OBJECTIVE:Prostaglandin and nitric oxide (NO) are both known to be involved in cervical ripening at term. The aim of the study was to investigate if NO has an effect on cervical expression of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), the two main isoenzymes involved in prostaglandin synthesis, and to localize these enzymes within the cervix.STUDY DESIGN:Women with an unripe cervix scheduled for elective caesarean section at term were randomly selected to receive vaginally either the NO donor isosorbide mononitrate (IMN) or placebo 4h before surgery. At the operating theatre, cervical tissue specimens were obtained for immunoblotting and immunohistochemistry.RESULTS:Increased expression of COX-2 was found in specimens exposed to IMN compared to specimens obtained from women in the placebo group. There was no difference in the expression of COX-1. Immunohistochemistry revealed similar localization of the two enzymes in treated and untreated women.CONCLUSIONS:Vaginal administration of IMN induces increased cervical expression of COX-2, but not of COX-1. This pathway may be of importance in the process of cervical ripening at term.

Endometrial cancer is predominantly a disease of postmenopausal women and is a relatively slowly developing disease in most cases, preceded by proliferative premalignant conditions of the endometrium. The present case concerns a 0-para woman in whom endometrial cancer was diagnosed at 47 years of age. She was followed without treatment for 9 years and more than 6 years after eventual diagnose of the disease. At the age of 40 she had irregular uterine bleedings. She had never taken any estrogen medication, she was of normal weight and otherwise free of disease. She underwent hysterography which indicated an intracavitary polyp. Subsequent curettage revealed normal proliferative endometrium but no polyp. Six years later (1992) she was admitted due to menorrhagia and brownish vaginal discharge. The uterus appeared slightly enlarged and myomatous. Transvaginal sonography (TVS) indicated myomas, a locally thickened endometrium of 10 mm and a 5 × 9 mm polyp in the uterine fundus. A hysteroscopy was recommended but the patient refused it. Four months later at follow-up, the polyp measured 7 × 15 mm and another irregular endometrial structure (polyp or thickened endometrium), 19 mm in diameter, was identified close to the cervix. She did not accept any other diagnostic procedures but wanted follow-up. Eight months later, the endometrial structures measured 9 × 19 mm and 20 × 30 mm, respectively. A cervical cytological smear was normal. Fifteen months later (1995), the menstrual bleedings were less, though she had daily bloodish discharge. She accepted an endometrial biopsy which showed a moderately differentiated endometrial adenocarcinoma. Intellectually, she was aware of the severeness of the cancer but wanted to place her trust in para-medical regimens that felt safe for her. At control after 1 year, she was in a good general condition. She had experienced more or less daily bleedings but no other discomfort. The uterus was slightly enlarged and TVS demonstrated an irregular thickening and indistinct delineation of the endometrium. She asked for an endometrial biopsy. Histopathology still demonstrated cancer. In 1997 – she was then 51 years old – a clinical examination revealed that the uterus was still slightly enlarged with a broadening of the lower uterine segment. The parametria were free. The generally thickened endometrium was poorly delineated during TVS, indicating myometrial infiltration. An endometrial biopsy now demonstrated a poorly differentiated cancer. Eight months later, these clinical and TVS signs of progression were still more obvious. The biopsy curette could not pass the internal os but a cervical sampling showed cancer. During the following 3 years, the bleedings became less, though she observed bloodish discharge. She was doing well, full-time working and continuing with her homeopathic regimens. Clinically, the uterus appeared to shrink to normal size during this period and the delineation of the endometrium during TVS tended to be more distinct. At control 6 years after the initial diagnosis of endometrial cancer (2000), she had noticed an increased desire to void. Bleedings were more often observed. Clinically, the posterior portion of the uterus protruded more and irregular and frequent non-echogenic 2–6 mm structures in the endo-myometrium, indicating fluid or blood, were demonstrated by TVS. During the following 6 months, she experienced daily spottings. The uterus appeared normal sized, was freely moveable though the posterior uterine segment was irregular and protruding. Four months later (2001), she noticed low pelvic pain, felt tired and noticed dysuria and constipation. Examination revealed that the cancer had advanced all through the vagina. The parametria were stiff and thickened and the uterus was fixed. She asked for an X-ray, so to be convinced about the advancement of the disease. Magnetic resonance tomography demonstrated the tumor penetrating towards the rectum and the vaginal walls. Although experiencing severe pain and anxiety, she was not willing to take analgesics such as opoids until the last few days of life 1 month later. In the hospice, she wrote to her doctor and expressed her gratefulness that her own ideas of the best treatment and her integrity had been respected over the years. Endometrial adenocarcinoma may be considered as the end stage of a continuous, estrogen-dependent proliferative disease having defined premalignant precursors. The present patient bore her malignant endometrial disease for at least 7 years. During this period, the cancer dedifferentiated from grade 2 to grade 3 disease. Around the years of menopause, the tumor clinically advanced but appeared to be stationary or even regress for another couple of years until eventual rapid progression. During the years, she accepted the bleedings and vaginal discharge but did not experience any other discomfort until the last few months of life. Nevertheless, she felt safe in being regularly controlled. During the years with disease she appeared to have a good life, personally and socially.

