Cold urticaria: case series and literature review

Cold urticaria is one of the five most common causes of chronic urticaria and is grouped as a physical urticaria. It can occur after exposure to cold, either through solid objects, air or liquids. Patients may have symptoms of urticaria, angioedema, respiratory distress and even anaphylaxis when the skin is exposed to a cold environment, such as handling refrigerated objects, swimming in cold water or entering an air-conditioned room. Five cases of cold urticaria are presented, followed by a brief literature review.     

Menstrual irregularities in adolescents: hormonal pattern and ovarian morphology

The endocrine pattern and ovarian characteristics of 110 healthy adolescents with menstrual irregularities were investigated during the early follicular and premenstrual phases and were compared to those of 14 adolescents with regular menstrual cycles and 20 adults. Over a period of six gynecological years a low ovulation rate (49%) was found in the group of subjects with irregular cycles and regular ovulation was noted in only a few subjects. Slight differences in endocrine pattern and ovarian morphology were observed between the group of adolescents with regular cycles and the group of adults. In contrast, adolescents with irregular menses had higher mean values of luteinizing hormone (LH), testosterone (T), and androstenedione (A) in comparison with the other two groups both in follicular and premenstrual phases. Nearly 35% of the subjects with irregular cycles had levels of T, A and LH which were higher than the upper limit of the adult normal range. Lower progesterone (P), 17P and oestradiol values were observed in the premenstrual phase. Within the group of subjects with irregular menses, LH levels were higher in anovulatory than in ovulatory cycles, in both phases of the cycle, while T and A levels were higher and prolactin levels were lower in the premenstrual phase of anovulatory cycles. Unlike irregular anovulatory cycles, irregular ovulatory cycles showed a hormonal pattern similar to that found in the adult group. By ultrasound evaluation, a high percentage of subjects with irregular menses had multicystic ovaries (57.9%) and the mean (+/- SEM) ovarian volume was higher (10.6 +/- 0.5 cm3) than that found in adolescents with regular menses (6.7 +/- 0.8 cm3) and in the adult group (7.7 +/- 0.3 cm3). With the increase in frequency and continuity of ovulation an improvement in the direction of adult volume and ovarian structure was observed. Besides the endocrine similarity the data emphasize the striking similarity, already documented by histological studies, between pubertal ovaries and those seen in micropolycystic ovary syndrome. These endocrine and ovarian characteristics are typical of a large number of adolescents with irregular menstrual cycles: these features may be representative of a developmental step toward adult normality, although the possibility of a pathological evolution for some subjects cannot be excluded.     

Disturbance of the Duration in the Menstrual Cycle under the Influence of Tight Clothing

We investigated the influence of skin pressure by clothing on the duration of menstrual cycle with 33 young adult women. The average age was 19.9 ± 2.1 years (mean ± SD), stature 159.5 ± 5.6cm and body mass 50.9 ± 5.5kg. Thirty-three women participated as subjects. They wore their usual clothing including foundation garments, panty stocking, pants or skirt and T-shirt or blouse and cardigan for the first 4 months from December to March (‘Tight 1’). For the second 4 months from April to July, the women wore loose clothes, i.e., they did not wear foundation garments at home. Skirt and jeans were worn loosely (‘Loose’). For the last 4 months, from August to November, they wore their clothes as tightly as possible, compared to ‘Tight 1’ (‘Tight 2’). Each participant marked the first day of the occurrence of menses in the pocket diary throughout the year. The main results were summarized as follows: 1) The average duration of the menstrual cycle was 44.2 ± 14.9 days (mean ±) in ‘Tight 1’, 30.4 ± 3.0 days in ‘Loose’ and 47.4 ± 22.7 days in ‘Tight 2’. 2) The number of months when the menses did not occur was 38 for ‘Tight 1’, 6 for ‘Loose’ and 40 for ‘Tight 2’. 3). The number of participants who had a duration of the menstrual cycles for more than 40 days, was 25 participants for ‘Tight’, 10 for ‘Loose’ and 29 for ‘Tight’. It can be concluded that skin pressure by clothing could disturb the duration in the menstrual cycle.     

