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Biomedical subjects

A DeCherney

Publications and source records attributed to A DeCherney.

At least 19 recordsLinked to original sources
PubMed1997

Results of conventional and hysteroscopic surgery.

Müllerian anomalies usually come to medical attention when they become problematic and require treatment. Most of these complications require surgical correction. The most commonly presenting anomaly is the double uterus which can be the source of recurrent abortion and preterm deliveries. The Strassman, Jones and Tompkins metroplasties have been shown to greatly improve the rate of successful deliveries in these patients. Hysteroscopic metroplasty, using either scissors, resectoscope or laser is now the recommended treatment for most septate uteri due to its relative simplicity, low morbidity and excellent reproductive outcome.

Female↗
PubMed1996

Bone-sparing properties of oral contraceptives.

Postmenopausal osteoporosis is a major health care problem that affects 20 million women in the United States and accounts for > 1 million fractures per year. Hormone replacement therapy is effective for reducing bone loss in the postmenopausal women. However, intervention before menopause may delay or prevent the decline in bone mass that begins between ages 30 and 40 years. The effects of oral contraceptives on bone mass have been investigated, and a positive association between oral contraceptive use and bone mass that is directly related to the duration of oral contraceptive use was observed. The effects of oral contraceptives on bone mass may be related to the specific formation. The effect of estrogens is dose related, and the optimal dose appears to be 25 to 35 micrograms of ethinyl estradiol or its equivalent. Results from several studies show that norethindrone has a positive effect on bone mass. An oral contraceptive may offer optimal birth control for the older premenopausal woman who currently uses other forms of birth control.

Adult↗
PubMed1993

Immunohistochemical localization of renin and angiotensin in the ovary: comparison between normal women and patients with histologically proven polycystic ovarian disease.

OBJECTIVE: This study was designed to test the hypothesis that the ovarian renin-angiotensin system may play a role in polycystic ovarian disease (PCOD). DESIGN: The immunohistochemical distribution of renin and angiotensin in ovaries from seven women with histologic diagnosis of PCOD was compared with that of normal ovaries. RESULTS: The large cystic follicles of polycystic ovaries (PCO) presented intense immunostaining for renin and angiotensin in both theca and granulosa cells (GCs). In developing follicles of normal ovaries, the immunostaining was restricted to the theca cell layer, with the exception of the immediately preovulatory follicles which displayed intense positivity of granulosa as well as theca cells. Atretic follicles of normal ovaries showed staining of both theca and GCs. In both normal and PCO, patches of hilus cells were intensely stained. Luteal cells also consistently stained both in normal ovaries and in the occasional corpus luteum present in polycystic ovaries. CONCLUSIONS: This study highlights the link between the ovarian renin-angiotensin system and those ovarian compartments known to be actively engaged in androgen secretion and/or luteinization and suggests that there may be an association between the ovarian renin-angiotensin system and PCOD.

Adult↗
PubMed1993

The multicentre transcervical balloon tuboplasty study: conclusions and comparison to alternative technologies.

Transvaginal tubal catheterization procedures have been suggested as an alternative to microsurgery and in-vitro fertilization (IVF) in the treatment of women with proximal tubal occlusion. A transcervical balloon tuboplasty (TBT) catheter was specifically developed and tested in a prospective multicentre trial. A total of 151 women with confirmed bilateral or unilateral tubal occlusion were studied. The primary study population included 106 women who, after exclusion of patients for protocol violations, represented those females who were treated for complete tubal occlusion with TBT. TBT is an ambulatory, minimally invasive catheter procedure, performed under paracervical block or mild sedation, which utilizes a co-axial balloon catheter under fluoroscopic guidance. Re-canalization, pregnancy and reocclusion rates following the procedure were documented. A total of 28 patients demonstrating uni- or bilateral tubal patency after either hysterosalpingography and/or selective salpingography represented the control population. TBT established tubal patency of at least one Fallopian tube in 95/106 patients (90%) and in 167/205 obstructed oviducts (82%). Clinical pregnancies occurred in 37/106 females (35%), with a life table adjusted rate of 37%. Patients without distal disease had significantly higher pregnancy rates than those with bipolar tubal disease (49% versus 12%, life table adjusted rate; P = 0.0002) but pregnancy rates were independent of underlying aetiology for tubal disease. Pregnancy rates in control patients who did not reach TBT because of tubal patency after hysterosalpingography and/or selective salpingography were significantly lower than in those successful treated with TBT (P = 0.027), and occurred only for four cycles after hysterosalpingography and with approximately a 1 year delay after selective salpingography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Physiologic and pharmacologic effects of estrogen and progestins on bone.

Estrogen deficiency has a primary role in the pathogenesis of osteoporosis, a major cause of morbidity and mortality in postmenopausal women. Estrogen therapy is associated with increased peak bone mass premenopausally and prevention of bone loss postmenopausally. The mechanisms by which estrogen exerts its effects on bone are not completely understood. Nonetheless, estrogen does affect calcium balance, and evidence suggests a direct mechanism via estrogen receptors on bone. The role of progestins in preventing bone loss is less well understood than that of estrogen. Studies in postmenopausal women and studies of add-back therapy in younger women have shown that norethindrone, but not medroxyprogesterone, treatment has a bone-sparing effect on cortical bone but not on trabecular bone. In addition, norethindrone, 5 or 10 mg daily, has effects on biochemical markers of bone turnover similar to those of estrogen, providing further evidence of a bone-sparing effect. The mechanisms for the effects of norethindrone on bone are unknown, although translocation of the estrogen receptor in an animal model and conversion in vivo to ethinyl estradiol have been postulated.

Aged↗
PubMed1993

Evaluation of a new generation of oral contraceptives. The Advisory Board for the New Progestins.

OBJECTIVE: To assess the differences and similarities in efficacy, safety, and metabolic effects of oral contraceptives (OCs) containing the new progestins desogestrel, gestodene, and norgestimate. All formulations reviewed contained no more than 35 micrograms ethinyl estradiol. DATA SOURCES: Data were reported from approximately 100 published reports, dating from 1980, of comparative and noncomparative clinical studies on phasic and fixed-dose preparations culled from computer searches of several sources, including MEDLINE and Excerpta Medica. METHODS OF STUDY SELECTION: An attempt was made to select the most meaningful studies in terms of length, size, methodology, and quality of description. All clinical studies were considered; in general, review articles were not. Some preclinical studies were also included. No abstracts were used. DATA EXTRACTION AND SYNTHESIS: The indices chosen for examination were contraceptive efficacy, cycle control, coagulation, carbohydrate and lipid metabolism, and androgenicity. CONCLUSIONS: The new formulations were found to be comparable in efficacy to each other and to established agents. They also appeared to be less androgenic than current OCs and to have less impact on carbohydrate and lipoprotein metabolism. Cycle control was similar to that of older products. Changes in coagulation-promoting and antithrombotic factors were minor. Clinical relevance of the results could not be determined because of small sample size and methodologic differences between studies.

Androgens↗
PubMed1990

Ovarian antibodies detected by immobilized antigen immunoassay in patients with premature ovarian failure.

An enzyme-linked immunosorbent assay (ELISA) was used to detect ovarian and oocyte antibodies in serum from 45 patients with premature ovarian failure (POF). Control sera were obtained from a similar group of normally cycling women without POF. A specific antibody reaction was found when POF sera were tested against human ovary (47%) or oocytes (47%). A combined total of 69% of the sera were positive for either ovary or oocytes. Fewer sera were positive for antibodies against human thyroid (18%) or human placenta (22%), and virtually no reaction with human liver (4%) was seen. LH antibodies were detected by ELISA against LH in only 3 POF sera that also contained ovarian antibodies. Therefore, gonadotropin antibodies alone do not appear to account for POF. In addition, 2 patients were treated by immunosuppression and became pregnant coincident with a decline in the serum concentration of ovarian antibodies. In summary, the results of this study are consistent with previous immunohistochemical data which indicate that ovarian and oocyte antibodies are common in patients with POF. This supports the concept that some forms of POF are associated with an autoimmune process. Furthermore, detection of ovarian and oocyte antibodies by ELISA may permit routine diagnosis of autoimmune POF and provide a basis for therapy.