Fallopian tube smooth muscle contractions are physiologically related to transport of the ovum within the oviduct. Nitric oxide (NO) has proved to be a mediator of tubal contractility. The main pathway by which NO exerts its relaxing effect on tubal contractions has not been fully elucidated. NO-mediated effects may be cyclic guanosine monophosphate (cGMP)-dependent or cGMP-independent. The objective of the present study was to investigate whether a NO-cGMP pathway is present in the Fallopian tube and, if present, to examine whether this pathway is involved in tubal contractility. Tubal smooth muscle strips were mounted in organ baths for measurement of tissue cGMP and for isometric recording of contractile activity. Following administration of the NO donor spermine NONOate a more than three-fold increase in tissue levels of cGMP was measured. Pretreatment with inhibitors of cGMP production prior to administration of spermine NONOate resulted in similar levels of cGMP as found in strips exposed to only plain buffer solution. Administration of spermine NONOate to muscle baths resulted in a significant inhibition of contractile activity, while pretreatment with inhibitors of cGMP production almost eliminated the relaxing effect of the NO donor. This study showed that a NO-cGMP pathway is present in the Fallopian tube and that the pathway is involved in Fallopian tube contractility.

Objective Our aim was to examine the effect of the nitric oxide donor isosorbide mononitrate on the uterine cervix at term and to evaluate possible adverse effects of this treatment. Study design Term pregnant women were randomly selected to receive either 40 mg vaginally administered isosorbide mononitrate or placebo 4 hours before elective cesarean section. Cervical status, maternal blood pressure, maternal pulse rate, fetal heart rate, umbilical arterial Doppler indices, and various side effects were examined. Results Isosorbide mononitrate induced a significant increase in cervical distensibility. It also caused a significant change in maternal blood pressure and maternal pulse rate. In addition, the frequency of maternal headache and palpitations was significantly higher in the isosorbide mononitrate group versus the placebo group. However, the intensity of these symptoms was moderate. Conclusion Vaginal administration of 40 mg of isosorbide mononitrate induces cervical ripening at term. Although the majority of women experienced side effects, no serious clinical maternal or fetal adverse effects, resulting in specific medication or emergency cesarean section, were diagnosed.

OBJECTIVE:To compare the efficacy of 400 microg of misoprostol with that of 1 mg of gemeprost as cervical priming agents when administered vaginally 3 to 4 hours before first-trimester vacuum aspiration abortion. METHODS:In a prospective controlled trial 90 nulliparous women who requested termination of pregnancy before 12 weeks' gestation were randomized to receive vaginally either misoprostol or gemeprost for cervical priming. The force to dilate the cervix was measured by the use of a cervical tonometer connected to Hegar dilators from 3 to 10 mm. The main outcome measures were baseline cervical dilation; the peak force to dilate the cervix at 8, 9, and 10 mm; and the cumulative force to dilate the cervix to 10 mm. RESULTS:Baseline cervical dilation did not differ significantly between the women who received misoprostol and those who were treated with gemeprost. Neither the peak force required to dilate the cervix at 8, 9, and 10 mm nor the cumulative force to dilate the cervix to 10 mm showed any significant difference between the two groups. CONCLUSION:Vaginally administered misoprostol (400 microg) is as effective as gemeprost (1 mg) for cervical priming 3 to 4 hours before surgical termination of first-trimester pregnancies.

