A 2-year comparative study of endometrial histology and cervical cytology of contraceptive implant users in Birmingham, UK

The objectives of this study were to evaluate the endometrial histology and cervical cytology of users of two contraceptive implants releasing etonogestrel/3-keto-desogestrel (Implanon) and levonorgestrel (Norplant) in West Midlands (UK) users. A 2-year prospective randomized design was used to study 60 implant users. Endometrial histology and cervical cytology were compared before insertion and after 12 and 24 months. At the end of 12 months, the majority of samples were inactive/weakly proliferative in both groups. At the end of 24 months, this remained unchanged in the Implanon group whereas the pattern was more diverse in the Norplant group. Endometrial thickness was significantly reduced in both groups during treatment. Cervical cytology remained unchanged. It is concluded that, after 2 years, there was no evidence of an increasing risk of endometrial hyperplasia, endometrial carcinoma, cervical intra-epithelial neoplasia or cervical carcinoma in either of the two groups of implant users.

Clinical and in situ cellular responses to Haemophilus ducreyi in the presence or absence of HIV infection

We aimed to determine if the clinical and histological features of chancroid are altered by HIV infection. Male patients presenting to the Nairobi special treatment clinic with a clinical diagnosis of chancroid were eligible for the study. A detailed history, physical examination, swabs for Haemophilus ducreyi culture and blood for HIV serology, syphilis serology and CD4 counts were obtained from all patients. Punch biopsies from an ulcer were obtained from 10 patients and either fixed in 10% formalin or snap frozen in Optimum Cutting Temperature (OCT) medium compound at -70 degrees C. Patients were treated with erythromycin and followed for 3 weeks. Chi-square and Student's t-test were used to determine if the clinical and laboratory features of chancroid differed between HIV-seropositive and seronegative individuals. Cox regression survival analysis was used to determine if HIV infection altered cure rates of chancroid at 21 days. Immunohistochemical staining was performed using lymphocytic and macrophage markers and tissue sections were analysed by 2 pathologists in a blinded manner. Between February and November 1994, 109 HIV-seropositive and 211 HIV-seronegative individuals were enrolled in the study. HIV patients had ulcers of longer duration than HIV-seronegative patients (P=0.03). Although cure rates were similar at 3 weeks, HIV patients had lower cure rates at 1 week (23% v 54%, P=0.002). A dense interstitial and perivascular inflammatory infiltrate extending from the reticular to deep dermis was present in all biopsies. This consisted of equal amounts of CD4 and CD8 T-lymphocytes as well as macrophages. The histological and immunohistochemical picture was identical for HIV-positive and negative patients. HIV infection slows the healing rates of chancroid ulcers despite appropriate antibiotic therapy. This clinical difference cannot be attributed to an altered histopathological response to HIV infection. Additional studies are needed to elucidate the mechanisms responsible for this finding.

Morphological and functional features of endometrial decidualization following long-term intrauterine levonorgestrel delivery

Irregular bleeding remains a common reason for the discontinuation of progestin-only contraception. The levonorgestrel releasing intrauterine system (LNG-IUS) has profound morphological effects upon the endometrium. Specific features are gland atrophy and extensive decidual transformation of the stroma. Morphological changes in the endometrium may be associated with perturbation of mechanisms regulating normal endometrial function. This study describes endometrial stromal and glandular features prior to and up to 12 months following insertion of the LNG-IUS. Comparison is made with first trimester decidua. In order to elucidate further mechanisms governing endometrial function with local intrauterine delivery of LNG, we here report histological features consistent with decidualization; a significant increase in granulocyte-macrophage colony stimulating factor (GM-CSF) immunoreactivity in decidualized stromal cells; glandular and stromal prolactin receptor expression and an infiltrate of CD56 + large granular lymphocytes and CD68 + macrophages. We are unaware of previous reports which have documented longitudinally both morphological and functional observations in endometrium exposed to local intrauterine levonorgestrel delivery. These studies demonstrate that long-term administration of intrauterine levonorgestrel results in features of altered morphology and function. No correlation was apparent between the end points in the study and the bleeding patterns described by the subjects. Further evaluation of these features in the context of menstrual bleeding experience may contribute to a better understanding of this troublesome side-effect which often leads to dissatisfaction and discontinuation of the intrauterine system.

