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Biomedical subjects

A Scommegna

Publications and source records attributed to A Scommegna.

At least 19 recordsLinked to original sources

The menstrual cycle: relations of biophysical and hormonal determinations in normal women of reproductive age.

Appropriate relationships between circulating levels of 17 beta-E2 and P are necessary for normal endometrial development and blastocyst implantation. The aim of this study was to relate biophysical and biochemical measurements obtained during the menstrual cycle of six healthy women in 25 menstrual cycles. One hundred eighteen vaginosonographic determinations of the endometrial thickness together with serum E2 and P assays were performed at 5-day intervals. The three parameters studied were standardized by the formula: observation minus mean determination for that parameter divided by the standard deviation of that parameter. Using this common unit, the physiological relations between ultrasonographically determined endometrial thickness, E2, and P were readily seen.

Adult

Nonsurgical treatment of a viable cervical pregnancy with intra-amniotic methotrexate.

Although a rare complication of gestation, the possibility of fertility loss is no more serious than with a cervical pregnancy. A case of a viable cervical pregnancy treated with ultrasound guided transabdominal aspiration and intra-amniotic methotrexate administration is presented. When the diagnosis is made early in gestation this method should be considered for the treatment of a cervical pregnancy when future fertility potential is desirable.

Adult

Free alpha-subunit response to gonadotropin-releasing hormone in women with polycystic ovaries.

The response of glycoprotein hormone free alpha-subunit to gonadotropin-releasing hormone (GnRH) was evaluated in 12 women with polycystic ovaries (PCOs). Six of these women were premedicated for 3 days with micronized 17 beta-estradiol before receiving a 100-micrograms bolus of GnRH. In nonmedicated PCO patients, GnRH did not significantly alter basal free alpha-subunit levels. In four of the six PCO patients receiving estrogen premedication, a significant increase in free alpha-subunit was observed; these four patients had low progesterone levels at the time of the GnRH test. Among the six premedicated patients, two had elevated (greater than 4 ng/ml) progesterone levels, and the GnRH tests showed no significant effect on the levels of free alpha-subunit. The study revealed a dissociation between the free alpha-subunit responses to GnRH and the responses of luteinizing hormone; a closer relationship was observed between free alpha-subunit and follicle-stimulating hormone responses. It was concluded that the lack of a free alpha-subunit response to GnRH in PCO patients is not due to a primary inability of the pituitary gonadotroph to produce free alpha-subunit but is a consequence of an altered estrogenic milieu, and a free alpha-subunit response to GnRH may reflect the replenishment of both follicle-stimulating hormone and luteinizing hormone in the gonadotrope.

Adult

Use of albumin gradients for X and Y sperm separation and clinical experience with male sex preselection.

Semen samples obtained from 18 normal males and 37 husbands requesting male child preselection were separated on concentration gradients of human serum albumin. Separated semen obtained from the husbands was then used for artificial homologous insemination (AIH). A significant increase in the sperm motility, progressive drive, and percentage of Y-bearing sperm along with a decrease in the total sperm count and percentage of abnormal forms were observed in separated specimens. Fathers of three or more female children had a slightly smaller but statistically significant percentage of Y-bearing sperm in their semen samples than did normal males. Ten conceptions were achieved with separated semen. Seven pregnancies terminated in normal deliveries of five male and two female infants, one ended in a spontaneous abortion of a male fetus, and two patients are still expecting. The ratio of male to female conceptions in this small study parallels the ratio of Y to X sperm in the final specimen used for AIH.

Adult

Artificial insemination homologous with oligospermic semen separated on albumin columns.

Semen samples obtained from 27 infertile men were separated on human serum albumin (HSA) columns prior to artificial homologous insemination (AIH). The columns contained either a single 7.5% HSA layer or two 17.5% and 7.5% HSA layers. Separated specimens were free of seminal debris, had significantly improved motility and progressive drive, and had a decreased percentage of abnormal forms. The total sperm count was also significantly decreased after separation, especially with the two-layer technique. No conceptions occurred in 21 couples when two-layer separation was used, but four pregnancies in 12 couples resulted from AIH with semen separated on the single-layer column. The mean total count of motile sperm obtained for AIH was 5 million with the two-layer and 31 million with the one-layer technique.

