摘要:

Patients with primary amenorrhea underwent stimulation with luteinizing hormone releasing hormone (LRH) before and after clomiphene administration to determine the maturational status of the hypothalamic–pituitary–gonadal axis, and to assess the development of feedback control mechanisms. Four patients with clinically recognizable conditions served as models. One patient had panhypopituitarism with undetectable baseline FSH and LH values, no response to LRH or clomiphene, and no detectable feedback control. One patient with a “specific” hypothalamic hypogonadotropism had low baseline gonadortropins with a normal response to LRH and no positive or negative feedback mechanisms reflected by no change in LRH response after clomiphene. A patient with delayed puberty due to low bodyweight had low FSH and LH, baseline values and an “immature” response to clomiphene, characterized by lowered baseline gonadotropins and an increased peak LH following LRH stimulation. The fouth patient, with an adolescent ploycystic ovarian syndrome, had a high baseline LH, normal FSH, hyperresponse to LRH, and a “mature feedback control” as evidenced by an increase in baseline FSH and LH, and a decrease in the LRH response while on clomiphene. The remaining patients showed inappropriate responses. They are regarded as having defects rather than dysfunctions, and the possible abnormalities are discussed in relation to the clinical findings.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A study was made of the endometria of 16 patients with gonadal dysgenesis who had been given cyclic replacement treatment with conjugated estrogens for 2 to 10 years, and of 9 other patients who had received medroxyprogesterone in addition to the conjugated estrogens for 2 to 5 years. Seven of the former group showed varying degrees of endometrial hyperplasia, and in all of these cases the duration of estrogen therapy had exceeded 5 years. At the time of the study no cases had developed frank adenocarcinoma. Only 1 of the 9 patients who had been given medroxyprogesterone in addition to the conjugated estrogens demonstrated evidence of hyperplastic change. Progesterone may afford some protection against the development of endometrial hyperplastic activity, but its potential role in protecting against neoplasia remains to be determined. This study supports the view that estrogen replacement therapy in gonadal dysgenesis carries the risk of endometrial hyperplasia and neoplasia. Possible methods of decreasing this hazard are discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Twenty hyperprolactinemic patients with galactorrhea were studied to determine their gonadotropic responses to various stimuli. Five women lacked response to gonadotropin following the administration of clomiphene citrate. Ten patients who had luteinizing hormone releasing hormone (LRH) tests before and during bromocriptine administration exhibited varied FSH and LH responses that apparently were unaffected by bromocriptine therapy. A loss of the normal positive feedback of estrogens at the level of the hypothalamus was demonstrated in most patients before and during bromocriptine therapy. Long-term treatment with bromocriptine in 11 women resulted in a decrease of serum prolactin, cessation of lactation in all, and pregnancy in 8. These results suggest that the failure of normal secretion of gonadotropins in hyperprolactinemic women may result from 1) inadequate release of endogenous LRH, and 2) loss of the positive feedback of estrogens, as a result of the same hypothalamic disturbance that provokes the hyperprolactinemia. In turn, the elevated prolactin levels may exert a short-loop negative feedback at the hypothalamic level, inhibiting cyclic gonadotropin release.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

At the Mayo Clinic, 198 exenterative operations were performed from 1950 through 1971. Although the 5-year survival rate of all patients was 33%, bowel obstruction occurred in 11.6% of patients and intestinal fistula formation in 12.6%. The majority of patients with these complications had had previous pelvic irradiation. The difficulty in dealing with the large raw area in the pelvis is discussed with a review of the various methods that have been tried to date to reperitonealize the pelvis and thereby, it is hoped, prevent adhesions or fistula form

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Serum human chorionic gonadotropin (hCG) was measured by a radioreceptorassay (RRA) and radioimmunoassay (RIA) and serum hCG-β and hCG-α by RIA in 10 patients with intact mole, 3 patients with choriocarcinoma, and 4 patients with hydatidiform mole during treatment. hCG levels by RRA were higher in 5 of 10 molar pregnancies and ranged from 20,900 to 100,000 ng/ml and from 30,000 to 100,000 ng/ml by RIA. hCG levels by RRA and RIA paralleled one another closely during treatment of hydatidiform mole. hCG-α was higher than hCG by RRA and RIA and hCG-β in molar pregnancies, in the uterine venous blood draining a uterine choriocarcinoma, and during chemotherapy of choriocarcinoma. In 2 of 3 choriocarcinoma patients who eventually developed cerebral metastases, hCG-α increased while hCG and hCG-β were declining or negative. hCG-β was usually lower than hCG or hCG-α in all the cases studied. These results demonstrate the production of free α and β subunits in trophoblastic disease. Further, due to the biospecificity, simplicity, and rapidity, the RRA of hCG is a useful diagnostic aid during treatment of trophoblastic neoplasia until the levels fall to within the sensitivity range of the assay. Finally, the RIA of hCG, hCG-β, and hCG-α, which requires several days, should be performed until they become negative or fall within normal range

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

One hundred ten patients suspected of having hydatidiform mole or partial mole were examined during a 21/2-year period, utilizing nonstored image echography. All echograms were performed and interpreted by an obstetrician-gynecologist. Hydatidiform mole was confirmed in 23 patients, 4 of whom presented with a coexistent fetus and 3 with blighted ovum. No false diagnoses of hydatidiform mole were made. Reasons for the superiority of a nonstored image technique are discussed, particularly with regard to elimination of primary and secondary problems inherent in echographic diagnosis.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID