HMG-hCG therapy has been used for the treatment of anovulation and controlled ovarian hyperstimulation for ART. Physiologically, ovulation occurs following LH surge. However, in the hMG-hCG therapy, LH surge seldom takes place, and therefore hCG is used instead. To clarify the comparative effects of LH and hCG on the survival of follicular granulosa cells after ovulation induction, we examined the proliferative ability and apoptosis of ovarian granulosa cells after ovulation induction with hCG or LH in PMSG-treated immature female rats. Following 10 IU PMSG injection in 3-week old female rats, 5 IU hCG (hCG group) or 20 IU LH (LH group) was administered for ovulation induction. The rats were decapitated 24 hours after the LH/hCG injection for sampling sera and ovarian tissues. The serum concentrations of E2 and P4 were measured by RIA. Immunohistochemical staining of proliferating cell nuclear antigen (PCNA) on the ovarian tissues was performed to determine the proliferative activity of granulosa cells. Terminal deoxy-nucleotidyl transferase deoxy-UTP-nick end labeling (TUNEL) method was utilized to determine apoptosis. The PCNA-positive rate and TUNEL-positive rate of granulosa cells were comparatively assessed in medium-sized follicles (diameter; 120-170μm) and large follicles (diameter; 170-500μm). The serum E2 levels and E2/P4 ratio were significantly higher in hCG group than in LH group, while the concentration of P4 did not show significant differences. In medium-sized follicles PCNA-positive rate of the granulosa cells was significantly higher in hCG group than that in LH group, whereas TUNEL-positive rate was significantly higher in LH group than in hCG group. In large follicles, PCNA-positive rate of granulosa cells was significantly higher in hCG group than that in LH group, whereas TUNEL-positive rate of granulosa cell nuclei did not present significant differences between the two groups. These results indicate that administration of hCG for ovulation induction stimulates the proliferation of granulosa cells in large follicles compared to that in LH treatment, resulting in the elevation of serum E2 levels but not P4, and that more surviving medium-sized follicles which may affect the next cycle are found in hCG-treated cycle relative to LH-treated cycle. The fact that the proliferative activity of granulosa cells of not only large-sized but also medium-sized follicles was higher in hCG treatment than that in LH treatment suggests that hCG administration seems to cause ovarian hyperstimulation syndrome. [Adv. Obstet. Gynecol., 54 (3) : 185-193, 2002 (H.14.5)]

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Immunocytochemistry of PCNA was used to evaluate the proliferative activity of uterine cervical cells obtained by cytological examination from patients with cervical neoplasm or other diseases, and to examine the association of PCNA expression with the cytological status of the cervical cells. The 57 patients were classified into five groups based on their disease, the cervical epithelial neoplasm group (n=6), the malignant disease group, i.e., patients with malignant disease other than cervical neoplasm (n=23), the autoimmune disease group (n=4), the severe atopic dermatitis group (n=5), and the control group (n=19). The groups showed no significant differences in mean age. Immunocytochemical staining of PCNA was performed with a modified version of the method reported by Noel. The PCNA labeling index (LI) and the percentage of patients with PCNA positive staining in each group (PCNA positive-patient rate) were determined. PCNA LI and PCNA positive-patient rate were 9.6±5.9% and, 100% for the cervical epithelial neoplasm group, 2.8±3.8% and, 34.8% for the malignant disease group, 4.7±5.0% and, 50% for the autoimmune disease group, 1.5±0.7% and, 20% for the atopic dermatitis group, and 1.2±0.5% and, 5% for the control group. Both PCNA LI and PCNA positive-patient rate of the cervical disease group were significantly higher than those of the control group with a p value of less than 0.01. The mean values of PCNA LI in patients with CIN and with invasive cervical cancer were 4.7% and 14.4% respectively, suggesting that proliferative activity increases with progression of the disease. Finally, the PCNA positive-patient rate for patients with class II or less cervical cytology was lower than that for patients with class III or more.[Adv. Obstet. Gynecol., 54 (3) : 194-198, 2002 (H.14.5)]

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Pelvic reconstructive surgery for pelvic relaxation is thought to be one of the most difficult gynecologic surgeries because of a high recurrence rate and complications after the operation. With the study of vaginal anatomy as described by DeLancey, vaginal support systems were divided into three levels. This classification of each level showed a clearer illustration of corrective surgeries concerning a support defect of uterus and vagina. The vaginal support defect at level I sometimes coexists with cystocele, rectocele, enterocele and/or paravaginal defect. Its repair will therefore be complex and difficult. Many operative methods for level I had been proposed and each of them has advantages and disadvantages. Recently, a new method of colposuspension for the deficiency of level I has been proposed by B. Shull. The method of surgical repair is easy, simple and theoretically understandable. It also has a few operative complications and a low recurrence rate. Methods of surgical repair at level II and III were also presented and discussed. The notion and the methods of female pelvic reconstructive surgery for vaginal wall relaxation and prolapse are still evolving. This article explains the notion of the pelvic reconstructive surgery and discusses its methods at length. [Adv. Obstet. Gynecol., 54 (3) : 199-204, 2002 (H.14.5)]

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