Water: mechanism of oral rehydration, water deficiency = deficiency in salt

UNICEF, the United Nations International Children Emergency Funds, has staged an enormous program to improve children's health conditions in the developing countries. One extremely fruitful field of engagement was, and still is, the treatment of dehydration. Oral rehydration therapy (ORT) has reluctantly been accepted in the industrialized countries. From clinical observations, we have gained a new understanding of known pathophysiological principles. Dehydration most often is a result of diarrhea, and therefore oral rehydration therapy is mostly referred to in the context of infections of the digestive system. We discuss additional causes of dehydration and its immediate and secondary consequences. We demonstrate not only that, but why and how, a very simple, inexpensive regimen is beneficial and effective in the treatment of dehydration. Without consideration of sodium deficit, understanding will fail, and treatment will remain ineffective.

Influence of menstrual cycle, parity and oral contraceptive use on steroid hormone receptors in normal breast

Steroid receptor was assessed immunohistochemically in 158 samples of normal breast for variation through the menstrual cycle. Patterns and intensity of reaction were used in a semi-quantitative scoring system to examine the influence of cycle phase, cycle type, parity and age. The changes in oestrogen receptor for natural cycle and oral contraceptive (OC) cycles indicated down-regulation by progestins. Progesterone receptor did not vary significantly in natural cycles, but increased steadily through OC cycles. This study provides strong evidence that both oestrogen and progesterone influence breast epithelium, but dissimilarities from the endometrium are apparent. The interval since pregnancy had a significant negative effect on frequency and score of oestrogen receptor and score of progesterone receptor. Multivariate analysis established the phase of cycle and OC use as independent significant influences on oestrogen receptor. The interval since pregnancy was an independent significant factor for both oestrogen and progesterone receptor presence.

Correlation of HPV antigen and type of genital warts with atypia

Five clinical types of genital warts were identified, studied histopathologically and stained for human papilloma virus (HPV) antigen. HPV antigen was found in all degrees of koilocytosis and it was present more often in the hyperplastic warts than in other types of genital warts. However, as reported earlier, the presence of HPV antigen did not decrease proportionately as the degree of atypia increased.

Diaphragm insertion increases human vaginal oxygen tension

The normal insertion of a contraceptive diaphragm into the vagina of five young women induced a dramatic increase in the vaginal oxygen tension (131 +/- 13 mm Hg, mean +/- SD, n = 5), which slowly fell at an initial rate of 0.9 +/- 0.2 mm Hg/min. Withdrawal of the diaphragm immediately restored vaginal oxygen tension to the normal hypoxic state (11 +/- 12 mm Hg). The change in gaseous equilibrium created by the trapped air of the diaphragm could have significant actions on the microbial activity and balance of the vagina.

Clinical and histopathological aspects of Kaposi's sarcoma in Africa: relationship with HIV serology

From 1983 to 1987, 45 Kaposi's sarcomas (KS) were diagnosed at the University Hospital in Bangui; 37 cases were easily classified as either endemic or AIDS-related KS on clinical grounds and HIV serology. Moreover, probably due to the stage at which patients consulted and lesions were sampled, noticeable histopathological differences were observed between the two clinical presentations. But for 8/45 which we classified as "borderline KS", strong discrepancies occurred between clinical aspects, patient evolution, HIV serology and histopathology. In two cases, HIV-positive patients had typical endemic non-evolutive KS and have survived 15 and 36 months.

The effects of vasectomy on the autonomic innervation of the human vas deferens

Neurohistochemical and fine structural techniques have been employed to examine the intramural autonomic innervation of the human vas deferens following surgical division of the duct one to 15 years previously. Samples from sites on the distal (testicular) and proximal (urethral) aspects of the original vasectomy have been compared with control specimens obtained at vasectomy as to the arrangement and distribution of autonomic nerves. In contrast with tissue from the proximal part and from controls, the distal samples revealed a marked reduction in the noradrenergic innervation of the muscle coat. In addition acetylcholinesterase-containing nerves associated with the basal aspect of the epithelium were usually absent from the distal portion of the vas deferens. These findings have been considered in relation to the contractile and secretory activities of the organ following vasovasostomy and may be of importance to the maturation and fertility of spermatozoa.

