study

INTRODUCTION

A decline in sexual activity has been reported as women age.

AIM

To compare, in young adult and middle-aged women, the clitoral volumetric and vascular modifications during the periovulatory phase of the menstrual cycle, and to analyze their relationship with circulating hormones, nitric oxide levels, and with questionnaires on sexuality, relationship, and depression.

METHODS

Fifteen young (18-25 years; Group I), and 16 middle-aged (35-45 years; Group II) eumenorrheic women were submitted, on day 14 of their menstrual cycle, to utero-ovarian and clitoral ultrasonographic analysis, and to color Doppler evaluation of the uterine and dorsal clitoral arteries. On the same day, hormonal parameters and plasma concentrations of nitrites/nitrates were assayed, and the two-factor Italian McCoy female questionnaire and the Beck's Depression Inventory questionnaire were administered.

MAIN OUTCOMES MEASURES

Utero-ovarian and clitoral ultrasonographic analysis, color Doppler evaluation of the uterine and dorsal clitoral arteries; evaluation of hormonal and nitrites/nitrates plasma concentrations; administration of the two-factor Italian McCoy Female Sexuality Questionnaire and the Beck's Depression Inventory questionnaire. RESULTS. The plasma levels of estradiol, testosterone, sex hormone binding globulin, and nitrites/nitrates were similar in both groups. Neither the ultrasonographic assessment of the clitoral body volume (0.82 +/- 0.24 mL vs. 0.73 +/- 0.26 mL) nor the Doppler analysis of the dorsal clitoral artery [pulsatility index (PI) = 1.35 +/- 0.31 vs. PI = 1.36 +/- 0.19] evidenced any significant differences in either Group I or Group II. The two-factor Italian McCoy Female Sexuality Questionnaire and the Beck Depression Inventory questionnaire gave the same results in Group I and Group II. The relationship between the different parameters evidenced that the NO(2-)/NO(3-) circulating levels are inversely correlated with uterine artery (r = -0.4611; P = 0.008) and dorsal clitoral artery (r = -0.331; P = 0.041) PIs. Furthermore, estradiol resulted inversely correlated with depression (r = -0.332; P = 0.045). The two sections (sexuality and partnership) of Italian McCoy Female Sexuality Questionnaire were positively correlated (r = 0.849; P < 0.0001) between each other.

CONCLUSIONS

In eumenorrheic young adult and middle-aged women, the periovulatory clitoral anatomic and vascular modifications similarly occur.

Ultrasonographic and Doppler findings of subclinical clitoral microtraumatisms in mountain bikers and horseback riders

INTRODUCTION

Repeated microtraumas in horseback riders and mountain bikers are, in males, associated with perineal and scrotal lesions. No data are reported in the females.

AIM

To report five cases of clitoral microcalcifications, diagnosed by ultrasonography, in six healthy, eumenorrheic athletes, and to verify the clinical and sexual impact of the ultrasonographic findings.

MAIN OUTCOME MEASURES

Translabial ultrasonographic evaluation of the clitoris, Doppler analysis of dorsal clitoral arteries, and the two-factor Italian McCoy Female Sexuality Questionnaire (MFSQ) METHODS: The patients were assessed with a detailed history, and were submitted, in the periovulatory phase of the cycle (day 14), to clitoral ultrasonographic analysis and color Doppler evaluation of the dorsal clitoral arteries. The women were not sexually aroused. On the same day, in a separate room--and prior the ultrasound and Doppler examinations took place--the subjects completed the two-factor Italian MFSQ.

RESULTS

All the patients were completely asymptomatic but reported a past history of intermittent perineal tenderness or discomfort. In five out of the six subjects, the ultrasonographic assessment of the clitoris evidenced a disseminated clitoral microlithiasis. Only the youngest (18 years old) biker showed a normal pattern of the clitoral structures. A normal clitoral body volume (0.68 +/- 0.21 mL) and a normal mean dorsal artery pulsatility index (PI) was found (PI = 1.75 +/- 0.32) in all the patients. The two-factor Italian MFSQ showed a mean value of 42 +/- 4 (range 37-45).

CONCLUSIONS

The chronic traumatisms may be responsible, especially in well-trained riders, for microhematomas, inflammation, and/or degenerative processes at level of the clitoral structure. Further studies should be undertaken to determine the clinical significance of the described disseminated clitoral microlithiasis.