Disturbance of the Duration in the Menstrual Cycle under the Influence of Tight Clothing

We investigated the influence of skin pressure by clothing on the duration of menstrual cycle with 33 young adult women. The average age was 19.9 ± 2.1 years (mean ± SD), stature 159.5 ± 5.6cm and body mass 50.9 ± 5.5kg. Thirty-three women participated as subjects. They wore their usual clothing including foundation garments, panty stocking, pants or skirt and T-shirt or blouse and cardigan for the first 4 months from December to March ('Tight 1'). For the second 4 months from April to July, the women wore loose clothes, i.e., they did not wear foundation garments at home. Skirt and jeans were worn loosely ('Loose'). For the last 4 months, from August to November, they wore their clothes as tightly as possible, compared to 'Tight 1' ('Tight 2'). Each participant marked the first day of the occurrence of menses in the pocket diary throughout the year. The main results were summarized as follows: 1) The average duration of the menstrual cycle was 44.2 ± 14.9 days (mean ±) in 'Tight 1', 30.4 ± 3.0 days in 'Loose' and 47.4 ± 22.7 days in 'Tight 2'. 2) The number of months when the menses did not occur was 38 for 'Tight 1', 6 for 'Loose' and 40 for 'Tight 2'. 3). The number of participants who had a duration of the menstrual cycles for more than 40 days, was 25 participants for 'Tight', 10 for 'Loose' and 29 for 'Tight'. It can be concluded that skin pressure by clothing could disturb the duration in the menstrual cycle.     

Chronic urticaria.

Urticaria affects 15% to 20% of the population once or more during a lifetime. Chronic urticaria is a frequent recurrent eruption over a period greater than 6 weeks; the cause remains a mystery in more than 75% of cases. Urticaria and angioedema may be produced by immunologic or nonimmunologic means. Urticarial vasculitis, contact urticaria, mastocytosis, physical urticarias, dermatographism, cholinergic urticaria, localized heat urticaria, cold urticaria, aquagenic urticaria, and vibratory angioedema all require specific evaluation and treatment. Chronic idiopathic urticaria is usually controlled by antihistamines; depending on the circadian rhythm of the eruption, sedative or nonsedative antihistamines are prescribed. Some patients will require a combination of H1 and H2 antagonists, or even parenteral corticosteroids.     

The effect of female proximity and social interaction on the menstrual cycle of crab-eating monkeys (Macaca fascicularis)

Twelve adult female crab-eating monkeys (Macaca fascicularis) were placed in six pairs of adjacent cages, allowing physical contact between members of these experimental pairs. Twelve additional females remained singly caged (no physical contact allowed) and served as six control “pairs.” In both experimental and control pairs, one member had a history of regular menstrual cycles, whereas the other tended to have cycles that were unusually long and/or irregular. Over a six-month period, menses and amount of vaginal secretion were recorded daily for all subjects, and the behavior of experimental pairs was sampled three times per week. During the course of the study, the irregular experimental subjects began to exhibit menstrual cycles of near normal length although there was no apparent trend to synchronize cycles. Irregular controls continued to show cycles that were abnormally long. Vaginal secretions tended to increase in all regularly cycling animals during days 9–15 (peak day 11) or reverse days 21–16 of the cycle, consistent with the estimated time of ovulation. Analysis of behavior indicated that irregularly cycling subjects inspected the genitalia of their regularly cycling cagemates at a significantly higher frequency than the converse (F=12.61,p<.005), particularly during the follicular phase (F=3.39,p<.07). These results suggest that close physical contact may serve to transmit chemical and/or hormonal cues that can normalize the menstrual cycle of crab-eating monkeys.     

Development of the selective progesterone receptor modulator CDB-2914 for clinical indications

