Biomedical subjects
Publications and source records attributed to A Abu-Musa.
Ectopic pregnancy is a known complication of in vitro fertilization and embryo transfer (IVF/ET). The overall incidence of ectopic pregnancy after IVF is 4.4-5.8% of clinical pregnancies. The risk factors associated with ectopic pregnancies are complex. We present a patient with two consecutive ectopic pregnancies after IVF/ET.
Synchronous vulvar and breast cancer is rare. A 44-year-old women presented with a lesion in the right labia majora and right upper quadrant breast lump. After work-up, she underwent radical wide local vulvar excision and modified radical mastectomy with axillary lymph node dissection. The pathology of the vulva revealed moderately-differentiated squamous cell carcinoma and that of the breast infiltrating ductal carcinoma. Only two such cases have been previously reported: one was an elderly patient and the second a young patient with HIV infection. Our patient is a young and healthy woman making her presentation a unique and rare case.
A woman in the sixteenth week of pregnancy experienced acute abdominal pain, and magnetic resonance imaging suggested a dermoid cyst. Laparoscopic unwinding and cystectomy of the twisted cyst was performed successfully.
Uterine rupture is a serious and often tragic complication that is life threatening to both mother and child. It occurs at a frequency of around 1% in patients with a previously scarred uterus. Rupture of an unscarred uterus is an unexpected and devastating complication of pregnancy. With the increased use of misoprostol as a labor-inducing agent, cases of rupture of an unscarred uterus following its use have been published in the literature. We report a case of uterine rupture in a multigravid woman with an intrauterine fetal death at 29 weeks' gestation whose labor was induced with misoprostol. A review of all cases of uterine rupture with misoprostol induction is also included. Excessive doses of misoprostol should be used with extreme caution in multiparous women and in patients with a previously scarred uterus even in the context of intrauterine fetal death or termination of pregnancy.
OBJECTIVE: To study the effect of follicular fluid (FF) on sperm survival. METHOD: Swim-up sperm suspensions obtained from 20 men with normal semen analysis were incubated with Ham's F-10 only and Ham's F-10 supplemented with 20% FF or 20% serum. Sperm motility was recorded every 12 hours for 72 hours. RESULTS: Sperm motility was maintained in all media for 48 hours. However, significantly more sperm samples remained motile at 72 hours in medium supplemented with FF and serum as compared to Ham's F-10 only. CONCLUSION: FF has a positive effect on conserving sperm motility as a function of time.
PURPOSE: To evaluate the immediate neonatal outcome and the presence of various placental lesions in 96 pregnancies with meconium-stained amniotic fluid. MATERIALS AND METHODS: The patients were divided into a group with acute (N = 41) and subacute and chronic (N = 55) meconium staining of the placenta. Apgar scores, arterial cord pH and admission to the neonatal intensive care unit (NICU) were determined in addition to the findings on gross and microscopic examination of the placentas. RESULTS: Of the 53 live births with subacute and chronic meconium staining, 13% had Apgar Scores < or = 7 at 5 minutes compared to 7% with acute meconium staining. Similarly, a significantly lower umbilical artery pH was determined in the former group [(32%) versus (7%)], (p < 0.01). When 9 different pathologic lesions of the placenta were evaluated microscopically, the frequency of villous vascular thrombosis (25.4%), infarcts (38%), acute chorioamnionitis (20%), villous edema (9.1%) and villitis (14.5%) was significantly higher in the group with longer meconium exposure compared to the other group (2.4%), (9.7%), (7.3%), (0%), and 1 (2.4%), respectively. In addition, when tested for 4 different lesions, cases with acute meconium were less likely to have one or more lesions. When one or more placental lesions were found, NICU admission rate was significantly higher in the patients with subacute and chronic meconium. CONCLUSION: Subacute and chronic meconium discharge is associated with significant placental lesions and an increased risk of adverse pregnancy outcome in the immediate neonatal period.
Patients with Kartagener's syndrome (KS) are invariably infertile with totally immotile spermatozoa. Intracytoplasmic sperm injection (ICSI) is considered to be the treatment of choice for patients with immotile spermatozoa. We report the second KS case in the literature from whom immotile spermatozoa from the ejaculate failed to fertilize mature oocytes after ICSI. The role of micromanipulation in the treatment of KS patients is discussed.
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A hysterosalpingogram revealed a septate uterus in a 29 year old nulliparous woman with a history of recurrent pregnancy loss. The patient underwent Tompkins metroplasty in the proliferative phase of the menstrual cycle. One month after the operation she presented with a delay in her menses and a positive pregnancy test. Ultrasound revealed a viable fetus commensurate with 10 weeks gestation, making the gestation period 5 weeks at the time of surgery. After reviewing the patient's menstrual history it was found that the period the patient had before surgery was on time but with unusually minimal bleeding. A repeat ultrasound scan for anomaly done 7 weeks later was commensurate with 17 weeks gestation. The patient carried her pregnancy for the first time until approximately 37 weeks when she delivered by Caesarean section a healthy female baby weighing 3700 g.