Adult

The relationship of changes in mammary blood flow and plasma progesterone at the time of parturition in the ewe.

Previous studies indicate that there is a fall in maternal plasma progesterone and a marked increase in mammary blood flow (MBF) at the time of parturition in ewes. In this experiment the role of progesterone as a cause of this increase in MBF was investigated. Progesterone was infused (9.9 mcg. per minute) into a branch of the mammary artery in five sheep during the induction of premature labor by fetal dexamethasone infusion (1 mg. per 24 hours) to prevent the normal fall in concentration of local mammary artery progesterone. Five ewes used as controls received a mammary artery infusion of cholesterol (9.9 mcg. per minute). In the cholesterol-infused group MBF increased significantly from baseline after 13 +/- 4 hours (mean +/- standard error) to a peak flow of 235 +/- 9 ml. per minute. In the group receiving the progesterone the increase in MBF was delayed to 35 +/- 7 hours, reaching only 161 +/- 22 ml. per minute. These results were significantly different from control group results (p less than 0.01). This study suggests that the fall in maternal plasma progesterone which occurs at the time of parturition may play a role in the increase in MBF that occurs prior to the onset of labor, delivery, and lactogenesis.

Animals

Effect of sparteine sulfate on uterine prostaglandin F in the rat.

Indomethacin, an inhibitor of prostaglandin synthetase, added to an in vitro bath in a concentration of 1, 5, and 10 X 10(-6) g/ml reduced sparteine-induced contractions of isolated uterine segments from pregnant rats. Contractions induced by prostaglandin F2alpha and acetylcholine were not reduced. Sparteine increased the prostaglandin F content of the blood and uterine tissue in the pregnant but not in the nonpregnant rat. This increase was significantly reduced by the administration of indomethacin (10 mg/kg). The present study suggests that the mechanism of sparteine action is mediated through a prostaglandin F system.

Acetylcholine

Conception following insemination with a freeze-preserved retrograde ejaculate.

Retrograde ejaculation, an infrequent cause of male infertility, may be the sequela of prostate or bladder neck surgery or the result of interruption in the sympathetic innervation to the bladder neck. The diagnosis is established by history and examination of the urine. In infertile couples artificial insemination homologous (AIH) using retrograde ejaculate recovered from the bladder has been successfully accomplished, but conception has occurred only in isolated cases. A literature review of the subject is presented. The technique of semen recovery from the bladder is time-consuming and uncomfortable to the patient, while the quality of the semen recovered is variable and the risk of iatrogenic urinary tract infection is increased. To avoid the above problems, and to have sperm available for AIH at the time of induced ovulation in an anovulatory wife, we were able to freeze-preserve ejaculate recovered from the bladder for future use. A case of conception following AIH with freeze-preserved retrograde ejaculate is presented.

Adult

Endometrial prostaglandin F content in women wearing nonmedicated or progestin-releasing intrauterine devices.

Prostaglandin F (PGF) was measured in endometrial samples from eight women wearing Lippes Loops and 14 women wearing Progestaserts after 6 months' use of the intrauterine devices (IUDs). In addition, in 37 women wearing dydrogesterone-T IUDs, endometrial PGF was measured after 1 month, 3 to 7 months, and 8 to 12 months of use. Endometrial samples were also obtained from 51 women without IUDs. The following means and standard errors of endometrial PGF, expressed in picograms per microgram of endometrial protein, were obtained in women without IUDs: early proliferative phase, 3.11 +/- 1.0; midproliferative phase, 4.1 +/- 0.7; late proliferative phase, 4.4 +/- 1.0; midluteal phase, 7.13 +/- 1.0; and late secretory phase, 6.08 +/- 1.0. The midproliferative phase mean was significantly different from the midsecretory phase mean (P is greater than 0.05). Except for one group, no differences were noted during the midproliferative and midsecretory phases among the groups of women wearing medicated and nonmedicated IUDs, when compared with values for women without IUDs. The only difference noted was during the midsecretory phase in the dydrogesterone group at 8 to 12 months. In these women, the mean endometrial PGF content was 2.8 +/- 0.8, significantly different (P is greater than 0.05) from that of women without IUDs (6.1 +/- 1.0).

