Bone mineral loss in young women with amenorrhoea

374

Citations from the Literature

was negligible. Of particular significance was the fact that the globozoospermic spermatozoa were incapable of sperm-oocyte fusion or binding the human zona pellucida, even after an intracellular calcium signal had been generated with the ionophore A23187. The sudden induction of sperm-zona interaction could, however, be achieved by the use of a ferrous ion promoter system to induce limited lipoperoxidation. This result demonstrates that the enhancing effect of peroxidation on sperm-zona adhesion involves a direct action on the properties of the sperm-plasma membrane, rather than an indirect consequence of acrosomal damage and acrosin leakage. Such findings emphasize the value of specific teratozoospermic in dissecting the conditions, such as globozoospermia, mechanisms that regulate human sperm function.

cholesterol over time. Estrogen users had a nonsignificant increase in high-density lipoprotein (HDL) cholesterol, estrogenprogestogen users maintained premenopausal HDL cholesterol levels, and non-users had decreases in HDL cholesterol. Both estrogen and estrogen-progestogen users had increases in apolipoprotein Al, apolipoprotein All, and triglycerides relative to the changes observed among the menopausal nonusers. In summary, estrogen, whether administered with or without medroxyprogesterone acetate, could provide cardiovascular benefits to postmenopausal women by protecting against the atherogenic changes in LDL and HDL cholesterol observed among the non-users. With the exception of the hormone-related increases in triglycerides, the results are consistent with the beneficial effect of hormone replacement therapy on coronary heart disease risk.

Treatment of idiopathic testicular failure with high-dose testosterone undecanoate: A double-blind pilot study

Spinal bone loss and ovulatory disturbances

Comhaire F

Department

Section

of Endocrinology,

Department

of Internal

Medicine,

State University Hospital, De Pintelaan 185, B-9000 Ghent. BEL

FERTIL STERIL 1990, 5414 (689-693) The effect of high-dose (240 mg/d) intake of testosterone (T) undecanoate was studied for sperm characteristics, function of the accessory sex glands, and hormonal parameters of men with idiopathic oligozoospermia, asthenozoospermia. or teratozoospermia using a two-phase protocol including a 3-month double-blind period followed by a 3-month open phase. Increased sperm viability and semen content of adenosine triphosphate were either not reproducible after patients on placebo were switched over to T undecanoate or did not reach statistical significance, whereas no changes were detected in other sperm characteristics and the accessory sex glands. Intake of T undecanoate significantly increased the concentration of 5-a-dihydrotestosterone (DHT) and the ratio of DHT over T in peripheral blood. suppressed the luteinizing hormone concentration, and tended to decrease serum follicle-stimulating hormone concentration. It is concluded that high-dose T undecanoate is not effective in the treatment of men with infertility with idiopathic testicular failure.

GYNECOLOGICAL

ENDOCRINOLOGY

Hormone replacement therapy and lipoprotein changes during early menopause

Egeland GM; Kuller LH; Matthews KA: Kelsey SF; Cauley J; Guzick D Department of Epidemio1og.v. sburgh, PA 15261. USA

University

of Pittsburgh,

Pitt-

OBSTET GYNECOL 1990, 76/S I (776782) The relationship of postmenopausal hormone replacement therapy to lipoproteins was assessed in a cohort of 21 I healthy premenopausal women followed during the menopausal transition. Both estrogen and estrogen-progestogen users had minimal increases in low-density lipoprotein (LDL) cholesterol levels, whereas non-users had significant increases in LDL Int J Gynecol Obstet 35

