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Biomedical subjects

B Held

Publications and source records attributed to B Held.

At least 37 records · Page 2Linked to original sources
PubMed1986

Characteristics of patients with and without gonadotropin surges during follicular recruitment in an in vitro fertilization/embryo transfer program.

Fifteen ovulatory patients undergoing ovarian stimulation with clomiphene citrate-human menopausal gonadotropin-human chorionic gonadotropin (hCG) for in vitro fertilization were studied. All 15 attained peak estradiol (E2) levels of greater than 600 pg/ml. Eight patients had an endogenous luteinizing hormone (LH) surge before the administration of hCG. The characteristics of these "surge" patients were compared with those of the remaining seven "nonsurge" patients. There was no significant difference in the peak morning E2 achieved before hCG or the endogenous LH surge, nor in the peak absolute increase in E2 over a 24-hour period in these two groups. The surge group had significantly higher E2 levels per follicle greater than or equal to 15 mm, measured by ultrasound on the morning of the day of administration of hCG or the LH surge (P less than or equal to 0.005). In addition, nonsurge patients had a greater number of follicles greater than or equal to 15 mm, compared with surge patients (P less than or equal to 0.05). It is hypothesized that greater quantities of nonsteroidal hormones, such as inhibin, produced by a greater number of preovulatory follicles in nonsurge patients, may block the pituitary response to hypothalamic gonadotropin-releasing hormone in the face of high and rising E2 levels.

Chorionic Gonadotropin↗
PubMed1986

Patterns of estradiol response in patients with endogenous gonadotropin surges during follicular recruitment in an in vitro fertilization and embryo transfer program.

This report is an analysis of 16 cycles in 15 patients stimulated with human menopausal gonadotropin and clomiphene citrate for the purpose of follicular recruitment in an in vitro fertilization program, all of which resulted in endogenous luteinizing hormone (LH) surges. A study of the pattern of estradiol (E2) response to stimulation revealed two groups of cycles, designated "leap" pattern (9 cycles) and "plateau" pattern (7 cycles), the rate of rise of E2 increasing or decreasing, respectively, as the time of the LH surge was approached. There were no significant differences between these groups of cycles in the peak E2 level attained or the number of follicles greater than or equal to 12 mm on the day of peak E2. In the plateau, but not in the leap pattern cycles, a significant correlation (r = 0.958) was found between the number of follicles greater than or equal to 12 mm and the peak E2. We tentatively conclude that "plateau" pattern cycles reflect relatively synchronous follicular recruitment; the greater the number of follicles recruited, the higher the E2 level attained, increased amounts of inhibin-like substances being available to restrain the LH surge; "leap" pattern cycles reflect asynchronous follicular recruitment.

Clomiphene↗
PubMed1985

Nonsuppressible insulin-like activity and somatomedin C levels in normal pregnant women, in pregnant women with gestational diabetes, and in umbilical cord blood of mature and premature infants.

This study was undertaken to determine the significance of the changes in nonsuppressible insulin-like activity as measured by the fat pad assay and by the levels of immunoreactive somatomedin C, growth hormone, and human placental lactogen in sera of term normal pregnant women, mothers who delivered prematurely, and women with gestational diabetes at term as compared to normal nonpregnant subjects. These hormones were also measured in the umbilical cord blood of these patients at the time of delivery to determine the possible mechanisms of the fetal growth in utero. Our investigations showed that (1) nonsuppressible insulin-like activity is elevated during pregnancy, but its level was lower in mothers with gestational diabetes in spite of significantly higher serum human placental lactogen compared with normal pregnant mothers; (2) nonsuppressible insulin-like activity is significantly lower in premature infants than in term infants; (3) somatomedin C levels were significantly elevated in pregnant mothers in spite of suppression of growth hormone; (4) nonsuppressible insulin-like activity and somatomedin C levels in infants of mothers with gestational diabetes were not significantly elevated in spite of higher birth weight, indicating that nonsuppressible insulin-like activity and somatomedins are not the only factors responsible for the increase of birth weight of children of diabetic mothers; (5) there was marked discordance between the growth hormone level in the neonates and somatomedin C levels.