CDB-2914 (17 alpha-acetoxy-11 beta-[4-N,N-dimethylaminophenyl]-19-norpregna-4,9-diene-3,20-dione) is a 19-norprogesterone derivative that acts as an antagonist in progesterone-responsive tissues. It binds to progesterone receptors A and B with high affinity. After oral dosing in humans, CDB-2914 serum levels peak at 60-90 min. CDB-2914 binds to serum proteins and is cleared slowly. Doses of 1, 10 and 50 mg exhibit proportional increases in peak serum levels, but serum levels from higher doses, 100 and 200 mg, are not dose-dependent, suggesting saturation of carrier sites. The biological effects of CDB-2914 vary according to time of the menstrual cycle that the drug is given. In the mid-follicular phase, CDB-2914 (50 mg) inhibits follicular development and delays ovulation and menses. At 100 mg, in some cases the original follicle ceases development and a new follicle is recruited. Endometrial maturation is delayed at all doses tested (10, 50, 100 mg). Given at mid-luteal phase, there was a dose-dependent effect on menses, with higher doses (100-200 mg) resulting in earlier menses. On average, CDB-2914 tends to lengthen the menstrual cycle by approximately 1-2 days although the amount of delay varies with timing in the menstrual cycle and dose.     

Helicobacter pylori infection and skin diseases.

There is increasing evidence for systemic effects of gastric H. pylori infection which may result in extragastrointestinal disorders. This review summarizes the available medical literature up to September 1999, identified through a MEDLINE research including own studies, regarding H. pylori and skin diseases. Due to current knowledge best evidence for a potential link of H. pylori infection exists for chronic urticaria although the data are still conflicting. Thus, the search for H. pylori should be included in the diagnostic management of chronic urticaria. With regard to other skin diseases such as rosacea, hereditary or acquired angioedema due to C1-esterase inhibitor deficiency, systemic sclerosis, Sch?nlein-Henoch purpura, Sj?gren's syndrome, sweet's syndrome, and atopic dermatitis only single of few cases have been reported so far. Thus, we clearly need further randomized, double-blind and placebo-controlled studies including adequate diagnostic schedules, sufficient eradication treatment protocols, confirmation of eradication, and adequate control groups to establish a role of H. pylori in skin diseases. Caution must be taken not to accuse H. pylori as the infectious agent responsible for every disease, particularly since H. pylori infection is very common. Although from an epidemiological and morphological view the skin diseases to which H. pylori has been linked seem to be completely different it is striking that in most of them an autoimmune pathogenesis is suspected or considerable vascular impairment can be found.     

Ovulation Inhibitors

One hundred and eighty-five women were followed up for periods up to 15 months (a total of 964 menstrual cycles) to determine the contraceptive efficacy and side effects of 2 mg. norethindrone with 0.1 mg. mestranol, as well as other therapeutic benefits. No pregnancies occurred in those using this method alone for contraception. Side effects were minimal. This low dosage was also useful in the management of dysmenorrhea, menorrhagia and irregular menses.     

Effects of ovarian tissue reduction on the menstrual cycle: persistent normalcy after near-total oophorectomy

These experiments were designed to evaluate whether removal of approximately 95% visible ovarian tissue would interrupt the short- or long-term regulation of cyclic ovarian function. On cycle Days 2 4 (onset of menses = Day 1), the entire left ovary and approximately 90% of the right ovary were removed from three cycling cynomolgus monkeys. After approximately 95% ovariectomy, there was an acute elevation of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which lasted 11 +/- 2 days. A midcycle-like gonadotropin surge occurred 20 +/- 3 days following approximately 95% ovariectomy; the next menses occurred 19 +/- 1 days later. Follicular phase patterns of estradiol preceded the midcycle gonadotropin surge, and luteal phase progesterone levels indicated subsequent ovulation. Two of three monkeys resumed normal menstrual cyclicity in the following cycle with follicular phase, luteal phase, and menstrual cycle lengths similar to pretreatment levels. Histological examination of the ovarian remnant removed on Day 21 of the next cycle revealed a morphologically normal corpus luteum and many small follicles. A second group of 6 rhesus monkeys also underwent approximately 95% ovariectomy for long-term evaluation of menstrual cyclicity; typical 28-day menstrual cycle patterns were observed in 4 of the 6 monkeys for 5 mo, with 2 of these 3 animals maintaining regular menstrual cycles for 1 yr. In summary, our data suggest that normal ovarian function, i.e. recruitment, selection, and dominance of the ovulatory follicle, ovulation, and subsequent corpus luteum function, is maintained with only approximately 5% of functional ovarian tissue remaining.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pericentric X inversion in dizygotic twins who differ in X chromosome inactivation and menstrual cycle function

Summary A 21-year-old female dizygotic twin was referred for cytogenetic evaluation because of mild mental retardation. Significant history, clinical, and physical findings included irregular menses, mildly coarse facies, and microcornea. Chromosome analysis revealed a pericentric inversion of the X chromosome, 46,X,inv(X)(p11;q22). Her twin who is phenotypically normal was also found to carry the same inversion. The twins differ significantly in X chromosome inactivation and menstrual cycle function.     