Prior JC; Vigna YM; Schechter MT; Burgess AE of Medicine, #3318, 910 W 10th Avenue, Vancouver, BC V5Z lM9, CAN NEW ENGL J MED 1990, 323/18 (1221-1227) Background: Osteoporosis develops in women with estrogen deficiency and amenorrhea who lose bone at an accelerated rate. It is not known to what extent bone loss differs between ovulatory women with regular menstrual cycles who are training intensely and those who are sedentary. Methods: We measured the density of cancellous spinal bone from the 12th thoracic vertebra to the 3rd lumbar vertebra by quantitative computed tomography on two occasions one year apart in 66 premenopausal women 21 to 42 years of age. All the women had two consecutive ovulatory cycles immediately before entering the study. Twenty-one women were training for a marathon, 22 ran regularly but less intensively, and 23 had normal levels of activity. The lengths of the women’s menstrual cycles and luteal phases, diet, exercise levels, and hormonal levels were also determined. We defined ovulatory disturbances as anovulatory cycles and cycles with short luteal phases. Results: The mean ( f SD) spinal bone density in the 66 women decreased 3.0 * 4.8 mg per cubic centimeter per year (2.0 percent per year) (P < 0.001). Amenorrhea did not develop in any woman during the year of observation (only 2.7 percent of the cycles were > 36 days long). Ovulatory disturbances occurred in 29 percent of all cycles, however. Bone loss was strongly associated with these disturbances (r = 0.54. 24 percent of the variance). The I3 women who had anovulatory cycles lost bone mineral at a rate of 6.4 f 3.8 mg per cubic centimeter per year (4.2 percent per year). The women training for a marathon had menstrual cycles similar to those of the women in the other two groups. Conclusions: Decreases in spinal bone density among women with differing exercise habits correlated with asymptomatic disturbances of ovulation (without amenorrhea) and not with physical activity. Bone mineral loss in young women with amenorrhoea Davies MC; Hall ML; Jacobs HS Cobbold Laboratories, GBR

Middlesex

Hospital,

London WIN 8AA.

Ciroti0n.s ,/rom the Literuture

BR MED J 1990. 301/6755

Depurmlent

(790-793)

Medicine,

of

Obsrerritlv

Lus Angeles,

und

Gyecoloe,~.

CA 90024-l

UCLA

375

School

of’

740. USA

Objective -To examine the impact of amenorrhoea on bone mineral density in women of reproductive age. Design -- Cross sectional study of 200 amenorrhoeic women compared with normally menstruating women. Setting - Teaching hospital

OBSTET GYNECOL 1990. 7615 I (84l--845) Fifteen gynecologic quality assurance indicators recently published by The American College of Obstetricians and

outpatient clinic specialising in reproductive medicine. Subjects - 200 women aged 1-0 with a past or current history of amenorrhoea from various causes and of a median duration of three years, and a control group of 57 age matched normal

Gynecologists were applied to a previously reported hysterectomy data base. Chart reviews were performed for the most recent 257 cases in the data base. representing an l8-month interval. The indicators were divided into two groups: those in-

volunteers with no history of menstrual disorder. Main outcome measure - Bone mineral density in the lumbar spine (LI-L4) as measured by dual energy x ray absorptiometry. Results - The amenorrhoeic group showed a mean reduction

tended to identify morbidity to screen for appropriateness and cases that failed to meet tomy were determined by

in bone mineral density of 15% (95% confidence interval 12% to 18%) as compared with controls (mean bone mineral density 0.89 (SD 0.12) g/cm’ v I .05 (0.09) g/cm’ in controls). Bone loss was related to the duration of amenorrhoea and the severity of

presence of a quality assurance indicator. A total of I35 indicators were identified in I I4 (44%) of the 257 cases, including 64 patients (25%) with morbidity indicators and 50 (19%) with appropriateness indicators. Actual morbidity was correctly

oestrogen deficiency rather than to the underlying diagnosis. Patients with a history of fracture had significantly lower bone density than those without a history of ftXtUre. Ten patients had suffered an apparently atraumatic fracture. Conclusions -

identified in all 64 cases in which morbidity indicators were present. Three cases with significant morbidity were identified by chart review but not identified by the indicators, yielding positive and negative predictive values of 100 and 98%. rcspec-

