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Three immunoreactive prolactin molecules have been separated according to size by chromatography and typified by radioimmunoassay. In the circulation immunoreactive prolactin exists in three forms designated as "extra-big", "big" and "small" after gel filtration on Ultrogel AcA 54. Most immunoassayable prolactin occurs in the small form, which corresponds to monomeric prolactin and presents totally 73.8 +/- 8% in normal subjects. This pattern is not significantly different from that obtained from the serum of normal subjects stimulated by thyroid releasing hormone (TRH) or insulin hypoglycaemia and from pregnant women. The response of big and small prolactin was in proportion to the rise in total prolactin and decrease in the proportion of big-big prolactin in normal women. In no instance was a big prolactin response seen in the absence of a total prolactin response in normal or hyperprolactinaemic patients. Essentially different stimuli have the increase in concentration of big prolactin toward the end of the tests.

The polymerase chain reaction (PCR) was used to identify human papillomavirus (HPV) in cervicovaginal cells in normal individuals and in patients with cervical intraepithelial neoplasia (CIN). By use of a set of primers encoding the E6 region of the HPV genome, the presence of HPV DNA was demonstrated in the cervicovaginal cells of 43 (42.2%) of 102 normal individuals and in all 12 CIN patients. High sensitivity of the PCR method produced an additional 9 positive results on second sampling from 48 individuals who were initially HPV-negative. On the other hand, 26 (24.3%) of 107 HPV-positive individuals were HPV-negative when sampled a second time 5-7 days later. The data suggested that retest probably should be considered for patients clinically suspected of having HPV infection whose initial test results are negative for HPV DNA. Also, single HPV DNA-positive results should be accepted with caution.

This study assesses the relative risks of first trimester transcervical chorionic villus sampling (CVS) versus midtrimester amniocentesis performed between April 1986 and March 1988. The most common indication for prenatal diagnosis was advanced maternal age. We discovered 5.1% chromosomal aberrations in CVS compared to 1.0% in amniocentesis. Bleeding was the most frequent early complication, and only 1 case had major hemorrhage with subsequent spontaneous abortion. The fetal loss rate (gestational age less than 28 weeks) was 4.5% in CVS versus 1.2% in amniocentesis, which was not significantly different from the background fetal loss rate reported in normal pregnancies after an 8-week gestational age. Three cases of fetal loss after CVS were probably procedure-related; 1 case had spontaneous abortion and 2 cases had chorioamnionitis. Therefore, we considered that the causal relationship between CVS and the infection was highly probable. The clinical pregnancy outcome indicated that there were no differences in overall perinatal mortality, Apgar score, body weight, body length, gestational age at delivery, intrauterine growth retardation, placenta weight and placental disorders between the CVS group and the amniocentesis group. The pregnancies did not reveal any specific effects of the prenatal diagnostic procedure, but a long-term pediatric follow-up is needed.

The diagnosis of ventral abdominal wall defect can now be made prior to birth. With this diagnosis, the family can make decisions and a planned optimal management can lead to a successful outcome. There were 31 cases of ventral wall defect identified at Chang Gung Memorial Hospital (CGMH) from January 1979 through March 1988. Twenty of them were classified as gastroschisis; among them, 17 (85%) were born in outside clinics and none of them had associated anomalies. In contrast, among 11 cases of omphalocele, there was a lower frequency of transferred cases (27% vs 85%), and 4 cases had additional defects, including two multiple anomalies and two bladder exstrophies. There were no significant differences between gastroschisis and omphalocele in the mortality rate (30% vs 36%), in the incidence of intrauterine growth retardation (IUGR) (30% vs 27%) and in the Cesarean section rate (15% vs 18%). All 4 cases of prematurity (less than 36 weeks of gestational age) expired after delivery and 2 of these had body weights of less than 1500 g. Three out of 5 cases delivered by Cesarean section expired; the mortality (60%) was higher than that of vaginal delivery (28%). All 3 cases were gastroschisis, 2 of them were transferred from outside clinics and all expired due to sepsis. The diagnosis of ventral wall defect should be made prenatally, with obstetric ultrasonography, maternal serum alpha-fetoprotein screening and fetal karyotyping. Therefore, fetal transport in utero to a referral center and optimal perinatal care for those fetuses with potentially correctable lesions can be well planned.