Cardiovascular risk in normal weight, eumenorrheic, nonhirsute daughters of patients with polycystic ovary syndrome: a pilot study

OBJECTIVE

To verify whether healthy daughters with polycystic ovaries (PCO) of patients with polycystic ovary syndrome (PCOS) have an increased risk of cardiovascular disease in comparison with healthy controls.

DESIGN

Prospective observational study.

SETTING

University hospital.

PATIENT(S)

Seventeen eumenorrheic daughters with PCO of patients with PCOS (group 1) and 20 healthy volunteers (group 2) with regular ovulatory cycles.

INTERVENTION(S)

Fasting blood sampling, ultrasonographic and Doppler analyses, 24-hour ambulatory blood pressure monitoring.

MAIN OUTCOME MEASURE(S)

Medical examination; blood measurement of nitrites and nitrates, biochemical and hormonal parameters; utero-ovarian ultrasonographic analysis and color Doppler evaluation of uterine and stromal ovarian arteries; brachial artery flow-mediated vasodilatation; 24-hour ambulatory blood pressure monitoring. An oral glucose tolerance test was performed to analyze glucose, insulin, and C-peptide levels.

RESULT(S)

At Doppler analysis a significantly higher uterine and a lower ovarian artery pulsatility index was found in group 1 compared with group 2. The brachial artery diameter, after the reactive hyperemia, showed a greater vasodilatation in controls in comparison with women with PCO. The 24-hour blood pressure monitoring demonstrated that patients with PCO have significant higher 24-hour, daytime, and nighttime diastolic and mean arterial pressure values than controls. The nitrites and nitrates plasma levels were lower in group 1 compared with group 2. The glucose and insulin plasma values were higher in patients with PCO than in controls.

CONCLUSION(S)

Eumenorrheic nonhirsute daughters of patients with PCOS who have PCO appearance on ultrasound have an increased cardiovascular risk.

Effects of high doses of recombinant human follicle-stimulating hormone in the treatment of male factor infertility: results of a pilot study

We performed a randomized double-blind placebo-controlled study on seminal parameters and endocrine profile of 30 normogonadotropic patients with male factor infertility to assess the efficacy of treatment with recombinant human FSH (rhFSH) at high doses (300 IU on alternate days) for a period of >or=4 months. The treatment induced a marked increase in sperm count, a slight increase in sperm motility, no change in sperm morphology, and an evident increase only in FSH serum levels, showing that a prolonged treatment with rhFSH at high doses led to an evident improvement of sperm count in normogonadotropic infertile patients with idiopathic oligoasthenozoospermia.

Uterine vascularization and pregnancy outcome in patients undergoing intracytoplasmatic sperm injection: the role of nitric oxide

PURPOSE

To evaluate whether, after pituitary desensitisation, the impedance to flow in the uterine vessels may be an indicator of an ICSI programme outcome, and to test the relationship between intrafollicular nitric oxide and oocyte/embryo quality.

METHODS

Thirty-eight women, on the basis of impedance to flow at the level of uterine artery, evaluated on the first day of COH, were divided in patients with normal (Pulsatility Index--PI, 2.5; Group II, n=27) PI values. The patients were submitted to hormonal, ultrasonographic and Doppler evaluations. Plasma and follicular fluid concentrations of nitrites/nitrate (NO(2) (-)/NO(3) (-)) were assayed.

RESULTS

In the Group I, the impedance to flow remained lower than in Group II and was associated to good quality embryos and to a higher pregnancy rate. Follicular fluid NO(2) (-)/NO(3) (-) levels were inversely correlated with the embryo quality. The uterine artery PI and the pregnancy rate were inversely correlated. The PIs analysed on the day 1 of stimulation, were positively correlated with those registered on day 8 and on the day of ovum pick-up.

CONCLUSIONS

A Doppler analysis done on day 1 of controlled ovarian hyperstimulation may be an useful indicator of ART outcome.

Abnormalities of somatic peptide-containing nerves supplying the pelvic floor of women with genitourinary prolapse and stress urinary incontinence

OBJECTIVES

To test the hypothesis that genital prolapse may be related to peripheral nerve abnormalities, we examined the changes occurring to peptide-containing nerve processes supplying the periurethral muscles in women with stress urinary incontinence associated with prolapse.