Amenorrhoea in young women should be investigated and treated to prevent bone mineral loss. Menopausal women with a past history of amenorrhoea should be considered to be at high risk of osteoporosis.

tively. and an overall accuracy of 99%~for morbidity indicators. By contrast, I4 of the 50 cases in which appropriateness indicators were present actually failed to meet published criteria sets. An additional seven cases failing to meet criteria sets were

Exogenous estrogen therapy for treatment of clomiphene citrate-

identified by chart review and not Identified by the indicators. yielding a positive predictive value of 28%. a negative predictive of X3% for apvalue of 97%. and an overall accuracy propriateness indicators.

induced cervical mucus abnormalities:

Bateman

BG: Nunley

Drpurtmenr Heulth

c$Ohsterrics

.Qiencr.v

Is it effective?

WC Jr; Kolp LA

Center,

und Gynecology.

Universiry

u/ Virginiu

Bo.u 387. Cl~url~~rte.v~~ill~~,VA,

USA Primary

FERTIL STERIL 1990, 5414 (577-579) Clomiphene citrate (CC) may have an adverse effect on cervical mucus (CM) quality and quantity. A placebo-controlled

treated by a randomized, placebo-controlled format using: (I) oral micronized estradiol (E,), 2 mg; (2) conjugated Es. 5 mg. or (3) placebo administered on cycle days 9 to 14. Cervical mucus was scored blindly during therapy within 48 hours before ovulation. Twelve subjects were observed through 36 treatment cycles with mean ( f SD) CM scores: micronized Ez, 4.2 f 1.8; conjugated Es, 4.3 f 1.7; and placebo. 4.7 f 2.9. There was no significant difference in mean values (P = 0.96. analysis of variance) or frequency of CM score > 4 (P = 0.X5. Fisher exact test). We conclude that therapy with the E preparations tested did not improve the quality or quantity of CM in CC-treated patients.

Quality

assurance

indicators

SURGERY and

hysterectomy

Gambone

JC: Reiter

RC; Lench JB

short-term

outcome

mass closure of midline incisions with a continuous

polyglyconate monofilament

study was performed to assess the effect of exogenous follicular phase estrogen (E) on CM. Subjects qualified for inclusion by repeated demonstration of poor CM while on CC therapy as judged by spinnbarkeit, quantity, and viscosity. Subjects were

GYNECOLOGICAL

and mortality and those intended of care. Rates of actual morbidity published criteria sets for hysterecchart review regardless of the

of

absorbable suture

Gallup

DC: Nolan TE: Smith RP

Section

of Gytmologic

Gynewlogy,

Mrdicul

Ontology, College

Depurlment

of Gcwyiu.

of Oh.v/errks

Au,!+v/tr.

untl

GA 309 12.

USA

OBSTET GYNECOL 1990. 7615 I (X72-m-875) Mass closure of midline incisions with a running

large-bore

permanent monoftlament polypropylene suture has been used in general surgery and gynecology patients with a reported small incidence of fascial dehiscence. Late-occurring wound sinus formation is one problem reported with the use of this permanent suture material. Over a 22-month period. 285 patients had midline incisions closed with a continuous, running no. I polyglyconate monofilament delayed absorbable suture. Closely spaced bites (about I.5 cm apart) were taken and placed 2 cm lateral to the fascial edge. Over 60% of the patients had surgery because of gynecologic cancer. Other high-risk factors included obesity in 62%. diabetes in 19’%,.and previous irrddiation or chemotherapy in 22%. An ovarian cancer staging procedure was done in 16’%1of the patients. Of the remaining patients. almost half had extensive operative procedures that ranged from exenterations to hysterectomies with lymph node dissection. Wound complications were noted in nine patients (3.2%). Seven had superficial infections, one had an evisceration, and one developed a ventral hernta. Wound sinuses did