Three hundred and sixty-eight cases of invasive cervical cancer (stage IB through early stage IIB) were treated with radical abdominal hysterectomy and bilateral pelvic lymphadenectomy at Chang Gung Memorial Hospital. Of these patients, 172 were classified postoperatively as a high-risk group after surgical-pathological assessment of tumor extent. Among these high-risk patients, 40 received adjuvant chemotherapy with cisplatin, vinblastine, and bleomycin (PVB), 38 received adjuvant radiotherapy, and 79 refused adjuvant treatment. The 3-year cumulative disease-free survival rate was 91.6% for the low-risk group and 59.7% for those at high risk. Among patients in the high-risk group, the 3-year survival rate was 75.0% for patients treated with adjuvant chemotherapy and 46.8% for those not treated with adjuvant therapy (P less than 0.05). The preliminary results of this pilot study showed a significant activity of adjuvant chemotherapy, which warrants further investigation of its role in the treatment of cervical cancer.

A rare case of Müllerian adenosarcoma occurred in the uterine endometrium of a 40-year-old woman. Histologically, the tumor was composed of an admixture of benign-appearing glands and a sarcomatous stroma. This neoplasm appears to have a relatively low malignant potential in contrast to the more aggressive form of malignant mixed Müllerian tumor. Our case was treated with hysterectomy and radiation. She was well after two and a half years.

Bone mineral density (BMD) was measured in 17 patients with gonadal dysgenesis, 21 patients with premature ovarian failure, 14 patients with hyperprolactinemia, 23 patients postoophorectomy and 41 normal healthy women. Each group was divided into two subgroups, on the basis of whether or not they were receiving estrogen replacement therapy. Linear regression analysis showed a significant loss of BMD at a rate of 0.006 g/cm2 per year in the lumbar spine of normal healthy women. The distribution of individual values in each study group was near or within normal confidence limits, except for the group with gonadal dysgenesis. The mean BMD of each group without estrogen replacement therapy was significantly less than that of the control group. There was a significant correlation between the duration of amenorrhea and BMD values in the groups with premature ovarian failure and postoophorectomy. These results indicate that BMD, measured by dual photon absorptiometry, was reduced in amenorrheic patients, especially in patients with gonadal dysgenesis. Estrogen replacement therapy was able to decrease the severity of bone loss, but failed to increase the bone mass. Dual photon absorptiometry (DPA) is a simple, effective, and accurate tool for assessing the severity of osteoporosis and monitoring the effect of therapy.

A total of 851 specimens of exfoliated cervicovaginal cells and 27 specimens of male urethral smears obtained from 706 individuals with various clinical findings were examined for the presence of human papillomavirus (HPV) types 6, 11, 16, 18, 31, and 33 by in situ DNA hybridization analysis. The nonradioactive DNA in situ hybridization method used in this study showed no detectable cross-hybridization either among different types of HPV (except between types 6 and 11) or between HPV DNA and human cellular DNA. Furthermore, this system was found to be more sensitive than the Southern blotting method in detecting HPV. HPV was found in 233 of 276 (84.4%) and in 34 of 47 (72.3%) samples of cervicovaginal cells from patients with urogenital condylomata and cervical dysplasia, respectively. HPV was also detected in 6 of 39 (15.4%) women with normal cytological findings who were also symptom-free. Young women who were at low risk but were infected with HPV showed significantly reduced ratios of helper-inducer T lymphocytes to suppressor-cytotoxic T lymphocytes compared with those of uninfected normal controls (1.28 +/- 0.31 versus 2.47 +/- 0.64; P less than 0.001). This in situ DNA hybridization method can have broad application to the screening of HPV in early lesions and in normal-looking tissues and may be used to identify patients at risk of more serious or possibly malignant progression.