OBJECTIVE:The purpose of the study was to investigate possible mechanisms and morphologic changes involved in nitric oxide-induced cervical ripening.STUDY DESIGN:Women scheduled for surgical termination of first trimester pregnancy were randomized to 1 of 3 groups: isosorbide 5-mononitrate 40 mg 4 hours or 10 hours before the operation or no preoperative treatment. Cervical specimens were obtained for the analysis of tissue levels of cyclic guanosine monophosphate, cyclic adenosine monophosphate, cyclo-oxygenase 1, cyclo-oxygenase 2, prostaglandin F(2 alpha), and prostaglandin E(2) or were fixed in glutaraldehyde for microscopy.RESULTS:Increased levels of cyclic guanosine monophosphate, cyclo-oxygenase 2, prostaglandin F(2 alpha), and prostaglandin E(2) were found in samples that were exposed to isosorbide 5-mononitrate compared with control samples. Electron microscopy revealed stromal edema and collagen disorganization after isosorbide 5-mononitrate treatment.CONCLUSION:Cyclic guanosine monophosphate, prostaglandin F(2 alpha), and prostaglandin E(2) are involved in nitric oxide-induced cervical ripening. Nitric oxide causes morphologic changes similar to those changes seen during spontaneous cervical ripening.

BACKGROUND Nitric oxide (NO) is predominantly a locally acting mediator, affecting several functions in the human female reproductive tract. In vivo, it is quickly metabolized to its stable end product nitrate, which is cleared by the kidney. METHODS AND RESULTS The aim of the present study was to evaluate possible fluctuations of plasma nitrate concentrations during the menstrual cycle, ovarian stimulation as well as ovarian hyperstimulation syndrome (OHSS). During the menstrual cycle (n = 19 women) the mean nitrate concentrations were between 26.7 and 29.5 micromol/l at all stages except for the day of ovulation, when the concentrations were significantly (P < 0.001) increased (mean 37.2 micromol/l +/- 2.0). Significantly lower concentrations of plasma nitrate (P < 0.01) were measured at the end of gonadotrophin-releasing hormone (GnRH) down-regulation (24.6 micromol/l +/- 1.4) compared with the concentrations found at day 8 of follicle-stimulating hormone (FSH) stimulation (34.9 micromol/l +/- 2.6) and at the day of human chorionic gonadotrophin (HCG) (35.6 micromol/l +/- 3.3). The concentrations of nitrate (33.4 micromol/l +/- 3.4) in women with OHSS (n = 13) were similar to those seen 5 days after embryo transfer (33.2 micromol/l +/- 2.3). CONCLUSIONS The results indicate that NO synthesis is increased at the time of spontaneous ovulation. GnRH treatment inhibits NO synthesis, while NO production is not increased in women with OHSS.

OBJECTIVE: The purpose of the study was to determine whether a nitric oxide-generating system exists in the uterine cervix at term pregnancy and to study the effects of nitric oxide on contracting cervical strips.STUDY DESIGN: Tissue specimens were obtained from the cervices of women after deliveries and at elective cesarean deliveries. Immunohistochemical techniques and immunoblotting were used to identify isoforms of nitric oxide synthase. The effects of nitric oxide on cervical contractility were examined by the addition of nitroglycerin or spermine NONOate [(Z)-1-(N-[3-aminopropyl]-N-[4-(3-aminopropyl-ammonio)butyl]-amino)-diazen-1-ium-1,2-diolate] to organ baths.RESULTS: Immunohistochemical examination demonstrated positive staining for both endothelial and inducible nitric oxide synthase. Both isoforms of nitric oxide synthase were clearly detectable by immunoblotting. Significant inhibition of contractile activity (10(-7)-10(-5) mol/L) was observed when nitroglycerin or spermine NONOate was administered.CONCLUSION: An endogenous nitric oxide system is present in the uterine cervix at term, and this tissue is responsive to nitric oxide, which causes relaxation of the cervical muscle.

