所謂出血性メトロパチー患者の卵巣機能に関する研究
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I made a study on the fluctuation of urinary estrogen and pregnanediol excretion in the patients of so-called Metropathia haemorrhagica, as a measure to know the entity of this disease, and also investigated the influence of the administration of sex steroids clinically and endocrinologically. Furthermore, concerning to these clinical experiments, histological studies were performed on the ovaries in persistent estrus rats which were believed to be in the same endocrinological circumstances as Metropathia haemorrhagica in human beings, and the influence of the same sex steroids on these rats were also investigated.<BR>In normal non-pregnant women, the excretion of estrogen and pregnanediol in urine fluctuated regularly according to the menstrual cycle, and the former showed two peaks during the cycle, one at or about the time of ovulation and the other several days before the onset of the expected menstruation, while the latter was proved to be excreted only during the luteal phase. These fluctuations were considered to reflect those of estrogen and progesterone secretion in the ovary.<BR>The patients of so-called Metropathia haemorrhagica did not excret pregnanediol in urine at all, and many of them were in a state of excessive estrogen secretion shortly before the onset of the characteristic bleedings. Comparing these findings with the results of Tojo who investigated the anterior pituitary function on the same subjects, I reached to the conclusion that the entity of this disease consisted in the ovulatoty disturbance based on the anterior pituitary disfunction, and I understood that the bleeding was caused by the withdrawal of excessive estrogen which was secreted from the persistent ovarian follicles.<BR>I noticed therefore that the causal therapy of this disease should be the establishment of ovulatory cycle, and applying our own method, that was, simultaneous administration of 2,000 I.U. PMSG and 1,000 I.U. HGG for three days, I succeeded in inducing ovulation and restoring normal ovulatory cycles in these patients, moreover confirmed that these effects were not temporary but rather permanent, judged from the study of urinary estrogen and pregnanediol or from the clinical features.<BR>On the other hand, it was found that though estrogen, progesterone or androgen were all excellent in bleeding arresting effects, their influences on the urinary estrogen or pregnanediol were only temporary, and showed no effects on inducing ovulation. This suggested that their therapeutic effects might be also temporary.<BR>From the histologic findings of the ovary in persistent estrus rat, I reaffirmed that the ovulation was suppressed by secondary ovarian dysfunction based on the anterior pituitary dysfunction, and affired that the administration of the sex steroids above mentioned induced ovulation temporarily but not effective enough in restoring normal sexual cycle.<BR>From these studies above cited I affirmed that the entity of the so-called Metropathia haemorrhagica was the secondary ovarian disfunction based on the anterior pituitary disfunction and its bleeding were caused by estrogen withdrawal, and I proved from the stand-point of ovarian function that the administration of gonadotropin was therapeutically better than that of sex steroids whose effects were only temporary.