Adult↗
PubMed1984

Estrogen replacement therapy. Universal remedy for the postmenopausal woman?

The menopausal woman is in a state of estrogen deficiency that induces a variety of metabolic, structural, and symptomatic disturbances. Indications for estrogen replacement therapy include vasomotor symptoms, psychosomatic complaints, urogenital atrophy, prevention of osteoporosis, and prevention of coronary heart disease. Potential risks of therapy include development of endometrial and breast cancer. The incidence of both can be decreased with combination estrogen-progestin therapy. Future research efforts should be directed toward identifying the postmenopausal woman at increased risk for osteoporosis and/or coronary heart disease.

Atrophy↗
PubMed1984

Potassium and glucose concentrations in patients treated with oral tocolytic agents: a preliminary report.

Fifteen patients referred to the Division of Maternal-Fetal Medicine with the diagnosis of cervical incompetence were placed in a study protocol where prophylactic oral beta mimetic agents were used in an attempt to prevent cervical dilatation between 20 and 36 weeks of gestation. Our study suggest that after the first week of therapy prolonged maternal oral tocolytic therapy has no significant effect on glucose or serum potassium levels and no deleterious effects on the immediate neonatal course.

Administration, Oral↗
PubMed1984

Evaluation of progestogens for postoperative adhesion prevention.

Progesterone (P) has been shown to have potent antiinflammatory and immunosuppressive properties. Previous reports have suggested that the use of P decreases postoperative adhesion formation. To further evaluate the role of pharmacologic doses of progestogens in adhesion prevention, 42 mature New Zealand White rabbits underwent standardized injuries to the uterine horns, fimbriae, and pelvic peritoneum and received one of six treatments. Group S had intraperitoneal placement of normal saline (0.9%); group H received intraperitoneal placement of 32% dextran 70; group IM-P received intramuscular P-in-oil 10 days before and after laparotomy in addition to intraperitoneal saline; group IP-P had intraperitoneal placement of an aqueous P suspension; group DP received medroxyprogesterone acetate intraperitoneally; and group C received no intramuscular or intraperitoneal adhesion-prevention agents. The animals were sacrificed 6 weeks after laparotomy, and the adhesions were scored. Intraperitoneal saline (group S) significantly reduced the amount of adhesions when compared with the control group (C) (P less than 0.05). No significant difference was observed when group S was compared with group H. Intramuscular P added to saline (group IM-P) did not cause further reduction in adhesions when compared with group S. Both group IP-P and group DP had more adhesions than did group S (P less than 0.01). These data fail to support previous claims regarding adhesion prevention by the use of locally or parenterally administered progestogens.

Animals↗
PubMed1984

Intrapartum maternal lumbosacral plexopathy.

Maternal intrapartum neurologic injuries are infrequently reported in modern obstetric practice. Two cases are presented and methods of evaluating the level of injury to differentiate this syndrome from peroneal nerve palsies are suggested. The long-term prognosis of lumbosacral plexus injuries encountered during labor and delivery appears to be favorable. Nonetheless, future intrapartum management of these patients should be conservative.

Adult↗
PubMed1983

Foeto-maternal morbidity in the presence of antibodies to Trypanosoma cruzi.

Pregnancy outcome and maternal morbidity were analysed in 302 pregnant women with positive Machado-Guerreiro Complement Fixation Test (MGCFT) for antibodies to Trypanosoma cruzi and 302 women with a negative MGCFT resident of Córdoba, Argentina. A comparison of positive and negative cases was employed to investigate the association between MGCFT reaction and pregnancy outcome assessed from abortion and perinatal infant mortality rates; similarly, the data were analysed for demographic and socio-economic factors, numbers of previous pregnancies (birth order) and maternal complications. A twofold increase in the risk of pregnancy loss associated with a positive MGCFT was found. The incidence of polyhydramnios and varicosities of the leg was significantly higher in the serologically reactive group.

