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Biomedical subjects

A Shulman

Publications and source records attributed to A Shulman.

At least 19 recordsLinked to original sources
PubMed1992

Lack of correlation between hormonal blood levels and endometrial maturation in agonadal women with repeat implantation failure following embryo transfer from donated eggs.

Five women with ovarian failure who repeatedly failed to conceive following embryo transfer from donated eggs underwent endometrial development investigation. One endometrial biopsy was obtained on cycle days 19, 21, and 23 during three consecutive artificially induced cycles. All five patients had only early secretory changes on days 19 and 21. Histological evaluation on cycle day 23 revealed various developmental stages: two women had "in-phase" endometrium, two patients had adequately developed stroma but significantly retarded glandular maturation, and one women showed no progress. The histological findings were conclusive for a significant maturation delay and an impaired endometrial receptivity. There was a lack of correlation between the peripheral hormonal blood levels and the endometrial maturation.

Abortion, Spontaneous↗
PubMed1992

The effect of gonadotropin-releasing hormone agonist on the ovarian response and in vitro fertilization results in polycystic ovarian syndrome: a prospective study.

OBJECTIVE: To assess the effect of gonadotropin-releasing hormone agonist (GnRH-a) on pituitary suppression, subsequent ovarian response, and results of in vitro fertilization (IVF) treatments in polycystic ovarian syndrome (PCOS) patients. DESIGN: Randomized prospective study. SETTING: In vitro fertilization program and endocrinologic institute. PATIENTS: Thirty patients with PCOS; 16 received GnRH-a, and 14 did not receive GnRH-a. INTERVENTIONS: Ovum pick-up and embryo transfer. MAIN OUTCOME MEASURES: Response to GnRH-a test, serum and follicular fluid (FF) hormonal measurements, steroid levels, and aromatse activity in granulosa cell (GC) culture, and results of IVF. RESULTS: Pituitary responsiveness was abolished in all patients 14 days after GnRH-a administration, and early luteinization was prevented. Steroid levels in FF did not differ between the two groups. In GC culture, progesterone (P) levels were higher in patients without the GnRH-a (3,704 +/- 1,232 nmol/L versus 2,117 +/- 235 nmol/L; P less than 0.05) as were androstenedione (A) levels (5.3 +/- 1.0 nmol/L versus less than 3.5 nmol/L; P less than 0.05). However, aromatase activity and IVF results were similar in the two groups. CONCLUSIONS: Administration of GnRH-a in patients with PCOS decreases P and A production by the GC cells and prevents early luteinization. It does not affect the IVF results.

Female↗
PubMed1992

Mumps orchitis among soldiers: frequency, effect on sperm quality, and sperm antibodies.

This study reports on 72 young soldiers who suffered from a recent epidemic of acute mumps, with special emphasis on 19 who suffered from mumps orchitis and whose spermograms were in the fertility range. The immunological work-up for antibodies in sera or seminal plasma gave normal results for the patients diagnosed with orchitis, as well as the controls. The only remarkable finding was an increased risk of borderline significance for orchitis in smokers. The present study has proven that the presence of antisperm antibodies does not play a role in the etiology of mumps orchitis.

Antibodies↗
PubMed1992

Conservative treatment of ectopic pregnancy and its effect on corpus luteum activity.

Corpus luteum activity was monitored in 15 women undergoing nonsurgical management of ectopic pregnancy with local methotrexate injection followed by alternating oral methotrexate and citrovorum factor (group A, n = 8) or local methotrexate injection alone (group B, n = 7). All patients initially demonstrated a viable corpus luteum (plasma progesterone ranged from 1.4 to 19 ng/ml). The treatment was successful in 14, with the exception of one whose tube ruptured 11 days after local administration of methotrexate, despite a continuous decrease in beta human chorionic gonadotropin, 17 beta-estradiol and plasma progesterone levels. There seems to be no correlation between the success of the treatment and the behavior of beta human chorionic gonadotropin, 17 beta-estradiol and plasma progesterone. Three patients from group A and two from group B displayed an initial rise in beta human chorionic gonadotropin following the initiation of the therapy, but the corpus luteum response differed. In group B patients, 17 beta-estradiol and plasma progesterone levels increased in parallel with beta human chorionic gonadotropin. Group A patients displayed a continuous decrease in 17 beta-estradiol and plasma progesterone levels despite the elevation of beta human chorionic gonadotropin, suggesting a possible effect of the systemic methotrexate on corpus luteum activity.

Adolescent↗
PubMed1992

Percutaneous catheter drainage of tubo-ovarian abscesses.