METHODS

Thirty patients with genital prolapse and 10 age-matched control subjects entered the study. All patients were evaluated by urodynamic investigations. Ten of 30 patients had pure stress urinary incontinence; none of the control subjects was incontinent. During surgery, four biopsy samples were obtained from each woman from the periurethral and perirectal muscles. The muscle sections were processed for immunohistochemistry using specific antibodies to glial (S-100 protein) and general neuronal markers (neuron-specific enolase) and neuropeptides, including neuropeptide Y, vasoactive intestinal polypeptide, and substance P. The evaluation of immunolabeled nerves was based on a semiquantitative analysis that allowed for a four-point ordinate scale score.

RESULTS

S-100 and neuron-specific enolase immunoreactive nerve fibers, running either singly or in small bundles, along with a dense network of neural processes containing neuropeptide Y, vasoactive intestinal polypeptide, and substance P, were found throughout the connective tissue and striated muscle of the control specimens. In contrast, in the muscle specimens from those with genitourinary prolapse, both the density and the intensity of neuropeptide Y, vasoactive intestinal polypeptide, and substance P immunoreactive nerves were markedly reduced compared with the control specimens.

CONCLUSIONS

The evidence of a reduced peptide-containing nerve supply to the perineal muscles provides a morphologic basis suggesting that neural abnormalities contribute to the pathogenesis of genital prolapse and urinary incontinence.

T-helper 2-cytokine levels in women with threatened abortion

OBJECTIVE

Considering that successful embryo development has been immunologically attributed to a T-helper 2 phenomenon and that threatened abortion is a very frequent but pathogenetically not well-defined clinical entity, our purpose was to investigate serum levels of the main T-helper 2-type cytokines during the evolution of this condition.

STUDY DESIGN

Three T-helper 2-type cytokines (interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-13 (IL-13)) were measured by an enzyme-linked immunosorbent assay (ELISA) in serum of 12 women with threatened abortion both at hospital admission and discharge time. Fourteen women with missed abortion, 14 normal pregnant women and 14 normal non-pregnant women represent study control groups.

RESULTS

Serum concentrations of the selected T-helper 2-type cytokines showed no significant differences in women with threatened abortion with those of normal pregnant and non-pregnant women, whereas showed significantly lower values in women with missed abortion.

CONCLUSION

Our data (a) confirm the concept that first-trimester normal pregnancy is a T-helper 2 phenomenon, (b) show that threatened abortion, when T-helper 2-biased, may tend to a positive evolution of the condition, (c) display that interleukin-10, particularly, may represent a useful diagnostic and prognostic marker for predicting the normal continuance of the pregnancy in threatened abortion, (d) confirm the existence of a T-helper 2-type pattern deficiency in missed abortion, and finally (e) may open the way to new T-helper 2-biased immune therapies in case of difficult first-trimester pregnancies.

A histological and immunohistochemical study of neuropeptide containing somatic nerves in the levator ani muscle of women with genitourinary prolapse

BACKGROUND

To evaluate the changes occurring in the somatic innervation throughout the levator ani muscle in women with genitourinary prolapse and stress urinary incontinence (SUI).

METHODS

Thirty-four patients with genital prolapse entered the study and ten subjects with non-malignant pathologies acted as a control group. All patients were evaluated by urodynamic investigation and an electromyographic study of pelvic floor muscles to define the type of urinary incontinence. Biopsy samples were obtained from both groups of patients: the site of muscle biopsies were left and right part of perirectal pubococcygeus muscle. The evaluation of immunoreactivity was semiquantitative and based on staining intensity and distribution.

RESULTS

In all cases, S-100 protein and NSE immunoreactivities were found in nerve fascicles running throughout the striated muscle. NPY and VIP positivities were more intense and diffuse, whereas SP immunoreactivity was quite scanty. The different patterns of NPY and VIP expression changed in relation to degree of genital prolapse and to the presence of SUI.

CONCLUSIONS

Our immunohistochemical study shows the presence in the pelvic floor of neurons that are able to synthesize neuropeptides. The lower immunoreactivity score of same neuropeptides (VIP, NPY) observed among patients with third degree genital prolapse and with SUI could be related to biochemical damage of the neurons with subsequent lower production of chemical messengers.

Prophylaxis of venous thrombosis after gynaecological surgery: a controlled pilot study of defibrotide

BACKGROUND

Defibrotide (Def), a new antithrombotic drug, has been proposed as a prophylactic agent in postoperative DVT. Most of the studies to date, however, have either not been controlled or have used unverifiable systems for asymptomatic DVT diagnosis. This randomized pilot study compared Def versus standard low-dose calcium heparin (CH) prophylaxis after gynaecological surgery, using objective criteria for DVT diagnosis.