OBJECTIVE: To evaluate the outcome of an oocyte donation program using synthetic estrogen and progestational agents for uterine preparation. METHODS: Conjugated estrogen, 1.25 mg per day at increasing doses and dydrogesterone, a synthetic progestogen, 30 mg per day were used for uterine priming. All embryo transfers were done on day 2 of progestogen supplementation. RESULTS: The pregnancy rates were 38% per embryo transfer. The ongoing pregnancy rate was 31% with an abortion rate of 20%. CONCLUSION: Endometrial preparation in an oocyte donation program using orally administered synthetic estrogen and progestogen gives pregnancy rates comparable to those reported with natural products.
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We determined the intrauterine insemination (IUI) pregnancy outcome in the same group of patients when applying different methods of ovulation induction. A group of patients with unexplained (no. 46) and male factor infertility (no. 101) consented to have the following treatment protocol at the American University of Beirut-Infertility Center: IUI to be performed in three natural ovulatory cycles in all patients, then in three clomiphene citrate (CC) stimulated cycles in the remaining non-pregnant patients, and then three cycles with controlled ovarian hyperstimulation (COH) in the remaining group. Of the total 147 patients 130, 138 and 123 underwent 273 natural, 278 CC and 266 COH IUI cycles, respectively. Semen processing for IUI was done by washing the sperm twice and using the swim-up technique. The chi-square test was used for statistical analysis. Pregnancy rate per cycle of IUI with COH (9.8%) was significantly higher than that of IUI in natural cycles (3.3%) but approached significance when compared to IUI with CC cycles (5.4%). Also unexplained infertility cases had a significantly higher pregnancy rate (58.7%) when compared to that of male factor cases (22.8%). IUI still has a place in the treatment of infertility due to selective causes. Combined with COH, IUI gives the best pregnancy rate although its benefit with natural or CC cycles remains obvious.
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OBJECTIVE: To evaluate the effect of serum from infertile and fertile patients with endometriosis on the development of 2-cell mouse embryos. PATIENTS: Serum was obtained from 26 infertile patients and 8 fertile patients with endometriosis. Mouse embryo development in serum samples was compared using chi 2 analysis. RESULTS: In the infertile group 23% of the embryos reached blastocyst stage, whereas 22 of the 26 samples were embryo toxic. In the fertile group significantly more embryos (45%) developed to blastocysts and only one serum samples was embryo toxic. CONCLUSION: The embryo toxicity of serum samples from patients with endometriosis is related to the infertility associated with the disease and not with the disease per se.
In order to investigate the pathological characteristics of polycystic ovaries diagnosed by transvaginal ultrasound (TVS) in patients with polycystic ovarian syndrome (PCOS) and to investigate the relationship between morphological and endocrine changes in the ovaries, 32 PCOS patients with bilateral polycystic ovaries (> 10 cysts) detected by TVS were studied; 20 ovulatory women served as controls. Ovarian tissues from wedge resection were examined histologically. A comparative histological and TVS study of ovarian morphology was made, and the relationship between the number of small cysts and the endocrine profile was examined. The position and size of small cysts on TVS agreed with those observed histologically. There was a significant correlation between the number of small cysts on TVS and the number of atretic follicles with hypertrophied and luteinized inner theca cells, and thickened ovarian capsules. Numerous atretic follicles and thickened ovarian capsules were observed in 97 and 64% of ovaries respectively, from PCOS patients. In patients with PCOS, a significant positive correlation was noted both between the number of small cysts and delta 4-androstenedione (ASD), and between ASD and the luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio. Furthermore, testosterone, ASD and the number of small cysts on TVS were significantly higher in PCOS patients with ovarian thickened tunica compared to PCOS patients without ovarian thickened tunica. TVS images of ovaries in patients with PCOS correlated with the histopathological and endocrine features. It is suggested that an increase in intra-ovarian small cysts leads to increased production of ovarian androgen, in turn influencing the secretion of gonadotrophin, and is correlated with ovarian capsular thickness.
The first reported case of cerebellar metastasis from primary clear cell adenocarcinoma of the fallopian tube is presented. Initially diagnosed as stage Ia, the patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy, followed by cisplatin-based chemotherapy and whole pelvic irradiation. Thirty six months later multiple pulmonary metastases were detected that did not respond to chemotherapy. Later the patient presented with cerebellar metastasis. She received whole brain radiotherapy and steroids. The brain lesion partially responded and the patient's neurologic symptoms improved. Throughout there was no evidence of local recurrence. This case suggests that with the prolonged survival achieved by aggressive treatment occult brain metastases might become apparent.
In the present study, the effect of the concentration of the hypoosmotic solution, incubation time and duration from sperm collection to incubation on the hypoosmotic swelling (HOS) test were evaluated. Sperm were obtained from 20 fertile donors. The most stable sperm tail swelling was obtained at 150 mOsm. Incubation for 30 minutes was sufficient for the evaluation of overall swelling but not for the evaluation of b- and g-type sperm swelling. This suggests that incubation for one hour is necessary to obtain stable results. Incubation for more than one hour did not affect the percentage or type of sperm swelling. The time from sperm collection to incubation did not affect the HOS test. The HOS test is practical and not affected by the duration of incubation or time from sperm collection to incubation.