We present the successful treatment of tubo-ovarian abscesses in three young patients by continuous percutaneous drainage, inserted under the guidance of real-time ultrasonography using only local anesthesia. Each patient had been diagnosed laparoscopically as suffering from acute pelvic inflammatory disease, but had formed abscesses despite extensive broad-spectrum antibiotic therapy. One case involved a complication of the ovum pick-up procedure; the woman had tubo-ovarian abscesses with infected hematomas. Because the abscesses were localized anteriorly in the lower abdomen and did not reach the pouch of Douglas, they could not be drained through a posterior colpotomy. Ultrasound guidance allowed us to drain all the areas of the multioculated abscesses. We suggest that percutaneous abscess drainage be the initial treatment of choice for tubo-ovarian abscesses before laparotomy is considered.

Abscess↗
PubMed1992

Third-trimester uterine rupture after prostaglandin E2 use for labor induction.

Prostaglandin E2 is a powerful oxytoxic agent that reliably initiates labor, even in the presence of an unripened cervix. The very low incidence of obstetric and neonatal side effects contributes to its universal use. Only nine cases of uterine rupture during the third trimester of pregnancy after application of various prostaglandin E2 preparations have been reported in English. Although uterine rupture after prostaglandin administration is a very rare complication, no prostaglandin compound seems to be exempt from it.

Adult↗
PubMed1991

Uterine rupture at term pregnancy with the use of intracervical prostaglandin E2 gel for induction of labor.

Prostaglandin E2 is a powerful oxytocic agent that reliably initiates labor, even in the presence of an unripe cervix. The low incidence of fetomaternal complication contributes to its universal use. We report a rare case of uterine rupture after intracervical application of prostaglandin E2 gel. Thus far no prostaglandin compound or method of administration seems to be exempt from such a complication.

Administration, Intravaginal↗
PubMed1991

Conservative approach to multiple pregnancy with intrauterine fetal death of one or more fetuses.

One of the less common complications of multiple gestation is intrauterine demise of one or more fetuses. Despite the many case reports in the literature, there are no firm guidelines regarding the management of this problem. We herein report the favorable outcome of the conservative approach we chose for managing four patients; two with twins, one with triplets and one with quadruplets (first report in the literature). Strict follow-up based on frequent physical examinations, ultrasonographic assessment of fetal growth and well being, and coagulation profiles is mandatory. Individualization of delivery dates and mode is recommended.

Adult↗
PubMed1991

Ultrasonic validation of residual bladder volume in postvaginal hysterectomy patients.

Transverse and sagittal bladder diameters were measured with real-time ultrasound in 80 patients (100 measurements) during the first 2 days of postvaginal hysterectomy to assess the residual bladder volume and compared with the catheterization volume for the same patients. The sonographic method, with a 97.7% specificity and a negative predictive value of 89.5%, proved to be specific enough to eliminate the necessity of routine catheterization for measuring residual bladder volumes of greater than or equal to 150 cm3, thus decreasing the incidence of some major postoperative complications that can occur due to unnecessary catheterization.

Adult↗
PubMed1991

Mumps vaccination of young adults is unwarranted.

A clinical and epidemiological study of mumps was carried out over a 18-month period and included 104 soldiers (61% of the reported cases in the Israel Defence Forces). The average number of days off work was 12.9 +/- 9.2 days. The most common complication was orchitis (19/72 men; 26%), followed by 3 cases of pancreatitis (3%) and 2 cases of meningitis (2%). 13 men with orchitis were tested, and all had normal spermograms. No long term important sequelae were described. The transmission rate was low with no respondent reporting more than one secondary case among soldiers serving in the same unit. The socio-economic level of mumps patients was comparable to that of the general army population at the time of the study. Our data do not support a mass immunization program of the adult population.

Adolescent↗
PubMed1990

The treatment of patients with polycystic ovarian syndrome by in-vitro fertilization and embryo transfer: a comparison of results with those of patients with tubal infertility.

Sixteen patients with polycystic ovarian syndrome (PCO) were treated by in-vitro fertilization (26 treatment cycles). The results were compared with 37 normo-ovulatory women with tubal disease (37 treatment cycles). The oestradiol and progesterone levels were higher during the follicular phase in the PCO patients, but were statistically significantly higher only on the day after human chorionic gonadotrophin administration. Although more oocytes were recovered per cycle from the PCO group (19.3 +/- 6.1) than from the control group (5.4 +/- 2.9) with P less than 0.004, the mean numbers of embryos per cycle were similar in both groups (3.7 +/- 2.4 versus 3.6 +/- 2.2, respectively). The pregnancy rate was also comparable in both groups (30.7 versus 29.7%, respectively). The fact that more oocytes are recovered from PCO patients, balances their lower fertilization and cleavage rates. We conclude, therefore, that IVF treatment may be a viable solution for PCO patients resistant to an in-vivo protocol treatment regimes.