The human respiratory nasal mucosa in females using contraceptive pills. An ultramicroscopic and histochemical study

The ultrastructure and histochemical changes in 25 females using contraceptive pills were studied. Fifteen pill-using females developing no nasal symptoms showed similar changes to those observed in symptom-free pregnant females. Ten pill-using females developing nasal symptoms showed squamous metaplasia, interepithelial oedema, glandular hyperplasia, histiocytic proliferation and fibrous tissue deposition, all attributed to the action of oestrogen. Their histochemical reactions were similar to those of chronic hypertrophic non-allergic rhinitis.

[Histological and cytological changes in women using intrauterine contraceptive devices (author's transl)]

We studied 175 surgically removed uteri containing intrauterine devices. As described, we found that inert and bioactive devices produced diverse histological changes. Cytological changes of the glandular and squamous epithelium are mentioned and evaluated.

The response of endometrial blood vessels to intrauterine contraceptive devices: an electron microscopic study

The ultrastructure of the vascular supply of the endometrium in uteri containing inert and copper bearing intrauterine contraceptive devices (IUCDs) has been compared with that in uteri removed at comparable stages of the menstrual cycle for dysfunctional uterine bleeding. In the endometrium from all uteri containing inert and copper IUCDs, stromal capillaries below the devices showed extensive microthrombosis with platelet and fibrin aggregations filling gaps in the endothelial linings of the vessels. Considerable stromal haemorrhage and erosion of surface epithelium was associated with this vascular pathology. In the uteri removed for dysfunctional bleeding, microthrombosis was a rare occurrence. In the stromal vessels of the endometrium not in contact with the devices, the surface epithelium was usually intact and the underlying stromal capillaries often showed breaks in the endothelial lining but without a haemostatic plug. Leucocyte migration into the stroma was more evident in association with the copper IUCDs than the other devices. The ultrastructural changes in the microvasculature of the endometrium associated with IUCDs did not appear to be related to a stage of the menstrual cycle. The extent and type of microvascular changes appeared to be related to the proximity and surface area of the IUCD and to the presence or absence of copper in the device.

The interaction of clomiphene, estradiol, and progesterone in the control of rat uterine glycogen metabolism

Uterine glycogen accumulation was studied in ovariectomized rats treated with all combinations of clomiphene citrate (0.25 mg/kg) estradiol (1.0 micron g) and progesterone (5.0 mg). The rats were given three consecutive daily dosages and killed 24 hours after the final dosage. Based on biochemical data, either estradiol or clomiphene increased uterine glycogen concentration and total glycogen, but progesterone did not. Progesterone significantly suppressed both the estradiol and clomiphene-induced glycogen increases. Based on the histochemical results, progesterone also suppressed the estradiol and clomiphene-induced glycogen responses, but the tissue affected differed. Clomiphene markedly increased luminal epithelial glycogen whereas estradiol induced primarily myometrial glycogenesis. Progesterone completely suppressed the clomiphene-induced epithelial effect and partially suppressed the estradiol-induced myometrial effect. Clomiphene also suppressed the estradiol-induced myometrial response. The results indicate that progesterone does have a significant interaction with clomiphene in the control of uterine morphology and biochemistry. The results also stress the importance of correlated histochemical and biochemical studies in the study of clomiphene-induced uterine glycognesis.

Histochemical studies of delta5-3beta-, 20lapha- and 20beta-hydroxysteroid dehydrogenases and possible progestagen production in hamster eggs

Hamster eggs at various developmental stages were studied histochemically fro the presence of delta5-3beta-hydroxysteroid dehydrogenase (HSD) (pregnenolone as the substrate and NAD as the cofactor), 20alpha-HSD (20alpha-hydroxypregn-4-en-3-one and NADP) and 20 beta-HSD (20beta-hydroxypregn-4-en-3-one and NAD). All three enzymes were absent from ovarian eggs but were demonstrated in unfertilized and fertilized eggs up to the blastocyst stage. The activities varied only slightly.

