- Email: [email protected]
MOLAR PREGNANCY AFTER ARTIFICIAL HOMOLOGOUS INSEMINATION FOR RETROGRADE EJACULATION
635
declined from 15 - 5% to 14-2% during 1968-79. Total fat as a percentage of energy intake has remained constant at 43%.3 The Nationwide Food Consumption Survey shows the figure for 1977 to be 42%. For men this represents a decline from 45% in 1965.4 The massive decline in mortality from CHD has occurred independently of the recommendations made in the COMA report, and it should not be used to justify those recommendations. 11 Colville
Terrace,
2. 3
4.
CORRADO BETTERLE ROBERTO CIPRIANI BENIAMINO PEDINI ANDREA PESERICO
Istituto di Semeiotica Medica
JAMES LE FANU
London W11 1.
Moreover, there is uncertainty about the number of circulating T cells. Galbraith’s finding14 of a reduction in "interactive T lymphocytes" only in some types of alopecia areata suggests that this disease is a heterogeneous disorder. No specific immunological markers have yet been indentified which would support an autoimmune aetiology of alopecia areata.
Department of Health and Social Security. Diet and coronary heart disease. Report on health and social subjects, no 7. London: HM Stationery Office, 1984. World Health Organisation. Annual statistics. Geneva: WHO, 1984. Rizek RL, Welsh SO, Marston RM, Jackson EM. Levels and sources of fat in the US food supply and in diets of individuals. In: Perkins ET, Visek WJ, eds. Dietary fat and health. American Oil Chemist Society, Champaign, Illinois, Apr 1983. Pao EM. Changes in American food consumption patterns and their nutritional significance. Food Technology 1981; 35: 45-53.
and Department of Dermatology, University of Padua Medical School, 35100 Padua, Italy
A, Dawber R. Diseases of the hair and scalp. Oxford- Blackwell Scientific Publications, 1982. 272-306. 2. Kern F, Hoffmann WH, Hambrick GW, Blizzard RM Alopecia areata immunologic studies and treatment with prednisone. Arch Dermatol 1973, 107: 407-12. 3. Du Vivier A, Munro DD Alopecia areata, autoimmunity and Down’s syndrome. Br 1. Rook
Med J 1975, i:
191-92
4 Friedmann PS Alopecia areata and autoimmunity. Br J Dermatol 1981; 105: 153-57. 5. Cunliffe WC, Hall R, Stevenson CJ, Weightman D. Alopecia areata, thyroid disease
ALOPECIA AREATA: A HETEROGENEOUS DISEASE?
SIR,-In the light of your editorial (June 16, p 1335), we present the following data. We studied 171 patients: 106 with alopecia areata (49 females, 57 males, mean age 29 years, range 3-59), 33 with alopecia universalis (14 females, 19 males, mean age 33 years, range 15-67), and 32 with alopecia totalis (15 females, 17 males, mean age 21 years, range 2-60). As controls we studied 411 apparently healthy subjects (206 females and 205 males) age-matched with patients. In the sera of patients and controls we looked for thyroid microsomal (TMA), parietal-cell (PCA), adrenal (AdA), islet-cell (ICA), smooth-muscle, nuclear, and mitochondrial autoantibodies with the indirect immunofluorescent technique on cryostat unfixed sections of normal human tissues. Thyroglobulin autoantibodies (TGHA) were detected by passive haemagglutination with a commercial kit. The results are summarised in the table. Males with alopecia universalis had a very significant frequency of TMA, PCA, and AdA. Females with alopecia universalis had a significantly increased frequency of PCA and ICA. Females with alopecia totalis demonstrated a significant prevalence of PCA. No other group of patients showed significantly raised frequency of organ-specific or non-organ-specific autoantibodies. From an immunological point of view, these data confirm that alopecia areata is a "heterogeneous This heterogeneity would explain previous clinical or absence5-1O of conflicting results concerning the organ-specific autoimmune manifestations in this disease. The autoimmune pathogenesis of alopecia areata does not satisfy the fundamental criteria of organ-specific autoimmune disorders. In
syndrome".