Objective: To assess the existence of a nitric oxide. (NO) system in the human myometrium and the effects of mediators of this system on contractile activity in vitro.Methods: Myometrial tissue was obtained before the onset of labor and during labor at term. Production of NO was assessed by the use of nicotinamide dinucleotide phosphate diaphorase staining and by immunoblots for NO. Effects of NO were examined by adding L-arginine (the substrate for NO synthesis); N-G-nitro-L-arginine methyl ester (an inhibitor of NO synthase); two NO donors, sodium nitroprusside and spermine NONOate; as well as 8-bromo cyclic guanosine monophosphate (8-bromo cGMP) (a second messenger analogue) to organ baths.Results: Myometrial NO production was indicated by positive nicotinamide adenine dinucleotide phosphate diaphorase staining. Immunoblots detected endothelial NO synthase, whereas only a weak signal for inducible NO synthase was seen. The addition of L-arginine (10(-4)-10(-3) mol/L) did not result in any change of contractility. N-G-nitro-L-arginine methyl ester (10(-3) mol/L) caused a minor increase of contractility in half of the specimens. Sodium nitroprusside, spermine NONOate, and 8-bromo cGMF resulted in a concentration-dependent inhibition of contractility (10(-7)-10(-6) mol/L for sodium nitroprusside, 10(-6)-10(-5) mol/L for spermine NONOate, and 10(-5)-10(-3) mol/L for 8-bromo cGMP). However, at 10(-5)-10(-4) mol/L, sodium nitroprusside exhibited a dose-dependent increase in the frequency of contractions. Women in prelabor did not differ from those in active labor.Conclusion: The myometrium produces NO at term. Nitric oxide inhibits myometrial contractile activity. The responsiveness to NO is similar in nonlaboring and laboring women. (Obstet Gynecol 1999;93:987-94. (C) 1999 by The American College of Obstetricians and Gynecologists.).

The objective of the study was to assess the plausible existence of a nitric oxide (NO) system within the human Fallopian tube and to examine the effects of NO on tubal contractility. Tissue was obtained from fertile women at operations due to non-tubal diseases. Production of NO and sites of nitric oxide synthase (NOS) activity were assessed by the use of NADPH diaphorase staining and by immunoblots as well as immunohistochemistry for the isoforms of NOS. Effects of NO on tubal contractility in vitro were examined by adding either of two NO donors (nitroglycerin, spermine NONOate) or an analogue of its second messenger (8-bromo cyclic GMP). The production of NO was indicated by positive NADPH diaphorase staining. In immunoblots, endothelial and inducible NOS were demonstrated in all samples analysed. By immunohistochemistry, moderate staining for endothelial NOS was demonstrated in the luminal epithelial cells and in the endothelial cells of blood vessels. Moderate staining for inducible NO synthase was seen in smooth muscle cells and weak staining in epithelial cells. Nitroglycerin, spermine NONOate and 8-bromo cGMP all resulted in a concentration-dependent inhibition of contractility with significant contractility inhibition at 10(-7) mol/l, 10(-6) mol/l and 10(-5) mol/l respectively. The study demonstrates the existence of an endogenous NO system, which may be of physiological importance in Fallopian tube function.