Cell Count↗
PubMed1990

Placental site trophoblastic tumors (trophoblastic pseudotumors): pathology and clinical importance.

Placental site trophoblastic tumor (PSTT), which can be regarded as a subtype of gestational trophoblastic neoplasia is discussed. The histopathological features include trophoblastic proliferation without the typical organization of the bilamelar cyto and syncytiotrophoblastic villus. Ultrastructural investigation has demonstrated a clone structural relationship between the infiltrating cells and those of the trophoblastic components of the normal human placenta. Clinical management should be based on the complete surgical resection of the mass and a follow-up by measuring the serum levels of beta-human chorionic gonadotropin fractions.

Female↗
PubMed1989

Ultrasonic assessment of the endometrium as a predictor of oestrogen status in amenorrhoeic patients.

Thirty consecutive amenorrhoeic patients were assessed with regard to the following: medical history, physical examination, pelvic ultrasonography, serum levels of 17-beta oestradiol (E2), other relevant serum hormones and the response to a progesterone challenge test. The results showed a correlation coefficient of 71% (P = 0.001) between the E2 levels and the endometrial width and of 52% (P = 0.03) between the testosterone levels and the E2 levels. Linear regression of endometrial width against E2 levels showed beta = 0.018 (R2 = 22%, P = 0.02). Patients with an endometrial width of 4 mm or less reported no bleeding or only scanty bleeding following progesterone and all the patients with an endometrial width of greater than 5 mm responded to progesterone with normal menstrual bleeding.

Adolescent↗
PubMed1989

Abnormal thyroid function in hyperemesis gravidarum.

Thyroid function was evaluated in 41 consecutive women with hyperemesis gravidarum (HG). In 11, increased free thyroxin concentrations (FT4) were measured. After one week of conservative therapy, 4 patients with persistent emesis were treated with antithyroid agents. Three of these 4 displayed other signs of hyperthyroidism. Emesis resolved in the other 7 patients within a week of conservative therapy. FT4 levels also returned to normal in these 7 patients within several weeks. Thyrotropin-releasing hormone (TRH) was administered to 10 of the 11 patients. Abnormal TSH responses, suggesting varying degrees of autonomous thyroid function were noted in all 4 patients treated with antithyroid drugs and in 3 of the untreated patients. Underlying clinical signs and symptoms of hyperthyroidism should be sought in patients with HG. In the presence of persistent emesis, despite conservative therapy of at least one week's duration and the presence of abnormal thyroid function studies, the use of antithyroid agents should be considered.

Adult↗
PubMed1988

The guinea-pig isolated atrium as a model system for the central actions of selected CNS stimulant and depressant drugs. Part 2. Mechanisms involved in the actions and interactions of the convulsant bemegride and its hypnotic homologue 3-methyl-3-n-butylglutarimide.

The present study explores pharmacologically on the model spontaneously beating 3H-noradrenaline pretreated guinea-pig atrial preparation the mechanism(s) by which the representative central nervous system (CNS) stimulant drug 3-methyl-3-ethylglutarimide (bemegride, MEG) and its representative CNS depressant homologue 3-methyl-3-n-butylglutarimide (MBG) affect transmitter release and the force and rate of atrial contraction and contracture, as well as the relevance of these atrial mechanism(s) to those involved in the production of drug-evoked convulsions and hypnosis in the mammalian CNS. The process(es) involved in the interaction of MEG and MBG on the atrial preparation have also been studied to provide insight into possible CNS mechanism(s) that may be involved in the related central phenomena of drug-induced analepsis and anticonvulsant action. It would appear that the actions and interactions of MEG and MBG on the atrium and in the mouse both depend critically on glutarimide-evoked enhancement (MEG) or inhibition (MBG) of Ca2+ flux through potential-operated Ca2+ channels located primarily on the responsive atrial sarcolemmal and neuronal synaptic membranes, respectively. In addition, it seems likely that the reciprocal antagonism shown by these substances on the atrium and in the CNS is predominantly functional in nature. The pharmacological and clinical implications of these findings are discussed, with particular reference to the possible benefit of selective calcium antagonists and related drugs in the management of drug dependence and withdrawal.

Animals↗