presence2-4
fact, neither organ-specific autoantibodies reacting against of hair2,9-12 nor cell-mediated reactivity antigenic constituents 13 against "scalp extracts" have ever been found. ORGAN-SPECIFIC AUTOANTIBODIES IN ALOPECIA AREATA AND CONTROLS
and autoimmunity. Br J Dermatol 1969; 81: 879-81 C, Peserico A, Del Prete GF, Trisotto A. Autoantibodies in alopecia areata. Arch Dermatol 1975, 111: 927. Main RA, Robbie RB, Gray ES, Donald D, Horne GHW Smooth muscle antibodies and alopecia areata. Br J Dermatol 1975; 92: 389-93. Cochran REI, Thomson J, MacSween RNM. An auto-antibody profile in alopecia totalis and diffuse alopecia Br J Dermatol 1976; 95: 61-65. Klaber MR, Munro DD. Alopecia areata Immunofluorescence and other studies. BrJ Dermatol 1978; 99: 383-86. Muller HK, Rook AJ, Kubba R Immunohistology and autoantibody studies in alopecia areata. Br J Dermatol 1980; 102: 609-10. Nunzi E, Hamerlinck F, Cormane RH. Immunopathological studies on alopecia areata. Arch Dermatol Res 1980; 269: 1-11 Bystryn JC, Orentreich N, Stengel F. Direct immunofluorescence studies in alopecia areata and male pattern alopecia. J Invest Dermatol 1979; 73: 317-20. Friedmann PS. Decreased lymphocyte reactivity and autoimmunity in alopecia areata
6. Betterle 7.
8
9. 10 11. 12. 13.
Br JDermatol 1981; 105: 145-52. GMP, Thiers BH, Vastly DB, Fudenberg HH. Immunological profiles alopecia areata. Br J Dermatol 1984, 110: 163-70.
14. Galbraith
MOLAR PREGNANCY AFTER ARTIFICIAL HOMOLOGOUS INSEMINATION FOR RETROGRADE
EJACULATION SIR,-Dr Olesnicky and Dr Quinn (June 9,
p 1296) have reported increased incidence of molar pregnancy after artificial insemination with donor semen in Victoria, Australia. We have been managing an infertile couple whose husband has retrograde ejaculation. Spermatozoa were recovered from urine after masturbation, washed, and concentrated in Ringer’s saline solution for insemination. At the second cycle of treatment the wife became pregnant. Unfortunately complete hydatidiform mole was diagnosed. After abortion and prolonged monitoring of levels of(3-hCG (&bgr;-subunit of human chorionic gonadotropin), no degeneration has been observed. In the small number of pregnancies 1-3 reported after management of retrograde ejaculation no such association has been described. Complete hydatidiform moles are diploid and are almost always female and androgenetic in origin.4-7 Our case, with Olesnicky and Quinn’s observations, suggest that a male factor, appearing or becoming enhanced during the in vitro management of sperm, could contribute to the onset of molar pregnancy. an
Reproductive Biology Laboratory, Department of Gynaecology and Obstetrics B, PME-CHR Nantes, 44035
Nantes, France; of Urology,
and Department CHR Nantes
p<0-05,tp<0-01; *p<0-01
in
PAUL BARRIERE PATRICE LOPES FRANÇOIS MOLLAT LOUIS BUREAU MARC-FRANÇOIS LERAT
1. Merckx M, Amy JJ, Vanerps P, Braeckman J. Freezing of retrograde ejaculate for AIH. Arch Androl 1982; 8: 73-75 2. Colpi GM, Sommadossi L, Zanollo A. Infertility caused by retrograde ejaculation: a successfully treated case. Andrologia 1983; 15: 592-94. 3. Thomas AJ. Ejaculatory dysfunction. Fertil Steril 1983; 39: 445-54. 4. Kajii J, Ohama K. Androgenetic origin of hydatidiform mole Nature 1977; 268: 633-34. 5. Jacobs PA, Hassold TJ, Maysuyama AM, Newlands IM Chromosome constitution of gestational trophoblastic disease. Lancet 1978; ii: 49. 6 Lawler SD, Pickthall VJ, Fisher RA, Povey S, Evans MN, Szulman AE. Genetic studies of complete and partial hydatidiform mole. Lancet 1979; ii: 580. 7. Jacobs PA, Wilson CM, Sprenkle JA, Rosenshein NB, Migeon BR. Mechanism of origin of complete hydatidiform moles. Nature 1980; 286: 714-16.
declined from 15 - 5% to 14-2% during 1968-79. Total fat as a percentage of energy intake has remained constant at 43%.3 The Nationwide Food Consumption Survey shows the figure for 1977 to be 42%. For men this represents a decline from 45% in 1965.4 The massive decline in mortality from CHD has occurred independently of the recommendations made in the COMA report, and it should not be used to justify those recommendations. 11 Colville
Terrace,
2. 3
4.
