Comparison of intermediate-dose purified urinary follicle-stimulating hormone with and without human chorionic gonadotropin for ovulation induction in polycystic ovarian disease*

Favalli G, Odocino F, Torri V, Pecorelli S. Early stage ovarian cancer: the Italian contribution to clinical research. An update. Early ovarian cancer (stages IA–IIA) accounts for 30% of all epithelial ovarian cancer. Even if relatively uncommon, when “high risk” patients are considered, it is lethal in 25–30% of the cases. Mainstay of treatment is surgery followed by either adjuvant chemotherapy or radiotherapy when indicated on the basis of still debatable prognostic factors. Literature data show a great variability in survival rate due to the great heterogeneity of patients considered in different reports and few randomized trials affected by a consequent low power. Italian groups have contributed both in investigating the role of surgery and of chemo or radiotherapy in the treatment of this disease. An important contribution in surgery has been made by Italian institutions in reducing the extent of surgery in young patients wishing to retain their reproductive capability showing that a “conservative surgery” (unilateral oophorectomy) can be safely performed in initial stages without affecting the probability of cure. Another important surgical topic investigated by Italian institutions concerns the role of lymphadenectomy. In early ovarian cancer the node involvement ranges between 14–24% in stage I and 37–50% in stage II. Although the node positivity rate detectable by sampling (SA) is lower than the one shown by a systematic procedure (LY), no data at the moment show that patients undergoing a sampling evaluation have a poorer prognosis. From 1992 through 1994, 202 patients (SA: 99; LY: 103) were enrolled by six Italian institutions in a randomized trial aimed to assess the diagnostic and therapeutic role of SA vs. LY in early stage ovarian cancer. Positive nodes were detected in 9.9% vs. 19.3% respectively as well as a different proportion of intra/perioperative complications occurred. No difference in time to relapse nor in overall survival were detected in the two groups showing no evidence of efficacy in favor of extensive staging of the retroperitoneum. From 1983 to 1990, 271 stage I ovarian cancer patients entered two prospective multicentric randomized trials conducted by Italian institutions. Trial I compared cisplatin (50 mg/m2, six cycles repeated every 28 days) vs. no further treatment in stage IA–B grade 2–3 patients; Trial II compared the same dose and schedule of cisplatin vs. intraperitoneal P32 in stage IC patients. Cisplatin significantly reduced the relapse rate by 65% in Trial I and by 61% in Trial II, but survival was not affected (Trial I: HR = 1.15, 95% CI = 0.44–2.98; Trial II: HR = 0.72, 95% CI = 0.37–1.43). The final conclusion drawn by these two important Italian studies was that adjuvant cisplatin treatment in early ovarian cancer prevents relapse although the impact of chemotherapy remains unclear. For this reason two international trials have been performed (ICON1 and ACTION) aimed at assessing the role of platinum-based chemotherapy on survival. Italian collaboration in both trials has been important, including about half of the total number of the 900 randomized patients. Results will probably be available during this year and are expected with a great interest by the whole scientific international community.

https://ijgc.bmj.com/content/ijgc/11/Suppl_1/12.full.pdf

Early stage ovarian cancer: the Italian contribution to clinical research. An update.

The isolation and purification of human prolactin 20 years ago was a major accomplishment leading to the now well recognized role of hyperprolactinemia in clinical endocrinology. The development of radioimmunoassays and prolactin-lowering agents, most notably the ergot-derived dopamine agonists, provided the means for identifying and treating hyperprolactinemia in women with these disorders. In this article the current status of hyperprolactinemia in reproductive disorders experienced by the female patient is reviewed, emphasizing etiology and treatment.

Etiology and Treatment of Hyperprolactinemia

Twenty-six daughters born to amenorrheic women after gonadotropininduced ovulation were studied at 10 to 16 years of age. The aim of the study was to assess whether the mothers' condition, namely, amenorrhea and infertility followed by the pharmacologic induction of ovulation, had any effect on their female offspring in terms of endocrine disorders at puberty. The daughters were found to have normal onset of puberty as well as normal physical and mental development. The mean age at menarche, body weight, and height were similar to those of the general female population in Israel. A functioning hypothalamic-pituitary-ovarian axis was evidenced by the appearance of menarche followed by regular cycles. These data form a reassuring sample for the clinicians, the treated mothers, and their offspring. ( JAMA 1983;250:3202-3204)

Menarche and Puberty in Daughters of Amenorrheic Women

The use of human menopausal gonadotropins (hMG or menotropins) became commercially feas ible as an agent of ovulation induction therapy after the successful extraction from the urine of post menopausal women. In 1949 the initial attempts at chemical isolation of hMG from this source were made. 1 Reports of the use of hMG for clinical induc tion of ovulation appeared in 1959. 2 Gonadotropins derived from human pituitary glands (hPG) re sulted in the first pregnancy. 2 Human pituitary go nadotropin as a therapeutic agent is now mainly of historical interest. Currently, hMG is the agent used for the stimulation of ovarian follicular maturation. An understanding of the pharmacologic action of the gonadotropins, the techniques of monitoring the re sponse to treatment, the methods of administration, the factors affecting prognosis, the results of treat ment for various indications, and the complications of treatment would facilitate their effective and safe clinical use. The purpose of this article is to review these as

http://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-2007-1021439.pdf

Induction of ovulation with exogenous gonadotropins in anovulatory infertile women

Conception rate after gonadotropin therapy in hyperprolactinemia and normoprolactinemia.

This is a retrospective study on 352 infertile women who were treated with HMG-hCG (Human Menopausal Gonadotropin/human Chorionic Gonadotropin) between 1962 and 1977. The purpose of this study was to search for hyperprolactinemia and prolactinomas in these women. Hyperprolactinemia was found in 75 women (21%). The prevalence of hyperprolactinemia increases with age. Asymptomatic pituitary tumors were found in 29 of 31 women evaluated (94%). Three women had macroadenomas and 26 had microadenomas. We were not able to demonstrate that the HMG-hCG treatment and the ensuing pregnancy had any long-term ill effects on the size of the tumor. These findings suggest that prolactinomas were slow growing. An active search for these tumors must be made in women treated for infertility in the past.

Prolactinomas in women treated in the past for infertility.

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Conception rate after gonadotropin therapy in hyperprolactinemia and normoprolactinemia.

Prolactinomas in women treated in the past for infertility.