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OBJECTIVE: To determine the histologic development of midluteal corpus luteum (CL) and endometrium in normal fertile women after induction of ovulation with clomiphene citrate (CC). DESIGN, PATIENTS, INTERVENTIONS: Twelve normally cycling women planning to undergo an elective tubal ligation were treated with 50 to 150 mg of CC daily on days 5 through 9 of the cycle. Luteectomy and endometrial biopsy were performed simultaneously 7 days after the urinary luteinizing hormone surge. RESULTS: Because polyovulation occurred in 10 of the 12 women, 22 CL and 12 endometrial biopsies were studied. Ten women had luteal and endometrial histology that were within 2 days of the ovulation to biopsy interval. The 2 remaining women had endometrial histology that lagged 3 days behind the chronological postovulatory date. In these women, out-of-phase endometrium occurred despite polyovulatory cycles in which two and three histologically normal CL lutea were present and associated with elevated progesterone concentrations. CONCLUSIONS: In CC-induced ovulatory cycles: (1) midluteal CL histology is normal and (2) apparently out-of-phase preimplantation endometrium occurs in midluteal phase.

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Midluteal phase endometrium was histologically dated with midcycle luteinizing hormone surge time in 29 cycles from 10 parous women during untreated cycles (control) and treatment with clomiphene citrate 50 mg and 150 mg daily on days 5 through 9. Integrated progesterone output for 7 days after luteinizing hormone surge calculated from the daily plasma progesterone levels was 66.6 +/- 9.8 ng/ml in the control group compared with 117.5 +/- 18.6 ng/ml for clomiphene citrate 50 mg treatment and 152.1 +/- 11 ng/ml for clomiphene citrate 150 mg treatment (p less than or equal to 0.05). Only one cycle (clomiphene citrate 150 mg) had an out-of-phase endometrium and a significantly reduced integrated progesterone output of 28 ng/ml. All other cycles showed synchronous endometrial maturation. We conclude that luteal insufficiency as a result of clomiphene citrate treatment in ovulatory women is infrequent and is more likely to be a result of functional outcome of a relative lack of luteal phase progesterone output.

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This article contains a brief description of the placenta in multiple pregnancy, including a classification based on embryogenesis. The biologic and clinical importance of recognition of the different types of twin placentas is emphasized. Finally, a classification of the pathological lesions seen in these placentas, either because of the twinning process or simply associated with it, is proposed.

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Conventional microsurgical reanastomosis was compared with laser microsurgical reanastomosis of previously ligated uterine tubes in 14 rabbits. A final laparotomy was performed to determine adhesion formation and uterine tube patency, and a histologic examination was done of the anastomosis sites using four histologic indices for grading. Laser microsurgery produced significantly less adhesions (mean +/- standard error of the mean adhesion score, 0.79 +/- 0.24) than conventional microsurgery (2.29 +/- 0.13, P less than 0.001). However, there was no significant difference in all four histologic indices of tissue reunion at the anastomosis site between the two types of surgical technique. In a separate experiment, CO2 laser was found to be unable to weld uterine tubes successfully. Thus, the CO2 laser can significantly reduce postoperative adhesions in microsurgical uterine tube reanastomosis but without any significant histologic difference in tissue reunion, compared with conventional microsurgery.

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Sixty-one cases of invasive cervical carcinoma and 40 cases of dysplasia and carcinoma in situ were studied by peroxidase-antiperoxidase method (PAP) for the presence of carcinoembryonic antigen (CEA). Forty-two cases (13 carcinomas in situ and 29 invasive carcinomas) also were tested for alpha-fetoprotein (AFP) and human chorionic gonadotropin hCG. CEA was not detected in normal cervical epithelium but was present in 90% of the neoplastic lesions. Not mere presence, but a pattern of CEA tissue distribution emerged as the main differential point between noninvasive and invasive lesions. Twenty-nine of 51 invasive squamous carcinomas (57%) contained CEA-positive cells at the stromal edge of epithelium, while this feature was not found in dysplasia and carcinoma in situ. Adenocarcinomas and adenosquamous carcinomas all were positive for CEA, while clear-cell carcinomas were negative. AFP was present only in a case of poorly differentiated adenosquamous ("glassy cell") carcinoma. hCG has not been revealed in any of the tumors.