Oral administration of the progesterone receptor antagonist mifepristone, as well as the synthetic prostaglandin analog, misoprostol, have been shown to reduce cervical resistance to dilation in connection with legal abortion. The present study is a prospective, randomized study of 45 women comparing the clinical efficacy and possible modes of action of these compounds to induce cervical ripening by studying leukocyte populations and collagenolysis in the cervical stroma.A significantly increased amount of cervical dilatation, estimated to be the diameter of the largest Hegar dilator that passed the internal os without resistance, was observed after both mifepristone (200 mg, 48 and 24 h before surgery) and misoprostol (600 mu g, 16-20 h before surgery) compared to placebo, with no significant difference between the two preparations noted (mean 6.9 and 5.9 mm vs 4.5 mm, p <0.01). However, in the mifepristone-treated group of women, there was a higher proportion of cervices graded as easily dilatable compared with placebo- and misoprostol-treated women (26% vs 0% and 13%, p <0.05). As assessed by visual analog scale, the pain experienced during preoperative treatment by both substances was comparable and low (1.8 and 2.7). Bleeding starting before evacuation was noted in both of the treatment groups, but not in the control group, with a higher frequency in the misoprostol- than in the mifepristone-treated group of women (67% vs 27%, p <0.05). Side effects, such as diarrhea, were significantly increased after misoprostol as compared with mifepristone and placebo (20% vs 0% and 0%, p <0.05), but the frequency of vomiting did not differ significantly between the groups (20%, 13%, and 7%, respectively). Active pretreatment did not influence cervical gross morphology or stromal leukocyte infiltration as studied by immunohistochemistry. Neither was tissue collagenolytic activity nor plasminogen activator activity levels affected by mifepristone or misoprostol pretreatment. In conclusion, the study demonstrates a significant amount of increased cervical dilatation with mifepristone and misprostol, and indicates that this, as assessed by the present techniques, is not due to invasion of leukocytes or increased activity of collagenase or plasminogen actrivator. (C) 1998 Elsevier Science Inc. All rights reserved.

Nitric oxide (NO) is an important modulator of contractile activity in various tissues. The aim of the present study was to investigate the possible existence of an NO system within the human uterine cervix and to study the effects of NO on the cervix in early pregnancy. Cervical tissue specimens were obtained from 24 women in connection with first trimester legal abortion. NADPH diaphorase staining was used to identify nitric oxide synthase activity within the cervical tissue. Cylindrical tissue specimens were mounted in organ bath chambers for isometric registration of contractile activity. The presence of a functional NO system in the cervix was investigated by adding either sodium nitroprusside or spermine NONOate, two different NO donors, or 8-bromo cGMP, an analogue of the second messenger cyclic guanosine monophosphate (cGMP), to the organ baths. Positive NADPH diaphorase staining was clearly observed in the walls of blood vessels, in cervical smooth muscle cells, and cells scattered in the connective tissue. The NO donating drugs sodium nitroprusside and spermine NONOate both caused a dose-dependent inhibition of spontaneous contractile activity with significant inhibition at concentrations of 10(-5) and 10(-7) M respectively. Furthermore, the participation of NO in the regulation of cervical contractility was indicated by a significant concentration-dependent inhibition of spontaneous contractions when 8-bromo cGMP (10(-5)-10(-3) M) was added to the organ baths. The study indicates the existence of an NO system within the human uterine cervix and a role of NO in control of cervical function.

Leukocyte subsets were detected by immunohistochemical methods in cervical tissue in either the first trimester or at term pregnancy. In tissue obtained during first trimester lower total numbers of leukocytes were observed in comparison with late pregnancy (2.7 cells/0.04 mm2 versus 5.5 cells/0.04 mm2). The major subgroup of leukocytes present in early pregnancy was T-lymphocytes. The majority of these cells were of the suppressor/cytotoxic subtype. Neutrophils were present at about 1/5th of the density of T-lymphocytes. Very few macrophages were observed at this stage. At term pregnancy, neutrophils were present in significantly higher numbers than during first trimester with no difference between tissue obtained before or during active labour. Macrophages were present at about 10-fold higher density than during early pregnancy. In conclusion, tissue-bound leukocytes are present in the human cervix at a higher density in late pregnancy compared to first trimester. The increased densities of neutrophils and macrophages at this stage indicate a role for these cells during cervical ripening.

