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Seven patients with an unruptured tubal pregnancy were treated with a single i.m. injection of methotrexate (1 mg per Kg) and monitored with beta hCG titer and ultrasound examination. Two of them required two doses for declining beta hCG titer. Among four infertile patients HSG done on two subsequently demonstrated tubal patency on the involved side in one patient.

The role of connective tissue in the aetiology of female stress incontinence has been investigated. Collagen content and extractability as well as estrogen receptor concentration in vesico-vaginal fascia were measured after small tissue biopsies had been obtained during vaginal repair surgery in cases of urinary incontinence. The mean concentration of estrogen receptor in vesico-vaginal fascia among incontinent women was 49.4 +/- 14.8 fmol/mg of protein as compared to 29.6 +/- 13.1 in continent control group (P < 0.03; t-test). The mean hydroxyproline concentration in vesico-vaginal fascia of incontinent women was 13.8 +/- 2.6 micrograms/mg wet weight, whereas in the control group it was significantly higher 20.6 +/- 2.4 (P < 0.001). The role of connective tissue components in the aetiology of female stress incontinence is discussed.

Objective: It is postulated that collagenase activity in the cervix and lower uterine segment is important for dilatation at the time of labor. If so, the enzyme must partially escape from control by inhibitors. A second hypothesis is that an elevated ratio of decorin (dermatan sulfate proteoglycan) to collagen may also contribute to the dilatation process., Study Design: The activity of collagenase, its natural inhibitors (tissue inhibitor of metalloproteinase-1 and alpha 2-macroglobulin), elastase, hydroxyproline (collagen), and decorin were quantified in biopsies of the lower uterine segment at term (not dilated) and during active labor., Results: Collagenase concentration is 23 times higher in the cervix of patients in labor than at term. The sum of alpha 2-macroglobulin plus tissue inhibitor of metalloproteinase-1 increased only twofold in labor, as did elastase. The ratio of decorin to collagen doubled., Conclusion: The imbalance caused by collagenase increasing much more than its inhibitors may contribute to collagen breakdown and dilatation. Neutrophils may be responsible for much of this increase of collagenase. The increased ratio of decorin to collagen supports the hypothesis that the interaction of these two components is important in dilatation.

Digoxin-like immunoreactive substance (endoxin) was measured in pregnant patients with pregnancy-induced hypertension. The mean level was significantly higher than that in healthy control subjects (p less than 0.001). Patients with eclampsia had a significantly higher concentration than did women with preeclampsia (p less than 0.03). A positive significant correlation was found between concentration of digoxin-like immunoreactive substance and the value of the index of gestosis of von Goecke and Schwabe (p less than 0.03). Analysis of patterns during various kinds of therapy revealed that nitrendipine was most effective in lowering endoxin concentration. Although an insignificant correlation was found between maternal concentration and both birth and placental weights, the compartmental differences observed seem to suggest fetoplacental origin of this substance.

When postpartum cervical biopsy specimens were compared with biopsy specimens from nonpregnant women, they revealed a 12-fold decrease in mechanical strength, a 50% reduction in the concentrations of collagen and sulfated glycosaminoglycans, a 35% reduction in hyaluronic acid, an increase in collagen extractability, and a fivefold increase in collagenolytic activity. Primiparas with relatively high concentrations of collagen and hyaluronic acid had relatively long cervical dilatation times during established labor, suggesting a physiologic importance to these variables. This correlation was not found in multiparas, even though the mean values of the biochemical parameters tested were similar to those in primiparas. Second-trimester biopsy specimens taken from patients with cervical incompetence contained normal collagen concentrations, but relatively high collagen extractabilities and collagenolytic activities, exceeding normal postpartum values. A biopsy specimen that was tested biomechanically had a very low strength and very high extensibility. Most likely, these data reflect a high turnover of collagen in incompetent cervices, resulting in a high proportion of newly synthesized collagen with low biomechanical strength.

The regional distribution of immunoreactive OT and AVP in the human uterus was investigated. Specimens of non-pregnant human uterus and oviduct were homogenized and extracted. The tissue levels exceeded the plasma concentrations of the peptides. The largest quantities of both peptides were found in the cervix and oviductal isthmus. The amounts found in the uterine fundus and isthmus were, however, not significantly different. Only 23% of immunoreactive OT eluted in the position of standard peptide on high-performance liquid chromatography. All immunoreactive AVP eluted with standard AVP after additional ether extraction of octadecasilyl extracts. We conclude that the human uterus contains materials immunologically and chromatographically identical to oxytocin and vasopressin.