Elevation of plasma concentrations of kisspeptin in human males significantly increases circulating LH, FSH, and testosterone levels. Kisspeptin infusion provides a novel mechanism for hypothalamic-pituitary-gonadal axis manipulation in disorders of the reproductive system.

Elevation of plasma kisspeptin in human females potently stimulates LH release in the preovulatory phase and provides a novel mechanism for manipulation of the HPG axis in women.

The role of gastrointestinal hormones in the regulation of appetite is reviewed. The gastrointestinal tract is the largest endocrine organ in the body. Gut hormones function to optimize the process of digestion and absorption of nutrients by the gut. In this capacity, their local effects on gastrointestinal motility and secretion have been well characterized. By altering the rate at which nutrients are delivered to compartments of the alimentary canal, the control of food intake arguably constitutes another point at which intervention may promote efficient digestion and nutrient uptake. In recent decades, gut hormones have come to occupy a central place in the complex neuroendocrine interactions that underlie the regulation of energy balance. Many gut peptides have been shown to influence energy intake. The most well studied in this regard are cholecystokinin (CCK), pancreatic polypeptide, peptide YY, glucagon-like peptide-1 (GLP-1), oxyntomodulin and ghrelin. With the exception of ghrelin, these hormones act to increase satiety and decrease food intake. The mechanisms by which gut hormones modify feeding are the subject of ongoing investigation. Local effects such as the inhibition of gastric emptying might contribute to the decrease in energy intake. Activation of mechanoreceptors as a result of gastric distension may inhibit further food intake via neural reflex arcs. Circulating gut hormones have also been shown to act directly on neurons in hypothalamic and brainstem centres of appetite control. The median eminence and area postrema are characterized by a deficiency of the blood-brain barrier. Some investigators argue that this renders neighbouring structures, such as the arcuate nucleus of the hypothalamus and the nucleus of the tractus solitarius in the brainstem, susceptible to influence by circulating factors. Extensive reciprocal connections exist between these areas and the hypothalamic paraventricular nucleus and other energy-regulating centres of the central nervous system. In this way, hormonal signals from the gut may be translated into the subjective sensation of satiety. Moreover, the importance of the brain-gut axis in the control of food intake is reflected in the dual role exhibited by many gut peptides as both hormones and neurotransmitters. Peptides such as CCK and GLP-1 are expressed in neurons projecting both into and out of areas of the central nervous system critical to energy balance. The global increase in the incidence of obesity and the associated burden of morbidity has imparted greater urgency to understanding the processes of appetite control. Appetite regulation offers an integrated model of a brain-gut axis comprising both endocrine and neurological systems. As physiological mediators of satiety, gut hormones offer an attractive therapeutic target in the treatment of obesity.

Vesicovaginal fistulas-vault fistulas as they are called when located at the vaginal apex following total hysterectomy-are rare lesions that are located on the anterior vaginal wall just in front of the transverse vaginal scar made when the cervix is removed. Latzko, in 1942, described a technique of treating vault fistulas solely through a vaginal approach. A vault colpocleisis is performed without attempting to dissect the fistulous tract. Although this is an effective and relatively simple procedure, there is as yet no consensus on first-line treatment of these lesions. The authors report the results of the Latzko procedure in 11 women with a mean age of 50 years who had a postoperative vesicovaginal fistula. All but one of the fistulas followed total hysterectomy. The mean interval between primary surgery and a fistula was just short of 2 weeks. Urethral bladder drainage for 5-8 days did not prevent a fistula from forming in these patients.Urinary drainage was maintained for at least 6 weeks before surgical repair. The fistula was drawn downward using a balloon catheter placed in its opening and was then circumcised 1.5 to 2 cm from the opening. All epithelium from the circumcised area to the edge of the fistula's opening was removed before approximating the anterior and posterior vaginal walls using interrupted absorbable sutures. The vaginal mucosa then was closed by a second layer of sutures. The bladder was drained with a Foley catheter until the cystogram was normal.The Latzko procedure succeeded in all cases as evidenced by the absence of urine loss during a bladder tightness test 1 month postoperatively. There were no intraoperative complications, and the only postoperative problem was a lower urinary tract infection. The patients were followed for a mean of 19 months after repair. These results show that the Latzko procedure is a safe, technically simple, and effective means of treating vault vesicovaginal fistulas. The investigators recommend it as the most appropriate first-line surgical treatment. GYNECOLOGYVolume 62, Number 1 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTObjective cure rates exceeding 75% are reported after colposuspension in women with stress incontinence, but extended follow-up has not been the rule. Small-scale studies also have been done to evaluate laparoscopic colposuspension after its introduction in 1991. A Cochrane review in the year 2000 yielded no conclusions about the long-term efficacy of this procedure.The present randomized controlled trial recruited, from six gynecology units in the United Kingdom, 291 women with proven stress urinary incontinence who required surgery. Participants were randomized to undergo open abdominal retropubic colposuspension or laparoscopic colposuspension. Subjective outcomes were based on patient satisfaction, and objective outcomes on a negative 1-hour pad test. Data on objective outcomes were available after 2 years of follow-up in 85% of women having laparoscopic surgery and 80% of those having open surgery. The respective figures for s...

The increasing prevalence of obesity worldwide has imparted renewed impetus to the study of the mechanisms of appetite regulation. Digestion and nutrient absorption take place in the gastrointestinal (GI) tract, whereas food intake is controlled by neuronal circuits in the central nervous system. The need for gut-brain cross talk is therefore clear. It is now recognized that hormones released into the circulation from the GI tract in response to nutritional stimuli form a key component of this gut-brain axis. Peptides such as glucagon-like peptide-1, oxyntomodulin, pancreatic polypeptide, and peptide YY3-36 reduce food intake in both animal models and in humans. Physiologically, such peptides are thought to act as satiety signals and meal terminators. Here, we review the current state of the field of the effects of gut hormone action on appetite control.

Food intake and energy expenditure are tightly regulated by the brain, in a homeostatic process that integrates diverse hormonal, neuronal and metabolic signals. The gastrointestinal tract is an important source of such signals, which include several hormones released by specialized enteroendocrine cells. These hormones exert powerful effects on appetite and energy expenditure. This Review addresses the physiological roles of peptide YY, pancreatic polypeptide, islet amyloid polypeptide, glucagon-like peptide 1, glucagon, oxyntomodulin, cholecystokinin and ghrelin and discusses their potential as targets for the development of novel treatments for obesity.

Acute administration of kisspeptin to women with infertility due to HA potently stimulates gonadotropin release, but chronic administration of kisspeptin results in desensitization to its effects on gonadotropin release. These data have important implications for the development of kisspeptin as a novel therapy for reproductive disorders in humans.

. Plasma kisspeptin is raised in patients with gestational trophoblastic neoplasia and falls during treatment.