Adult↗
PubMed1986

Quadruplet pregnancy in IVF.

The frequency of multiple pregnancy following IVF with the presently accepted methods is ten times higher than in natural cycles, and is identical to that following induction of ovulation with HMG. In spite of the fact that multifetal pregnancy exposes both fetus and mother to certain dangers, most couples joining IVF programs expose themselves to, and generally accept the risk of, multiple pregnancy, since this is their last resort for having a baby of their own. We report such a case of quadruplet pregnancy after the IVF procedure and review the literature.

Abortion, Induced↗
PubMed1986

Enhancement of human sperm motility and velocity in vitro: effects of calcium and creatine phosphate.

Because of their roles in motility regulation and energy transport, calcium and creatine phosphate were examined for their effects on sperm motility and velocity in specimens of normal donors. Semen or migrated sperm fractions were incubated with of 1 mmol of calcium, 5 mmol magnesium, and 10 mmol of creatine phosphate (n = 28) or in the presence of 4 mumol of Verapamil, calcium, and creatine phosphate (n = 10). The samples were subjected to multiple exposure photography (four picture frames of two different drops) at 0, 1, 4, or 5 and at 10 hours and sperm motility and velocity were analyzed. In both calcium and calcium-creatine phosphate conditions, sperm motility and velocity were significantly increased, compared with control values (P = between less than 0.001 and 0.05). Sperm motility declined following Verapamil exposure, but the motility values remained at the level of the control in the presence of additional calcium or creatine phosphate. The effects of calcium and creatine phosphate take place rapidly; within 1 minute all improvements in sperm velocity and motility are fully achieved. There is no loading effect of calcium, and when the sperm is transferred into media without the additional calcium, the velocity decreased to that of the initial control value. Magnesium alone had no effect on motility or velocity. These experiments indicate that calcium or creatine phosphate can support sperm motility and velocity at a significantly increased level. Thus the addition of calcium or creatine phosphate to the insemination media may enhance the fertilizing capacity of sperm during in vitro fertilization or gamete intrafallopian transfer procedures.

Calcium↗
PubMed1986

Severe obstetric complications after aggressive treatment of Asherman syndrome.

Thirty-three cases of Asherman syndrome from Yale-New Haven Hospital are presented. Restoration of menses occurred in 91% of patients with pregnancy resulting in 79% of all treated patients. Spontaneous abortion occurred in only one patient (4%), whereas viable pregnancies resulted 96% of the time. Severe obstetric complications excluding premature labor occurred in three cases (12%) and included placenta increta, uterine sacculation, and a paper-thin uterine fundus (ie, uterine dehiscence). These cases are discussed to reinforce considering treated patients with Asherman syndrome to be a high-risk obstetric population, and to counsel and manage these patients accordingly.

Abortion, Spontaneous↗
PubMed1986

Infertility and the new reproductive technology: a role for social work.

Infertility affects 1 in 6 couples in the United States during their childbearing years. The causes are sociological, medical and environmental. The new reproductive technology such as in-vitro fertilization and the alternatives to biological parenting such as surrogate motherhood raise legal and ethical issues as they raise the hopes of those couples previously unable to have a baby. As expectations have risen and treatment options become more complex, the social worker has become an essential member of the treatment team.

Counseling↗
PubMed1985

Diagnosis of ectopic pregnancy: value of the discriminatory human chorionic gonadotropin zone.

