We report here results of clinical trials on a birth control vaccine, consisting of a heterospecies dimer of the .3 subunit of human chorionic gonadotropin (hCG) associated noncovalently with the a subunit of ovine luteinizing hormone and coijugated to tetanus and diphtheria toxoids as carriers, that induces antibodies of high avidity (Ka 1010 M-) against hCG. Fertile women exposed to conception over 1224 cycles recorded only one pregnancy at antibody titers of >50 ng/ml (hCG bioneutralization capacity). The antibody response declines with time; fertility was regained when titers fell to <35 ng/ml. This study presents evidence of the feasibility of a vaccine for control of human fertility.A number of contraceptive methods are available; they do not, however, suit all potential users. There is need to develop additional methods, in particular those that are reversible, require only periodic intake, and do not disturb menstrual regularity or bleeding. Vaccines regulating fertility offer promising prospects to meet these specifications. The rationale for these vaccines is to induce the formation of antibodies and/or cell-mediated immunity to intercept selectively a process critical to the success of reproduction. A number of potential antigens are being investigated (1-7). Among these are hormones, which play an important role in the regulation of fertility. Human chorionic gonadotropin (hCG) is an early signal of conception and is considered essential for establishment and maintenance of early pregnancy. An advantage in choosing hCG as a target for immunocontraception is that its inactivation would not interfere with other physiological processes in the female, such as ovulation and production of sex steroid hormones.Carrier conjugation with tetanus toxoid (TT) was proposed as a strategy to overcome the immunological tolerance of a woman against hCG (8). This initial prototype vaccine (/3hCG-TT adsorbed on alum) had limitations. It induced high antibody titers in only a small percentage of women, and those with low titers were not protected from pregnancy (9). Three changes were made to enhance immunogenicity.(i) An adjuvant, the sodium phthalyl derivative of lipopolysaccharide, was included in the first injection. This nonpyrogenic adjuvant is usable in aqueous phase (10). Its use doubled, on average, anti-hCG titers and increased the frequency of high responders.(ii) The intrinsic immunogenicity of (3hCG was enhanced by associating it noncovalently with the a subunit of ovine luteinizing hormone (LH) to form a heterospecies dimer (HSD), a laboratory-made hormone that attains a conformation which recognizes receptors on target tissues (whereas isolated subunits do not) and generates a steroidogenic response even superior to that by hCG (11). HSD linked to carriers was indeed found to be more immunogenic than ,8hCG in rats and monkeys (12). Moreover, the antibodies had better capacity to neutralize the bioactivity of hCG (11,13 It was important to determine whether the antibodies induced by the HSD-and 8hC...

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Ultrasonographic measurement of fetal foot length, a new parameter, was correlated with the gestation age. One hundred and five ultrasonographic measurement of fetal foot length was performed between 13 and 42 weeks gestation. Comparison of linear regression of foot length versus gestational age demonstrated a strong correlation with an r2 value of 0.84 (P less than 0.001). Ninety-five percent confidence intervals at each week compared favorably with both biparietal diameter and femur length data. Mean foot lengths at each week of gestation compared favorably with data based on pathological specimens described in 1920 (Streeter GL: Weight, sitting height, head size, foot length and menstrual age of the human embryo. Contrib Embryol Carnegie Inst. 11: 143, 1920). Measurement of fetal foot length is of particular use when other parameters do not accurately predict gestational age, e.g. hydrocephalus, anencephaly, short limb dysplasia. It can also be used in conjunction with biparietal diameter and femur length in the management of patients with premature labor in order to patients with premature labor in order to accurately predict gestational age. Hence the present study demonstrates that the ultrasonographic measurement of foot length is a reliable indicator of gestational age.

The aetiologic types of sporadic acute viral hepatitis in 169 pregnant women were compared with those of 70 non-pregnant women and 287 adult men. The majority of pregnant women (87.6%) came with acute hepatitis in the last trimester of pregnancy. Non-A, non-B (NANB) hepatitis accounted for 81.6% of hepatitis during pregnancy in comparison with 48.6% in non-pregnant women and 57.1% in adult men. Hepatitis A was extremely uncommon during pregnancy. Hepatitis B infection accounted for 17% of all cases in pregnant women compared with 45% in controls. Acute viral hepatitis in pregnancy had a poor outcome as assessed by maternal and/or fetal mortality (28.5%). The outcome was equally bad in hepatitis NANB and hepatitis B. Pregnant women generally had significantly lower immunoglobulin levels in comparison with non-pregnant women. In acute NANB hepatitis during pregnancy, serum IgG and IgM levels were lower and higher, respectively, compared with those in non-pregnant women and pregnant women with acute hepatitis B. It is suggested that an immune suppression during pregnancy might be responsible for increased susceptibility to acute NANB viral hepatitis, which, by itself, seems to induce only a transient acute phase IgM response.

In the short term, micronized diosmin 90% and hesperidin 10% is safe, acceptable, and effective in the treatment of hemorrhoids of pregnancy.

Residues of dichlorodiphenyltrichloroethane (DDT) and its metabolites were monitored in leiomyomatous and normal human uterine tissue by gas-liquid chromatography (GLC). The metabolites detected were: 2,2-bis-(p-chlorophenyl)-1,1-dichloroethylene (p,p'-DDE), 2-(o-chlorophenyl)-2-(p-chlorophenyl)-1,1,1-trichloroethane (o,p'-DDT), 2,2-bis-(p-chlorophenyl)-1,1-dichloroethane (p,p'-DDD) and 2,2-bis-(p-chlorophenyl)-1,1,1-trichloroethane (p,p'-DDT). Total DDT ranged from 0.245 to 1.982 ppm, with a mean value of 0.845 ppm in leiomyomatous tissue. In normal human uterine tissue, total DDT ranged from 0.030 to 0.282 ppm, with a mean value of 0.103 ppm. Significantly higher levels of DDT and its metabolites in leiomyomatous tissue as compared to normal uterine tissue suggest their involvement in uterine leiomyomas. The data is discussed in the light of existing knowledge on estrogenic activity of DDT analogs and estrogen-influenced growth of uterine leiomyomas.

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