The physiological basis of complementary and alternative medicines for polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that is characterized by chronic hyperandrogenic anovulation leading to symptoms of hirsutism, acne, irregular menses, and infertility. Multiple metabolic and cardiovascular risk factors are associated with PCOS, including insulin resistance, obesity, type 2 diabetes, hypertension, inflammation, and subclinical atherosclerosis. However, current treatments for PCOS are only moderately effective at controlling symptoms and preventing complications. This article describes how the physiological effects of major complementary and alternative medicine (CAM) treatments could reduce the severity of PCOS and its complications. Acupuncture reduces hyperandrogenism and improves menstrual frequency in PCOS. Acupuncture's clinical effects are mediated via activation of somatic afferent nerves innervating the skin and muscle, which, via modulation of the activity in the somatic and autonomic nervous system, may modulate endocrine and metabolic functions in PCOS. Chinese herbal medicines and dietary supplements may also exert beneficial physiological effects in PCOS, but there is minimal evidence that these CAM treatments are safe and effective. Mindfulness has not been investigated in PCOS, but it has been shown to reduce psychological distress and exert positive effects on the central and autonomic nervous systems, hypothalamic-pituitary-adrenal axis, and immune system, leading to reductions in blood pressure, glucose, and inflammation. In conclusion, CAM treatments may have beneficial endocrine, cardiometabolic, and reproductive effects in PCOS. However, most studies of CAM treatments for PCOS are small, nonrandomized, or uncontrolled. Future well-designed studies are needed to further evaluate the safety, effectiveness, and mechanisms of CAM treatments for PCOS.     

Influence of the Male Axillary Extracts on Regulation of Menstrual Cycles in Women

The effect of male axillary extract on the length and regularity of the menstrual cycle in women was studied in a long-term experiment (9 months). The male secret extract had no statistically significant influence on the menstrual cycle duration in the reproductive-age women (21–45 years) with normal (26–32 days) and regular cycles or in women with abnormally short (<26 days) cycles. In the group of the reproductive-age women with irregular and abnormally long (>32 days) cycles, as well as in the group of the premenopauseage women (46–51 years) with irregular cycles, the secret extract caused a significant shortening of the menstrual cycle as compared to the control. The effect was preserved for at least two months after the exposure completed.     

Carcinoma of the breast; possible significance of menstrual cycle in results of operation

Among 55 patients upon whom mastectomy was done for cancer of the breast, survival without evidence of metastasis (after varying periods of follow-up) was significantly higher for those who were operated upon in the seven days preceding the beginning of menses than it was for those who underwent operation in any of the three other seven-day periods in the menstrual cycle. Moreover, in a comparison of results of operations done in each of the four seven-day periods, there was a graduating increase in mortality and metastasis from the first period (the seven days preceding menses) through the fourth period. The results of the study of this small series are considered not conclusive but indicative of possible profit in studies of larger and better controlled series.     

CARCINOMA OF THE BREAST—Possible Significance of Menstrual Cycle in Results of Operation

Among 55 patients upon whom mastectomy was done for cancer of the breast, survival without evidence of metastasis (after varying periods of follow-up) was significantly higher for those who were operated upon in the seven days preceding the beginning of menses than it was for those who underwent operation in any of the three other seven-day periods in the menstrual cycle. Moreover, in a comparison of results of operations done in each of the four seven-day periods, there was a graduating increase in mortality and metastasis from the first period (the seven days preceding menses) through the fourth period.The results of the study of this small series are considered not conclusive but indicative of possible profit in studies of larger and better controlled series.     