A prospective study was conducted to test the hypothesis that the absence of an intrauterine gestational sac when the serum level of human chorionic gonadotropin (hCG) is above 6500 mIU/mL is indicative of ectopic pregnancy. A total of 383 patients who were clinically suspected to have ectopic pregnancies had pelvic ultrasound examinations with serum hCG determinations on the day of the scan. There were 217 (57%) intrauterine gestations, 104 (27%) ectopic pregnancies, and 62 (16%) spontaneous abortions. Forty-one percent of patients had an hCG level above 6500 mIU/mL. The absence of an intrauterine gestational sac at an hCG concentration above this level had a sensitivity of 100%, a specificity of 96%, a positive predictive value of 86%, a negative predictive value of 100%, and was 98% efficient, based on a 19.4% prevalence of ectopic pregnancies among this group.

Abortion, Spontaneous↗
PubMed1984

Factors affecting sperm motility. IX. survival of spermatozoa in various biological media and under different gaseous compositions.

The role of various environmental conditions on sperm motility and their survival was investigated by incubating washed human spermatozoa in various biologic or artificial media and under different atmospheric compositions. When sperm were analyzed by the multiple exposure photography technique for objective motility determination, it was found that none of the investigated biologic media induced any immediate stimulatory effect on the tested spermatozoa. Exchange of seminal fluid between normal and oligoasthenospermic specimens did not reveal any beneficial or harmful effect on sperm motility. Sperm did not survive for more than 24 hours when kept in their original seminal fluid under any circumstances. The most favorable media tested for prolonged sperm survival were pure human umbilical cord serum or Ham's solution containing 0.5% human albumin. However, even in these media sperm did not survive much beyond 24 hours unless incubated in an atmosphere containing 5% CO2 or a triple mixture of 90% N2, 5% O2, and 5% CO2. Only under these circumstances could sperm stay alive, in some cases up to 5 days.

Carbon Dioxide↗
PubMed1984

Peritoneal fluid accumulation with dextran 70 instilled at time of laparoscopy.

A patient is presented that had instillation of Hyskon at the time of laparoscopy and then had a laparotomy. Fifty milliliters of Hyskon was instilled into the abdomen, and the next day at laparotomy 255 ml of peritoneal fluid was present, demonstrating that Hyskon was able to promote the transfer of a large volume of fluid into the peritoneal cavity. By separating fibrin-covered surfaces, this hydroflotation effect inhibits adhesion formation.

Adolescent↗
PubMed1984

Improved techniques for collecting motile spermatozoa from human semen. I. A self-migratory method.

A simple apparatus to collect moving sperm by non-traumatic means which can be used for artificial insemination is described. The technique is based on enhancing the process of migration from the seminal fluid into a top-layered artificial medium in an ordinary test tube. This has been achieved by controlling 3 main variables: 1) The dilution of migrated sperm was minimize by using only 0.5 ml of the medium layered onto 1 ml semen; 2) increasing the surface area between these media by turning the test tube from a vertical to almost a horizontal position; 3) stimulating sperm activity by incubation at 37 degrees C under air: 5% CO2 for 30 min. When restored to a vertical position approximately 0.3 ml medium, sufficient for most AIH or IVF procedures, was gently aspirated. The effects of these variables on the rate of sperm migration was tested one at a time, and increments that ranged from 20% to as much as 10-fold were detected. When these 3 variables were optimized and 58 semen specimens analyzed, it was found that motility increased from 42 to 87%, velocity from 24.5 to 27.3 micron per sec, whilst abnormal forms dropped from 37 to 15%. The final concentration of motile sperm was 23 X 10(6)/ml compared to an original mean concentration of 34 X 10(6)/ml, indicating a relative recovery of 68%. Oligoasthenospermic specimens revealed similar changes in sperm motility, velocity, morphology and recovery. However, due to the low initial content of moving sperm (4.8 X 10(6)/ml), their final concentration was also low (2.7 X 10(6)/ml). Such specimens required additional preliminary preparation to increase the sperm concentration prior to the migratory procedure.

Cell Separation↗