Endogenously produced nitric oxide (NO) induces relaxation in smooth muscle in various organs. The purpose of this study was to investigate whether a NO-mediated relaxation system exists in the human Fallopian tube. To study contractility, the isthmic portion of the tube was obtained from 23 fertile women during operations due to benign non-tubal diseases. Tubal smooth muscle strips were mounted in tissue chambers containing HEPES buffer and connected to a Grass transducer for the isometric registration of contractile activity. By adding L-arginine (the substrate for NO synthesis) or N-nitro-L-arginine methyl ester (L-NAME; an inhibitor of NO synthesis) to the tissue chambers, changes in tubal contractility were monitored. The addition of L-NAME caused increased tubal contractility, while L-arginine, after an initial transient increase in tonus, caused relaxation of the strips. Using immunohistochemistry, NO synthase, the enzyme that catalyses the production of NO from L-arginine, was identified in tubal tissue cells. These results indicate that a NO-dependent relaxation system exists in the Fallopian tube and that NO may play a role as a mediator of tubal contractility.

OBJECTIVE:To review the incidence, treatment and outcome of cervical cancer during pregnancy in the Western region of Sweden. METHODS:Population based data on cervical cancer during pregnancy were collected from 1973 to 1992. RESULTS:Cervical carcinoma was diagnosed in 33 women in association with pregnancy, giving an incidence of 11.1 cases per 100,000 deliveries and 7.5 cases per 100,000 pregnancies. Pregnancy complicated one of every 55 cases of invasive carcinoma. Twelve women were in the 3rd trimester and nine women were post partum. Abnormal bleeding was the symptom that led to examination and diagnosis in 54.5% of the women and 45.5% of the women were asymptomatic but had an abnormal cervico-vaginal cytological test (39.4%) or abnormal finding at vaginal examination (6.1%) in association with pregnancy. In the 1st-2nd trimester all but one woman and in the 3rd trimester all but two women, had a stage I carcinoma. Post partum five women were in stage I, three women were in stage II and one woman had a stage III carcinoma. Histology revealed squamous cell carcinoma in 29 women, adenocarcinoma in three women and adenosquamous carcinoma in one woman. During the follow up period 1/12 women in the 1st trimester, 4/12 in the 3rd trimester and 2/9 women post partum have died of disease. CONCLUSION:During the years of this study different modalities of treatment were used, with a change from primary radiation to primary surgery.

OBJECTIVE:To compare a new regimen for second trimester abortion using Dilapan and vaginal gemeprost suppositories with extra-amniotic Rivanol instillation and oxytocin i.v. immediately or 16 h after instillation.METHODS:A prospective study was performed in 153 women to analyze the induction-abortion interval, the use of analgesics and the complication rate. Wilcoxon's rank sum test was used for statistical evaluation.RESULTS:The mean induction-abortion interval was significantly shorter in the Dilapan-gemeprost-treated women than in the immediate or 16-h Rivanol-oxytocin-treated women, 12.5 vs. 23.3 and 26.8 h, respectively. The 24-h cumulative abortion rate was 91% in the former group vs. 49% and 61%, respectively. The use of analgesics was less frequent among the Dilapan-gemeprost-treated women, whereas the complication rate did not differ.CONCLUSIONS:The Dilapan-gemeprost treatment was advantageous with respect to a shorter induction-abortion interval and ease of handling. However a minority of women do not respond to this treatment and it is therefore necessary to employ alternative methods to complete the abortion in these cases.

Antiprogestins are used to induce first trimester abortion and to dilate the cervix before vacuum aspiration. Cervical dilatation is associated with profound changes in the connective tissue. In what respect antiprogestins interfere with this process has hitherto been sparsely investigated. The aim of present study was to examine the influence of the antiprogestin mifepristone on cervical collagen synthesis in nonpregnant, early and late pregnant women. The effects were compared with those of progesterone. The content of collagen in cervical tissue was determined by measuring hydroxyproline. Collagen synthesis was studied in vitro either by incubation of cervical tissue specimens from women, pretreated with mifepristone in vivo, in the presence of 14C-proline or by incubation of cervical tissue of not pretreated women in the presence of the isotope and mifepristone or progesterone. Pretreatment with mifepristone, but not progesterone, induced a significant increase in cervical dilatation. The cervical concentration of collagen was not altered after mifepristone administration. Pretreatment with mifepristone did not quantitatively influence the time course of radiolabeling in vitro or the pattern of radiolabeling in different protein components as revealed by electrophoresis. In vitro mifepristone, like progesterone, reduced the incorporation of 14C-proline. From the present data we conclude that mifepristone pretreatment in connection with first trimester abortion is not associated with any major changes, qualitatively or quantitatively, of collagen synthesis. However, we cannot exclude that mifepristone still may affect the de novo formation of collagen since mifepristone, administered in vitro, did reduce collagen synthesis.