Physical activity of adult female rhesus monkeys (Macaca mulatta) across the menstrual cycle

Physical activity is an important physiological variable impacting on a number of systems in the body. In rodents and several species of domestic animals, levels of physical activity have been reported to vary across the estrous cycle; however, it is unclear whether such changes in activity occur in women and other primates across the menstrual cycle. To determine whether significant changes in activity occur over the menstrual cycle, we continuously measured physical activity in seven adult female rhesus monkeys by accelerometry over the course of one menstrual cycle. Monkeys were checked daily for menses, and daily blood samples were collected for measurement of reproductive hormones. All monkeys displayed ovulatory menstrual cycles, ranging from 23 to 31 days in length. There was a significant increase in estradiol from the early follicular phase to the day of ovulation (F(1.005,5.023) = 40.060, P = 0.001). However, there was no significant change in physical activity across the menstrual cycle (F(2,12) = 0.225, P = 0.802), with activity levels being similar in the early follicular phase, on the day of the preovulatory rise in estradiol and during the midluteal phase. Moreover, the physical activity of these monkeys was not outside the range of physical activity that we measured in 15 ovariectomized monkeys. We conclude that, in primates, physical activity does not change across the menstrual cycle and is not influenced by physiological changes in circulating estradiol. This finding will allow investigators to record physical activity in female primates without the concern of controlling for the phase of the menstrual cycle.     

Changes in plasma adrenomedullin levels during the menstrual cycle

We investigated whether the levels of adrenomedullin, a novel peptide produced by several tissues, including the pituitary gland, change during the ovarian cycle. We studied 13 healthy women with regular menstrual cycles. Plasma samples were collected at 7, 14, 21 and 28 days of the ovarian cycle and assayed for adrenomedullin 1-52 using a specific RIA. LH, FSH, 17beta-estradiol, and progesterone concentrations were also determined. The adrenomedullin profile during ovarian cycle was similar to that of LH; plasma adrenomedullin increased from 10.9 pg/ml at the 7th day to 15.1 pg/ml at the 14th, and decreased to 8.5 pg/ml in the subsequent menses. The changes in plasma adrenomedullin were related to changes in LH and 17beta-estradiol. The cause of the increase in adrenomedullin levels during the late follicular phase of the menstrual cycle is not clear. Since it has been demonstrated that adrenomedullin is involved in the regulation of hypothalamus-pituitary-adrenal gland and its secretion is regulated by sex hormones we speculate that adrenomedullin could also play a role in regulating the hypothalamus-pituitary-ovary feedback. Alternatively it may be involved in the regulation of fluid and electrolyte homeostasis during the menstrual cycle.     

Menstrual cycle phases and female receptivity to a courtship solicitation: an evaluation in a nightclub

Previous research has demonstrated that female behaviors toward men or sexual interest are different across the menstrual cycle. However, women's receptivity to an explicit courtship solicitation still remained in question. In a field experiment, 20-year-old women were approached by 20-year-old male confederates in nightclubs and solicited to dance during the period when slow songs were played. A survey was administered to the women in order to obtain information about the number of days since the onset of previous menses. It was found that women in their fertile phase agreed more favorably to the dance request than women in their luteal phase or in their menstrual phase.     

Impact of lactation upon fertility in the New World primate capuchin monkey (Cebus apella)

In the present paper, we have studied the impact of lactation upon fertility in the capuchin monkey, Cebus apella, under laboratory conditions. Nursing females (ten females, 12 postpartum periods) presented lactational amenorrhea (first menses at 159.2 +/- 9.0 vs 42.6 +/- 5.8 days postpartum in five non-nursing females, seven postpartum periods). Plasma estradiol and progesterone concentrations during lactational amenorrhea were lower than those during the follicular phase of the menstrual cycle. Prolactin was higher than in non-nursing females at 31-60 days postpartum. Interbirth interval, studied in three non-nursing (four intervals) and six nursing females (eight intervals) lasted for 349.5 +/- 11.8 and 613.4 +/- 30.8 days, respectively. In non-nursing females, early recovery of the menstrual cycle was followed by a residual infertility (mating but no pregnancy) lasting 152.8 +/- 7.9 days. In nursing females, recovery of the menstrual cycle was followed by an extended residual infertility of 301.5 +/- 22.7 days. Thus, in the capuchin monkey, nursing prolongs the interbirth interval by inducing lactational amenorrhea and extending the residual infertility period.