Ralph M. Wynn

University of Arkansas at Little Rock, Little Rock, Arkansas, United States

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Publications (5)17.86 Total impact

  • K W Schweppe · Ralph M. Wynn ·
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    ABSTRACT: The comparison of the ultrastructural features of endometriotic implants in 96 patients before and after suppressive therapy by danazol showed that the glands of the ectopic endometrium had a wide range of morphologic development. In about one-third of the pretreatment biopsies significantly different ultrastructural patterns were observed in the same specimen, ranging from poorly to highly differentiated endometrial glands. Adequate morphological changes during the menstrual cycle were found in implants only in 14 patients during the proliferative phase, but adequate, homogeneously performed secretory changes were completely missing during the luteal phase. Besides incomplete or delayed secretory changes the majority was proliferative rather than secretory. After 6 months of endocrine suppression laparoscopic biopsies of endometriosis were repeated, and the ultrastructural findings lead to three conclusions. 1. Poorly differentiated endometriotic foci do not respond to danazol. 2. Endometriotic implants consisting of highly differentiated epithelium with adequate cyclic variations respond well to danazol and disappear in nearly 80% of cases. 3. In endometriosis with mixed areas consisting of various degrees of glandular differentiation the hormonal suppression can eliminate endometriotic implants or arrest them at a proliferative stage. If the morphological appearance of the ectopic implants depends not simply upon the endocrine stimulus, but primarily on the degree of differentiation and maturity of the cell, then perhaps cyclic modulation is only a secondary phenomenon, and hormones play only a secondary role in therapy. If this hypothesis is correct, only complete elimination of endocrine influence can cure endometriosis. Transient or incomplete suppression may lead only to partial regression.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 06/1984; 17(2-3):193-208. DOI:10.1097/00006254-198411000-00018 · 1.70 Impact Factor
  • K W Schweppe · Ralph M. Wynn · Fritz K. Beller ·
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    ABSTRACT: Ultrastructural features of endometriotic implants suggest an incomplete response to the prevalent hormonal milieu. The cyclic changes, especially in the secretory phase, appear to depend more on the morphologic differentiation of the ectopic implants than on the hormonal stimulus. The endometriotic tissue encompassed a wide range of morphologic development from poorly to highly differentiated glands. Variations occurred from gland to gland and even within the same gland. Complete proliferative development was found only in some of the patients and full secretory transformation was absent in all. The incomplete morphologic response to cyclic hormonal changes may explain the frequent failure of endocrine therapy.
    American Journal of Obstetrics and Gynecology 05/1984; 148(7):1024-39. DOI:10.1016/0002-9378(84)90546-5 · 4.70 Impact Factor
  • K W Schweppe · R M Wynn ·
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    ABSTRACT: This report, the first ultrastructural study of endometriotic implants, compares the ectopic endometrium in 14 patients with that found in the uterus. The ultrastructural features of most of the glands of the ectopic endometrium resemble those of the corresponding glands lining the uterus. Specific ultrastructural characteristics associated with ovulation, such as giant mitochondria and nuclear channel systems, however, could not be detected in ectopic tissue. Although no pathognomonic electron microscopic characteristics were found in the ectopic endometrium, it was generally possible to assign each sample to a particular phase of the menstrual cycle.
    Obstetrics and Gynecology 11/1981; 58(4):465-73. · 5.18 Impact Factor
  • K W Schweppe · W P Dmowski · R M Wynn ·
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    ABSTRACT: Electron microscopic examinations were carried out on 29 representative endometriotic glands obtained from 16 biopsies. Patients with endometriosis diagnosed by laparoscopy and confirmed by laparoscopic biopsy prior to hormonal treatment received danazol, 800 mg daily. The tissue samples were obtained after 2, 4, and 6 months of usage of the drug to study the ultrastructural effect of this treatment. The glandular epithelium appeared to be arrested in what looked like the late proliferative stage of the normal menstrual cycle. The ciliated cells remained unchanged for the most part. The findings were correlated with possible effects of danazol on the target tissue, but caution is required in the interpretation of ultrastructural effects of steroids until detailed knowledge of the metabolic pathways is available.
    Fertility and Sterility 08/1981; 36(1):20-6. · 4.59 Impact Factor
  • K W Schweppe · Ralph M. Wynn ·
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    ABSTRACT: Transmission electron microscopy and ultracytochemical localization of alkaline phosphatase were employed to compare the glands of the isthmic mucosa with those of the fundal endometrium. Examination of 40 biopsies during various phases of the menstrual cycle and in the postmenopause have demonstrated the features of this transitional mucosa. The cyclic morphologic changes in the isthmus are almost identical with those of the glands of the basalis of the corpus. Alkaline phosphatase was demonstrated consistently on the plasma membranes of the isthmic mucosa but not on those of the glands of the basalis; technical considerations may in part explain these differences. Secretory activity was found in every phase of the cycle. The data from postmenopausal patients suggest the concept of migration of the isthmic mucosa toward the corpus uteri above the internal anatomical os.
    Gynecologic and Obstetric Investigation 02/1981; 12(5):225-44. DOI:10.1159/000299608 · 1.70 Impact Factor