Oocyte retrieval for in vitro fertilization and embryo transfer (IVF/ET) through the cul-de-sac under the guidance of a vaginal sector scanner was performed on 12 patients and compared with the previous laparoscopical oocytes retrieval for in vitro fertilization. Using a transvaginal sector scanner with puncture guide line, the needle was introduced through the posterior fornix of the vagina into the ovary. Vaginal sonography obviously has more benefits than the conventional laparoscopic method as the patients can be rid of the risk of repeated laparoscopy, can have less anesthetic and it is not necessary to have CO2 pneumoperitoneum, etc. When this method is compared with the transvesical approach, the transvaginal method does not require a full bladder, and has a shorter distance between the transducer and the follicles so it can provide better patient acceptability and better sonographic images which can increase the accumulated success rate. The recovery rate of oocytes was 8.83 per cycle which equals a mean recovery rate of 84%. The clinical pregnancy rate was 25% per retrieval cycle and 33.3% per embryo transfer. The results were not worse than those by laparoscopy and the transvesical method. This procedure is less time-consuming and has less blood loss than the other methods. We believe that, after a period of progression, IVF/ET can be performed in an outpatient setting with decreased risks and expenses of laparoscopy and general anesthesia.

Four cases of severe preeclamptic patients with the findings of hemolysis (H), elevated liver enzymes (EL) and a low platelet count (LP) were presented. Maternal mortality occurred in two of the four cases with one experiencing liver rupture. Intrauterine fetal death occurred in 3 cases. The entity has been termed the HELLP syndrome. The high maternal and perinatal mortality of our cases was mainly due to the severe coagulopathy associated with the HELLP syndrome. The practicing obstetrician must be knowledgeable about this severe consequence of toxemia in pregnancy and aggressive management is essential to improve maternal and perinatal outcome.

This article reports on the treatment of 21 obesity patients employing auricular acupuncture. The auricular points used were Mouth, Shen-men, Stomach, Hunger and Spleen, and the period of treatment lasted from two to six weeks. The weight loss in these patients varied from 2 to 16 pounds. The rationale for using these points and cautions for this type of treatment were discussed.

A review is presented summarizing the IVF-ET, GIFT and combined IVF-ET-GIFT experienced at Chang Gung Memorial Hospital. Since the building of an aseptic dust free laboratory next to the operation room, the clinical pregnancy rate has been 12.2% per embryo transfer in IVF-ET, 16.7% in the GIFT program and 30.0% in the combined IVF-GIFT program. The overall clinical pregnancy rate was 14.9%. The overall pregnancy rate appeared to be independent of the causes of infertility, be it tubal factor, endometriosis or unexplained infertility. It was lower in couples with male factor or combined factors. The different regimens for follicular stimulation were hMG-hCG, clomiphene-hMG-hCG and FSH-hMG-hCG. No one regimen showed a better pregnancy rate than the others. The methods of oocyte retrieval were laparascopy, laparotomy, transbladder ultrasound-guided, and transvaginal ultrasound-guided retrieval. There were 4.53 oocytes retrieved pertreatment cycle. The transvaginal ultrasoundguided oocyte retrieval has greatly simplified the procedures in the IVF-ET program. The patient selection was important not only for the indications but also for the methods of IVF-ET, GIET and combined IVF-GIFT.

In this report, we present the selective reduction of quadruplets to triplets by transabdominal ultrasound guided cardiac puncture and injection of 1% xylocaine and air. This treatment resulted in the successful continuation of pregnancy until premature labor developed at the 33th week. Alive births of a normal male and a normal female infant, and a dead female infant were delivered.