Abortion, Spontaneous↗
PubMed1981

The menstrual cycle and plasma testosterone levels in women with acne.

A prospective study of the ovarian function and plasma testosterone levels was conducted in a group of 139 women presenting with a chief complaint of acne. In 90% of the patients the plasma testosterone levels were above the normal mean. Amenorrhea was present in 17.2%, anovulation in 18.4%, and variable degree of ovulatory dysfunction in 57.2% of the patients. The severity of ovarian dysfunction was directly proportional to the plasma testosterone levels. Age was inversely related to both plasma testosterone levels and severity of ovarian dysfunction. The results of this study suggest that acne may be associated not only with a hyperandrogenic state but also with ovarian dysfunction. They emphasize the need for a careful investigation of androgen levels and ovarian function in women with chief complaint of acne.

Acne Vulgaris↗
PubMed1979

Contemporary management and conduct of preterm labor and delivery: a review.

Current concepts in the conduct of preterm labor and management of delivery of the premature infant are reviewed. Pharmacologic modalities available for inhibiting preterm labor are discussed as well as the efficacy, indications and contraindications for these agents. An analysis of the role of corticosteroids in achieving fetal pulmonary maturity in the preterm infant is reviewed, and based on the existent literature the intrapartum management of the small fetus is outlined. The mode of delivery, vaginal or via cesarean section, for these infants is likewise discussed.

Adrenal Cortex Hormones↗
PubMed1977

Uterine trauma associated with midtrimester abortion induced by intra-amniotic prostaglandin F2alpha with and without concomitant use of oxytocin.

Five of 80 (6.2%) nulliparous women sustained uterine trauma in association with midtrimester abortion induced by intra-amniotic prostaglandin F2alpha and intravenous oxytocin. All five women suffered cervical lacerations, one extending to the lower uterine segment of the corpus and another associated with myometrial necrosis caused by cornual sacculation and ischemia. No uterine trauma was observed among 95 parous women aborted in the same fashion during this study. The different mechanisms of cervical dilation in the parous woman and the nullipara are offered as an explanation for this difference. Thirty-nine other cases of uterine injury associated with the use of intraamniotic prostaglandin F2alpha from the literature were reviewed, and found to indicate that midtrimester abortion induced by intra-amniotic prostaglandin F2alpha is associated with a significant risk of uterine trauma in the nullipara. The risk seems to increase with the use of oxytocin and with increasing gestational age.

Abortion, Induced↗
PubMed1977

Second trimester abortion: single dose intra-amniotic injection of prostaglandin F2alpha with intravenous oxytocin augmentation.

One hundred-sixty mid-trimester pregnancies were terminated by intra-amniotic injection of Prostaglandin F2alpha with concomitant intravenous oxytocin. Only four of 77 nulliparas and one of 83 multiparas required a second prostaglandin injection. Mean injection-abortion interval was 22.8 hours, and 17.0 hours respectively. This difference between groups was statistically significant. Four nulliparas sustained uterine trauma, a high incidence suggesting that this method may be ill-advised in these women. Because of the predictable short injection-abortion interval in the multipara, this method can be combined conveniently with surgical sterilization.

Abortion, Induced↗
PubMed1977

Postabortal laparoscopic tubal sterilization. Results in comparison to interval procedures.

This report documents our experiences in 3 groups of women undergoing laparoscopic tubal sterilization: those undergoing sterilization as an interval procedure, those performed in association with suction curettage, and those performed within 18 hours of second trimester pregnancy termination via intraaminiotic injection of prostaglandin F 2 alpha. As a postabortal sterilization procedure, laparoscopy is effective, logistically appealing, and convenient. There is, however, an increased risk of complications to the procedure when performed on the postabortal women. These include specifically, a 10-fold increased risk of infection and a 2.5-fold increased risk of bleeding complications as seen in our series. The results of these findings are discussed, and some suggestions for reducing these risks are offered.

Abortion, Induced↗