CORRADO BETTERLE ROBERTO CIPRIANI BENIAMINO PEDINI ANDREA PESERICO
Istituto di Semeiotica Medica
JAMES LE FANU
London W11 1.
Moreover, there is uncertainty about the number of circulating T cells. Galbraith’s finding14 of a reduction in "interactive T lymphocytes" only in some types of alopecia areata suggests that this disease is a heterogeneous disorder. No specific immunological markers have yet been indentified which would support an autoimmune aetiology of alopecia areata.
Department of Health and Social Security. Diet and coronary heart disease. Report on health and social subjects, no 7. London: HM Stationery Office, 1984. World Health Organisation. Annual statistics. Geneva: WHO, 1984. Rizek RL, Welsh SO, Marston RM, Jackson EM. Levels and sources of fat in the US food supply and in diets of individuals. In: Perkins ET, Visek WJ, eds. Dietary fat and health. American Oil Chemist Society, Champaign, Illinois, Apr 1983. Pao EM. Changes in American food consumption patterns and their nutritional significance. Food Technology 1981; 35: 45-53.
and Department of Dermatology, University of Padua Medical School, 35100 Padua, Italy
A, Dawber R. Diseases of the hair and scalp. Oxford- Blackwell Scientific Publications, 1982. 272-306. 2. Kern F, Hoffmann WH, Hambrick GW, Blizzard RM Alopecia areata immunologic studies and treatment with prednisone. Arch Dermatol 1973, 107: 407-12. 3. Du Vivier A, Munro DD Alopecia areata, autoimmunity and Down’s syndrome. Br 1. Rook
Med J 1975, i:
191-92
4 Friedmann PS Alopecia areata and autoimmunity. Br J Dermatol 1981; 105: 153-57. 5. Cunliffe WC, Hall R, Stevenson CJ, Weightman D. Alopecia areata, thyroid disease
ALOPECIA AREATA: A HETEROGENEOUS DISEASE?
SIR,-In the light of your editorial (June 16, p 1335), we present the following data. We studied 171 patients: 106 with alopecia areata (49 females, 57 males, mean age 29 years, range 3-59), 33 with alopecia universalis (14 females, 19 males, mean age 33 years, range 15-67), and 32 with alopecia totalis (15 females, 17 males, mean age 21 years, range 2-60). As controls we studied 411 apparently healthy subjects (206 females and 205 males) age-matched with patients. In the sera of patients and controls we looked for thyroid microsomal (TMA), parietal-cell (PCA), adrenal (AdA), islet-cell (ICA), smooth-muscle, nuclear, and mitochondrial autoantibodies with the indirect immunofluorescent technique on cryostat unfixed sections of normal human tissues. Thyroglobulin autoantibodies (TGHA) were detected by passive haemagglutination with a commercial kit. The results are summarised in the table. Males with alopecia universalis had a very significant frequency of TMA, PCA, and AdA. Females with alopecia universalis had a significantly increased frequency of PCA and ICA. Females with alopecia totalis demonstrated a significant prevalence of PCA. No other group of patients showed significantly raised frequency of organ-specific or non-organ-specific autoantibodies. From an immunological point of view, these data confirm that alopecia areata is a "heterogeneous This heterogeneity would explain previous clinical or absence5-1O of conflicting results concerning the organ-specific autoimmune manifestations in this disease. The autoimmune pathogenesis of alopecia areata does not satisfy the fundamental criteria of organ-specific autoimmune disorders. In
syndrome".