Influence of a progestogen on carbohydrate histochemical and histologic features of the ampulla of the bovine uterine tube

In the present experiment, study was made of the effects of melengestrol acetate given to heifers (0.5 mg for 14 days, starting at day 15 of the estrous cycle) on carbohydrate histochemical and histologic features of the ampulla of the uterine tube (oviduct). Melengestrol acetate-treated animals had significantly (P less than 0.5) fewer fertilized ova at 3 days after mating (50%) as compared with control animals (100%). Estrussynchronization treatment with melengestrol acetate reduced the amount of cytoplasmic and nuclear extrusions from the secretory cells of the uterine tubular ampulla, but did not alter the amount or types of mucosubstances within these cells.

Enzyme histochemistry of cultured ovarian cells. I. Histochemistry of porcine preovulatory granulosa cells in culture

Histochemical activity of hydroxysteroid dehydrogenases as well as alkaline and acid phosphatase was investigated in porcine granulosa cells cultured in vitro. Granulosa cells, isolated from preovulatory procine ovarian follicles, during in vitro culture showed activity of enzymes participating in steroid biosynthesis. High activity of delta53betta0H-SDH and G6P-DH as well as the activity of alkaline phosphatase, appearing in the course of culture, could be evidence of progressive luteinization of the cells. Activity of 17beta0H-SDH was lower and exhibited strong fluctuations, similarly low was 20xOH-SDH. Gonadotropic hormones caused the increase of synthesis and accumulation of intracellular lipids. They stimulated alkaline and acid phosphatase, and also the activity of the dehydrogenases. LH had the most visible effect. Estradiol stimulated the activity of acid but not alkaline phosphatase and was not influencing, even lowering the activity of dehydrogenases.

Sequential histopathological and biochemical events in rat caput epididymis after alpha monochlorohydrin administration

This paper presents sequential histological, histochemical and biochemical changes in rat caput epididymis after a single 100 mg/kg oral dose of alpha chlorohydrin. Desquamation of caput epithelium occurs as early as two days after drug treatment. The caput epididymis is blocked because of accumulation of testicular fluid containing exfoliated immature testicular cells and caput epithelium. There was no effect of drug on motility and morphology of spermatozoa examined from different segments of epididymis and vas deferens. Marked decrease in acid and alkaline phosphatases, nucleic acids and proteins have been registered after drug treatment. On the contrary increase in SDH, cholesterol and glycogen was observed after drug treatment. Decrease in phospholipids in initial stages has also been observed.

Effect of a copper and a plastic IUD on the histochemistry of endometrial enzymes in the rabbit during early pseudopregnancy

The influence of a copper and a plastic IUD on the localization and intensity of alkaline and acid phosphatase and beta-glucuronidase activity in the rabbit endometrium during early pseudopregnancy was investigated. The activities of the two lysosomal enzymes, acid phosphatase and beta-glucuronidase were increased in surface epithelial cells in the presence of both types of IUDs. The alkaline phosphatase activity was almost completely abolished in surface and glandular epithelial cells in uterine horns.

The effect of oestrogen on the nasal respiratory mucosa. An experimental histopathological and histochemical study

An experimental histopathological and histochemical work carried out in thirty guinea-pigs of an average weight of 475 gm. receiving oestrogen in the form of ethynyl oestradiol in a dose of 10 microgram/animal/day and aiming at a study of the effects of oestrogen on the respiratory nasal mucosa. The histopathalogical lesions of the respiratory nasal mucosa were in the form of squamous metaplasia and spongiosis of the lining epithelium, with oedema of the underlying corium, glandular hyperplasia submucosal cellular infiltration, increased vascularity and some vascular changes in the form of endothelial proliferation with intimal thickening. Histochemical enzymatic alterations were in the form of increased succinic dehydrogenase activity in the epithelium as well as in the hyperplastic submucous glands, intensified reaction of the acid phosphatase in the cells of the corium, and the appearance of alkaline phosphatase activity in the apical parts of the cells lining the glands, indicating increased secretory activity. All the changes obtained in the histopathological and histochemical studies can be attributed to hormonal stimulation of the nasal mucosa.

Effect of some contraceptive steroids on growth and development of salivary glands and incidence of dental caries in female rats

Synthetic contraceptive steroids, ethynylestradiol and medroxyprogesterone acetate, were given individually in different doses to weanling female rats for eight weeks. In proportion to the doses administered, ethynylestradiol inhibited and medroxyprogesterone acetate stimulated the growth and development of the salivary glands. The steroid-treated rats exhibited an increase in dental caries incidence as compared to controls.