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We compared the anatomic structures, computerized tomographic (CT) scan images and the histopathologic findings after surgery in 15 patients with laryngeal epidermoid carcinoma. We examined the horizontal whole-mount histologic sections along with the preoperative CT and verified the preoperative impression of the soft tissue changes of preepiglottic space involvement; true cord, false cord and aryepiglottic fold invasion; or subglottic extension in all 15 patients. It was impossible to judge reliably the microscopic invasion of bone or cartilage with this method. Preoperative CT evaluation of carcinoma of the larynx was a reliable method for judging gross tumor size, though decisions regarding conservation surgery cannot be based on CT evaluation alone.

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Guaiacol peroxidase (G-Px) was measured in extracts from five sections along the length of human uterus on different days of the menstrual cycle or after menopause. The lower uterine-endocervical region had a significantly higher G-Px content (expressed as enzyme units per g wet tissue) than the other sections, although in postmenopausal patients the G-Px activity was uniformly low in all sections of the uterine cavity. We observed no significant changes in G-Px levels during the menstrual cycle, except, possibly, a decrease around ovulation, which precluded a positive correlation between plasma estrogen levels and uterine G-Px content; such estrogen dependence of G-Px has been previously shown in the rat. In vitro, G-Px was inhibited by estriol and 17 beta-estradiol, marginally inhibited by estrone, and most notably inhibited by the catecholestrogens tested (2-hydroxy-17 beta-estradiol, 2-hydroxy-estriol, and 2-hydroxy-estrone), which were equipotent inhibitors; LH and FSH, progesterone, or cortisol had no effect on G-Px activity. We hypothesize that catecholestrogens are natural substrates and regulations of G-Px activity in the human uterus.

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We report a case of respiratory failure caused by Strongyloides stercoralis in a patient with a renal transplant; the respiratory failure showed dramatic response to therapy with thiabendazole. The clinical aspects of infestation with S stercoralis in the immunocompromised host are discussed, and features are demonstrated which may have significant implications concerning primary treatment and prophylaxis.

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We describe features of multiple cancers in a small kindred wherein a cluster of tumors affecting various anatomic sites has been observed among eight directline relatives. Three of these individuals have had two or more primary malignancies, and one woman showed a remarkable tolerance to invasive cancer, having had four histologically verified neoplasms (cancers of the ovary, endometrium, and colon, and myelogenous leukemia). The constellation of tumors occurring at an early age among relatives of the kindred supports a genetic etiology.

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The occurrence of multiple primary malignant neoplasms characterizes virtually all varieties of hereditary cancer. This report focuses on this phenomenon in 11 families with the Cancer Family Syndrome (heritable adenocarcinomas of the colon and endometrium) and a single extended kindred with site-specific colon cancer. Of the 316 relatives with cancer in the 12 families, 68 (21.5%) had two or more primary malignancies and 59 (86.8%) of these multiple primaries involved the colon and/or endometrium. A pooled analysis of this resource revealed a consistent 3% risk for a second primary cancer in each year of survival following first onset. If a second primary occurs, the risk for a third is extremely high (6.9% per year), but shows a nonlinear trend with increasing survival following second onset. The high risk for development of extraprimary malignancies in patients from these kindreds indicates that careful consideration should be given to total removal of their principal target organs following the initial manifestation of cancer.

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A family with site-specific colon cancer and discrete adenomatous colon polyps in certain members has provided a prototype for the study and clinical management of hereditary cancer. Analysis of this kindred showed an autosomal dominant mode of inheritance, early onset of cancer with predilection for the right colon, and frequent extraprimary cancers of the colon. Knowledge of these phenomena are critical to the management of this hereditary cancer syndrome. On our recommendation, two brothers of the family who were treated for colon cancer by hemicolectomy underwent prophylactic total colectomy. The resected colon from one of these patients had an occult adenocarcinoma in a villoglandular polyp.

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The etiology of Hodgkin's disease is complex, as is evident in studies suggesting the importance of horizontal transmission, occupational factors, racial and ethnic background, and familial, genetic factors, or both, including HL-A associations. The present study is of a remarkable kindred in which Hodgkin's disease was histologically verified in two sibships involving second-cousins related through maternal great-grandparents. Cancer of the lung, breast, endometrium, ovary, pancreas, and brain, as well as leukemia and Wilms' tumor, occurred in first and second-degree relatives of the Hodgkin's patients. HL-A haplotypes in patients with Hodgkin's disease in this family showed HL-AB5 or HL-ABW35, an association confirmed in other reports. The findings of associated malignant neoplasms in familial Hodgkin's disease, here and elsewhere in the literature, suggest that in the quest for etiology of Hodgkin's disease one must view the disorder eclectically, with a painstaking search for multiple etiologies, genetic and environmental.

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