A 27 year old nulliparous woman with a history of chronic anovulation and signs of virilization with a markedly elevated serum level of testosterone, underwent a laparotomy with peroperative bilateral ovarian vein catheterization and bilateral bisection of both ovaries. A solid, 1.5 cm, well delimited tumor located centrally in the right ovary, was excised. Testosterone levels in ovarian venous blood from the tumor bearing side, were 88.4 nmol/1 and from the contralateral ovary 3.9 nmol/1. Histopathological examination showed a Sertoli‐Leydig cell tumor which was radically extirpated. Postoperatively, the serum levels of androgen normalized, the woman had regular cycles, became pregnant and delivered a normal female baby. Pieces of tumor tissue were incubated for 2 h, with and without addition of gonadotropins and adrenocorticotropic hormone (ACTH). Human chorionic gonadotropin (CG), follicle stimulating hormone (FSH) and adrenocorticotropic hormone (ACTH) caused significant increases in cyclic monophosphate (cAMP) production in tumor tissue in vitro , as compared to controls. Furthermore, ACTH also significantly stimulated 17β‐estradiol production. In tumor cells cultured for 48 h, FSH slightly, but not significantly, increased the production of progesterone. In the cell culture, [ 3 H]‐thymidine incorporation into deoxyribonucleic acid (DNA) was stimulated by IGF 1α but not by hCG and FSH. It is concluded that Sertoli‐Leydig cell tumors may be sensitive to gonadotropins and ACTH and that their small size, solid shape and intra‐ovarian localization can cause diagnostic difficulties.

Cervical dilatation and softening after pretreatment with mifepristone are well documented. As this effect is similar to that observed after local application of prostaglandin E2 (PGE2) it is tempting to speculate that the effect of mifepristone is mediated via an increase of the endogenous secretion of prostaglandins from the cervical mucosa. Eighteen healthy women in the first trimester of pregnancy were treated with oral mifepristone (200 mg) 48 and 24 hours before legal abortion by vacuum aspiration and 18 women in the same age of gestation without any pretreatment served as controls. Cervical mucus was collected for measurement of prostaglandins by radioimmunoassay before administration of the drug and in connection with vacuum aspiration. The cervical dilatation at the time of surgery was significantly increased in women given mifepristone as compared with untreated women (7.6 versus 5.8 mm). The wet weight of collected cervical mucus was significantly increased in mifepristone treated women. The amount of PGE2 and prostaglandin F2α per sample was unchanged in mifepristone-treated women, whereas the concentration was lower as an effect of dilution due to an increased yield in cervical secretion observed after mifepristone treatment. The present observation does not give any support to the hypothesis that mifepristone-induced cervical maturation is mediated via an increase in cervical prostaglandin production.

Endovaginal scanning (EVS) of the endometrium has recently been proposed as a method for the investigation of the endometrial mucosa. In this study, the specificity and sensitivity of EVS have been compared with endometrial cytology and D&C to discriminate between a normal and pathological endometrium. The study included 105 women who underwent preoperative endovaginal ultrasound investigation, endometrial cytology, and D&C because of postmenopausal bleeding. A specificity of 81% and a sensitivity of 97% in diagnosing morphological alterations by means of endovaginal ultrasound was found. The corresponding figures for cytological evaluation were 81 and 58%, respectively. We conclude that endovaginal ultrasound is a valuable diagnostic instrument for detecting pathological conditions in the uterine mucosa and as sensitive as endometrial cytology or D&C.