Endometrium

Premature labor treatment with ritodrine in multiple pregnancy with three or more fetuses.

Modern treatment for anovulatory infertility increases the incidence of multiple pregnancies with three or more fetuses and predisposes to prematurity with high perinatal mortality and mortidity. Premature labor was successfully treated in four multifetal pregnancies with ritodrine hydrochloride, a beta-mimetic drug relaxing the uterus. Another patient misdiagnosed as false labor was not treated and lost three out of four premature babies. Beta-mimetic treatment is indicated in multiple pregnancies even in false labor, or when painless progress in cervical dilatation is observed, to avoid asymptomatic progression into true labor. In contrast to singleton pregnancies, advanced labor with more than four centimeters cervical dilatation should not preclude good chances for successful treatment. Persistence in treatment and repreated use of the most effective intravenous route combined with oral ritodrine administration is needed because of marked tendency to recurrences of premature labor. Progressive increase in the dose of oral ritodrine may be indicated by decrease in therapeutic response. Maternal tachycardia should be considered as an index of patient responsiveness to the beta-mimetic treatment. The therapy is most successful when the patient is hospitalized from the first episode of treatment until at least the 37th week of pregnancy. This is probably less expensive than prolonged hospitalization of several prematures in an intensive care nursery.

Adult

Neonatal acid-base balance in spontaneous and instrumental vaginal deliveries.

The acid-base balances of 63 neonates delivered either spontaneously or by the vacuum extractor or low forceps were compared. The outcome was similar in neonates delivered by vacuum extractor or forceps. However, significant differences were noted in the pH and base deficit of infants born by instrumental versus spontaneous delivery. These differences were no longer present when groups with similar duration in the second stage of labor were compared. We conclude that the use of instruments for outlet vaginal delivery carries no additional risk for the fetus.

Acid-Base Equilibrium

The effect of intrauterine progesterone treatment on the endometrial prostaglandin F content in the rabbit.

The effect on rabbit endometrial prostaglandin F caused by progesterone delivered directly to the uterus was investigated. Four groups of animals were used in the experiment: (1) no treatment (control); (2) an empty Silastic capsule (as an intrauterine device [IUD]) was inserted in one horn and the other horn was sham-operated; (3) a Silastic capsule releasing 150 microng of progesterone/day was placed in one horn and the other horn was sham-operated; (4) a Silastic capsule releasing progesterone was placed in one horn and the opposite horn received an empty Silastic capsule. In group 1, which received no treatment, no difference was noted. In group 2, the prostaglandin content of the horn containing an empty IUD was significantly higher than that of the sham-operated horn. In group 3, the same significant difference was noted between the prostaglandin content of the IUD-containing, progesterone-treated horn and the sham-operated horn. In group 4, no significant difference was observed between the horn containing an inert IUD and that containing a progesterone-releasing device. The addition of progesterone to an IUD does not significantly affect the elevated prostaglandin content of the endometrium caused by an inert IUD.

Animals

Ultrastructural observations of the so-called strumal carcinoid of the ovary.

A strumal carcinoid arose in a benign cystic teratoma of the ovary. Ultrastructural studies demonstrated that both the solid acinotubular areas as well as the "follicular" components were comprised of light and dark cells that contained numerous secretory granules. These findings indicate that this neoplasm is a pure carcinoid tumor with a follicular pattern. The present study raises the question of whether all strumal carcinoids are indeed pure carcinoid neoplasms.

Adult