METHODS

Forty-one pts received 400 mg Def intramuscularly twice a day starting the day before surgery; 40 pts received 5000 IU CH s.c. twice daily beginning 2h before surgery. The two groups were well matched for all relevant risk factors. DVT was diagnosed by means of the 125I fibrinogen uptake test (FUT) and venography. Blood coagulation and fibrinolysis tests were also carried out perioperatively.

RESULTS

Isotopic DVT (FUT-positive for two consecutive days) was recorded in 6 (14.6%) of the Def and 5 (12.5%) of the CH groups. In cases where FUT was positive for at least three consecutive days (4 in Def and 1 in CH), venography confirmed DVT in 3 cases (all in the Def group). No side-effects were recorded in either group and the amounts of transfused blood were not different. No significant differences in blood coagulation or fibrinolysis tests were recorded, except for higher fibrinogen levels on the 8th post-operative day in the Def group.

CONCLUSIONS

These results do not indicate any trend suggesting that Def, as a prophylactic agent in gynaecological surgery, offers any clinical or practical advantages over standard low-dose heparin prophylaxis.

An enzyme-linked immuno sorbent assay for salivary estriol during normal pregnancy

It has been recently demonstrated that the concentration of Estriol in saliva increases in the course of pregnancy, similarly to the plasmatic concentration of unconjugated and total Estriol. As an alternative to RIA, which is an expensive method and requires a highly specialized laboratory, there is now available a competitive, sensitive and rapid enzyme-linked immuno sorbent assay (ELISA) for Estriol in saliva and plasma. Aim of this study is to compare the levels of Estriol concentration, measured by RIA and by ELISA in saliva and plasma in seven women tested every week from the 30th week to the term of pregnancy.

ELISA for salivary and plasma estriol in pregnancy

A competitive, sensitive, and rapid enzyme-linked immunoadsorbent assay (ELISA) was developed for the determination of estriol in saliva and in plasma. Horseradish peroxidase (HRP) was used as the label enzyme; separation between free and bound steroid was carried out by insolubilized antibody prepared by adsorbing purified IgG of rabbit anti-6-oxoestriol-6-(O-carboxymethyl)oxime-BSA on polystyrene balls. The enzyme activity was measured by a colorimetric reaction using o-phenylenediamine dihydrochloride and hydrogen peroxide as substrate. The sensitivity of the assay was 12 pg/tube. In order to compare ELISA to RIA estriol estimations in different biological fluids, we selected six women during normal pregnancy, from the 30th to the 40th week of gestation. Salivary estriol was assayed by direct and extraction methods, while the corresponding plasma samples of the same subjects were analyzed only for unconjugated estriol by an extraction method. A good agreement was found between the results obtained by RIA and ELISA: r = 0.897, p less than 0.001 between direct RIA and direct ELISA in saliva; r = 0.909, p less than 0.001 between extraction RIA and direct ELISA in saliva; and r = 0.916, p less than 0.001 between extraction RIA and extraction ELISA in plasma. A good correlation (r = 0.793, p less than 0.001) was present between plasma samples by RIA and saliva samples by ELISA (direct method). These results indicate that: ELISA is a reliable method for the determination of estriol in plasma and saliva. Saliva samples can be used for the assay of estriol and therefore for the assessment of fetal conditions during pregnancy.

[Cyproterone acetate - ethinylestradiol treatment of hirsutism, acne, seborrhea and alopecia]

Twenty-five female patients, aged 14 to 49, and suffering from syptoms of virilization (hirsutism, acne, seborrhea and alopecia) were treated with an estrogen-progestogen combinantion, i.e. cyproterone acetate and ethinylestradiol, having antiandrogenic and antiovulatory action. Patients were submitted to monitoring by means of a series of laboratory tests in order to detect any toxic or hormonal effects that might occur. In most cases symptoms of virilization were significantly reduced, while untoward side effects were not noted.

[Androgenic treatment with depot mesterolone in dyspermia]

The clinical use of testosterone, and more recently of orally administered mesterolone in disorders of male fertility is of limited therapeutic efficacy, as shown by data found in the literature. On the basis of these considerations, the authors have tested mesterolone cyclopentylproprionate in 15 subjects suffering from sperm disorders. The drug, which is slowly released in the tissues has been parenterally administered at a total dose of 1,200 mg (100 mg per week). During the therapeutic trial the following aspects have been studied: spermiologic and hormonal patterns, general conditions, libido, principal organic functions and the possible side effects. Results are critically evaluated.