Thirty-five samples of serum with levels of immunoreactive prolactin greater than 500 mu/l have been fractionated by gel filtration. In samples from seven normal subjects with elevated prolactin levels following TRH or insulin stimulation and samples from twelve patients with prolactin levels greater than 1500 mu/l, over 8% of the immunoreactive material eluted in the position of native or 'little' prolactin. In eleven out of sixteen samples containing 500 to 1500 mu/l the proportion of 'little' prolactin was less than 80% and more than 20% eluted as 'big-big' prolactin. It appears therefore that patients with moderately elevated levels of immunoreactive prolactin may not have genuine hyperprolactinaemia.

Exogenous progesterone (P) was supplemented to gamete intrafallopian transfer (GIFT) patients to determine the optimal timing to start P supplementation and the role of isthmic block in GIFT. Patients were alternatively divided into two groups. In the immediate group, exogenous P was supplied from the day of surgery. In the delayed group, P was supplied 4 days after the surgery, the day the fertilized ovum is supposed to arrive in the uterine cavity. Except for higher serum P levels on luteal day 3 in the immediate group, no significant differences were found in serum P levels during the early luteal phase, the pregnancy rate, and the abortion rate between the two groups. It is possible that in stimulated cycles, higher serum P levels during the early luteal phase render the endometrium receptive for embryo implantation, albeit unlock the isthmic block. It may not be crucial to start exogenous P supplementation either before or after a fertilized egg(s) arrives in the uterine cavity. The role of isthmic block in GIFT needs further evaluation.

Factors affecting pregnancy rates in gamete intrafallopian transfer (GIFT) and in vitro fertilization (IVF) were evaluated. Higher pregnancy rates were found when more mature oocytes were recovered (6.2 +/- 2.5 vs 3.8 +/- 3.0) and more oocytes (4.6 +/- 1.0 vs 3.3 +/- 1.2) or zygotes (4.7 +/- 1.4 vs 3.0 +/- 1.7) were transferred. Ultrasound-guided follicular aspiration was successful for in vitro fertilization and had a pregnancy rate (14.3%) comparable to the laparoscopic approach (13.3%). Laparotomy for correction of pelvic pathology concomitant with oocyte retrieval should be used cautiously despite the high preliminary pregnancy rate (42.9%). Failed fertilization of the surplus oocytes left after gamete intrafallopian transfer did not mean a poor chance of pregnancy (27.6%). The combined treatment of gamete intrafallopian transfer and in vitro fertilization may have a higher chance of pregnancy (43.5% vs 21.4% in GIFT and 13.3% in IVF), and more multiple pregnancies (40.0% vs 22.2% in GIFT and 16.7% in IVF). Cycles with spontaneous LH (luteinizing hormone) surges, detected by daily morning urine samplings, need not be aborted and the timing of ovum recovery should be individually evaluated.

The presence of Chlamydia trachomatis-related deoxyribonucleic acid sequences in endocervical specimens of 317 women was analyzed by deoxyribonucleic acid hybridization techniques with deoxyribonucleic acid from C. trachomatis used as probes. Samples from 56 of 172 high-risk patients (32.6%) and 16 of 145 low-risk patients (11.0%) contained C. trachomatis-related deoxyribonucleic acid sequences. Direct detection of chlamydial antigen with enzyme-linked immunoassay on the same patients yielded positive rates of 26.3% and 7.3% for the high- and low-risk patients, respectively. C. trachomatis culture confirmed 86.3% of deoxyribonucleic acid-positive results and 84.0% of antigen-positive results. The overall sensitivities of chlamydial deoxyribonucleic acid and antigen assays were 91.7% and 68.8%, respectively, whereas the specificities were 95.3% and 94.7%. Results also suggested that the test of the C. trachomatis deoxyribonucleic acid correlated better with the female urogenital chlamydial infections than did the antigen test of C. trachomatis. The combined results of higher sensitivity in detecting the microorganism and better correlation with disease activity may make the deoxyribonucleic acid hybridization test a useful tool for the early and accurate diagnosis of C. trachomatis infections in female patients.