presence2-4
fact, neither organ-specific autoantibodies reacting against of hair2,9-12 nor cell-mediated reactivity antigenic constituents 13 against "scalp extracts" have ever been found. ORGAN-SPECIFIC AUTOANTIBODIES IN ALOPECIA AREATA AND CONTROLS
and autoimmunity. Br J Dermatol 1969; 81: 879-81 C, Peserico A, Del Prete GF, Trisotto A. Autoantibodies in alopecia areata. Arch Dermatol 1975, 111: 927. Main RA, Robbie RB, Gray ES, Donald D, Horne GHW Smooth muscle antibodies and alopecia areata. Br J Dermatol 1975; 92: 389-93. Cochran REI, Thomson J, MacSween RNM. An auto-antibody profile in alopecia totalis and diffuse alopecia Br J Dermatol 1976; 95: 61-65. Klaber MR, Munro DD. Alopecia areata Immunofluorescence and other studies. BrJ Dermatol 1978; 99: 383-86. Muller HK, Rook AJ, Kubba R Immunohistology and autoantibody studies in alopecia areata. Br J Dermatol 1980; 102: 609-10. Nunzi E, Hamerlinck F, Cormane RH. Immunopathological studies on alopecia areata. Arch Dermatol Res 1980; 269: 1-11 Bystryn JC, Orentreich N, Stengel F. Direct immunofluorescence studies in alopecia areata and male pattern alopecia. J Invest Dermatol 1979; 73: 317-20. Friedmann PS. Decreased lymphocyte reactivity and autoimmunity in alopecia areata
6. Betterle 7.
8
9. 10 11. 12. 13.
Br JDermatol 1981; 105: 145-52. GMP, Thiers BH, Vastly DB, Fudenberg HH. Immunological profiles alopecia areata. Br J Dermatol 1984, 110: 163-70.
14. Galbraith
MOLAR PREGNANCY AFTER ARTIFICIAL HOMOLOGOUS INSEMINATION FOR RETROGRADE
EJACULATION SIR,-Dr Olesnicky and Dr Quinn (June 9,
p 1296) have reported increased incidence of molar pregnancy after artificial insemination with donor semen in Victoria, Australia. We have been managing an infertile couple whose husband has retrograde ejaculation. Spermatozoa were recovered from urine after masturbation, washed, and concentrated in Ringer’s saline solution for insemination. At the second cycle of treatment the wife became pregnant. Unfortunately complete hydatidiform mole was diagnosed. After abortion and prolonged monitoring of levels of(3-hCG (&bgr;-subunit of human chorionic gonadotropin), no degeneration has been observed. In the small number of pregnancies 1-3 reported after management of retrograde ejaculation no such association has been described. Complete hydatidiform moles are diploid and are almost always female and androgenetic in origin.4-7 Our case, with Olesnicky and Quinn’s observations, suggest that a male factor, appearing or becoming enhanced during the in vitro management of sperm, could contribute to the onset of molar pregnancy. an
Reproductive Biology Laboratory, Department of Gynaecology and Obstetrics B, PME-CHR Nantes, 44035
Nantes, France; of Urology,
and Department CHR Nantes
p<0-05,tp<0-01; *p<0-01
in
PAUL BARRIERE PATRICE LOPES FRANÇOIS MOLLAT LOUIS BUREAU MARC-FRANÇOIS LERAT
1. Merckx M, Amy JJ, Vanerps P, Braeckman J. Freezing of retrograde ejaculate for AIH. Arch Androl 1982; 8: 73-75 2. Colpi GM, Sommadossi L, Zanollo A. Infertility caused by retrograde ejaculation: a successfully treated case. Andrologia 1983; 15: 592-94. 3. Thomas AJ. Ejaculatory dysfunction. Fertil Steril 1983; 39: 445-54. 4. Kajii J, Ohama K. Androgenetic origin of hydatidiform mole Nature 1977; 268: 633-34. 5. Jacobs PA, Hassold TJ, Maysuyama AM, Newlands IM Chromosome constitution of gestational trophoblastic disease. Lancet 1978; ii: 49. 6 Lawler SD, Pickthall VJ, Fisher RA, Povey S, Evans MN, Szulman AE. Genetic studies of complete and partial hydatidiform mole. Lancet 1979; ii: 580. 7. Jacobs PA, Wilson CM, Sprenkle JA, Rosenshein NB, Migeon BR. Mechanism of origin of complete hydatidiform moles. Nature 1980; 286: 714-16.