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Biomedical subjects

B S Shapiro

Publications and source records attributed to B S Shapiro.

At least 19 recordsLinked to original sources
PubMed1992

A model-based prediction for transvaginal ultrasonographic identification of early intrauterine pregnancy.

OBJECTIVE: Our objective was to develop a mathematic model for the prediction of transvaginal ultrasonographic identification of intrauterine gestation as a function of human chorionic gonadotropin titer or gestational age. STUDY DESIGN: In this prospective, descriptive study normal intrauterine pregnancies of 31 patients from the Yale in vitro fertilization and embryo transfer program and infertility clinic were studied. Logistic regression analysis was used to develop a probability curve of transvaginal ultrasonographic detection of intrauterine pregnancy as a function of human chorionic gonadotropin titer or gestational age with a 5 MHz vaginal transducer. RESULTS: A model-based prediction was constructed. It revealed that nearly all intrauterine sacs should be identified by a human chorionic gonadotropin titer of 3000 mIU/ml (first international reference preparation) or by a gestational age of 37 days on the basis of the 5 MHz vaginal transducer. CONCLUSIONS: A model-based prediction for transvaginal ultrasonographic identification of early intrauterine pregnancy is presented that can be readily adapted by individual institutions using their own ultrasonographic equipment and human chorionic gonadotropin assay.

Chorionic Gonadotropin↗
PubMed1992

Oral patient-controlled analgesia in adolescents.

Adolescence is a time when concerns about independence and self-control are of paramount importance. These developmental issues must be considered when planning treatment for adolescents with acute or chronic pain. Patient-controlled analgesia (PCA) is a method of administering opioids that reinforces patient autonomy. Traditionally, opioids given by PCA are administered via the intravenous or subcutaneous route. Issues of autonomy and control, however, are no less important for patients receiving oral opioids. To augment patient autonomy, we have provided oral medication kept at the bedside (oral bedside PCA) for adolescents with diverse pain problems. We describe our selection criteria and methods for using oral bedside PCA with adolescents and present 4 patients who used this method.

Administration, Oral↗
PubMed1991

Experience of an interdisciplinary pediatric pain service.

This article is a report of our experience with an interdisciplinary pain service in a large tertiary care pediatric hospital. During the first 2 years of operation, we received 869 consultations and referrals from more than 19 hospital divisions. Postoperative pain was the most frequent reason for consultation (56% of patients). Patients with pain related to cancer and sickle cell disease comprised 25% of the consultations. The remaining patients had a wide variety of primary diagnoses and causes of pain. We calculated the time spent by pain service physicians in direct patient care. The majority (63%) of physician time was spent with a small number of patients (17%). Most of these patients had pain that was unrelated to surgery, cancer, or sickle cell disease, and many posed dilemmas in diagnosis and treatment. Physician time was correlated directly to the use of psychologic and physical therapies for the pain, involving multiple team members. This experience supports the demand for an interdisciplinary pain service in a tertiary care children's hospital. A significant amount of physician time is necessary to provide patient care and to maintain a team approach, however, and pediatricians and other health care professionals who aim to implement such services should be cognizant of the time required.

Child↗
PubMed1990

Chlamydial IgG and IgA in serum and follicular fluid among patients undergoing in vitro fertilisation.

The point prevalence of IgG and IgA antibodies to Chlamydia was analyzed in serum and follicular fluid in 63 patients undergoing in vitro fertilisation (IVF) in comparison to sera of 298 healthy women by the single serovar (L2) inclusion immunoperoxidase assay (IPA). The presence of specific IgG and IgA to Chlamydia in follicular fluid was demonstrated. No statistical association was found between the presence of specific Chlamydia IgG and IgA in serum and follicular fluid to oocyte fertilization. The positive predictive value for mechanical infertility of Chlamydia IgG at titers of greater than or equal to 128 and IgA titers at greater than or equal to 16 was 91 and 92%, respectively, in this high-risk group for mechanical infertility. Multiple regression analysis singled out Chlamydia IgG levels as a major contributor to the variance between the groups of infertile patients.

Adolescent↗
PubMed1989

Super high estradiol response to gonadotropin stimulation in patients undergoing in vitro fertilization.

The likelihood of establishment of a term pregnancy from in vitro fertilization (IVF) is related to the estradiol (E2) pattern and peak level. To examine the influence of super high E2 peak levels (greater than or equal to 2000 pg/ml), we reviewed the clinical outcomes of all IVF cycles with follicular phase E2 levels greater than 2000 pg/ml from May 1982 through June 1987. Among 1651 IVF cycles initiated during this time, 102 cycles (6.2%) had super high E2 levels. Twenty-seven of these cycles occurred in 34 IVF attempts in 12 women. Stimulation was performed with human menopausal gonadotropin (hMG) in 96 cycles and follicle-stimulating hormone (FSH) in 6 cycles. A mean of 9.3 +/- 0.7 oocytes per cycle was recovered, of which 5.5 +/- 0.5 fertilized and underwent cleavage. In 11 cycles, with a mean of 6.8 oocytes recovered, none fertilized. Polyploid fertilization occurred in 23 of 90 cycles (25.6%), and 40 of 558 fertilized oocytes (7.2%). From these cycles, 10 clinical pregnancies (9.8%) have resulted: 6 pregnancies in 59 cycles with luteal-phase progesterone support (10.2%) and 4 pregnancies in 31 cycles without luteal-phase progesterone support (12.9%). Among the 1549 cycles with peak E2 levels less than or equal to 2000 pg/ml, 143 (9.2%) resulted in clinical pregnancies. We conclude that there is a small subset of patients who will have super high E2 responses to gonadotropin stimulation and that there is a tendency to stimulate repetitively in this fashion.(ABSTRACT TRUNCATED AT 250 WORDS)

Chorionic Gonadotropin↗
PubMed1989

The association between chlamydial-specific IgG and IgA antibodies and pregnancy outcome in an in vitro fertilization program.

Chlamydial-specific IgG and IgA antibodies were determined by a single serovar (L2) immunoperoxidase assay (IPA) in the serum of all patients that have conceived in an in vitro fertilization and embryo transfer (IVF & ET) program (n = 106) and in a group of patients that went through the program at the same period of time and did not conceive (n = 94). The prevalence rate of elevated IPA IgG (titers greater than or equal to 1:128) and IPA IgA (titers greater than or equal to 1:16) specific to chlamydiae was significantly higher (P less than 0.001) in the IVF & ET pregnancy loss and nonconception groups ("failures") versus the IVF & ET term pregnancy group ("successes") (74 vs 47%, odds ratio = 4.1, and 34 vs 14%, odds ratio = 4.3, respectively). Stepwise discriminant analysis revealed that elevated specific chlamydial IgG had the greatest effect on the variance between successes and failures in this study group. Our study indicates the possible role of past or chronic active chlamydiae infection on the "take-home baby rate" in an IVF & ET program.

Adult↗
PubMed1989

The management of pain in sickle cell disease.

For people with sickle cell disease, vaso-occlusive crisis pain is a frequently encountered problem that poses unique and often perplexing challenges in management. This article reviews the natural history of vaso-occlusive crisis and discusses intervention appropriate for the care of patients with pain due to this chronic illness.

Adolescent↗
PubMed1989

Ectopic pregnancy: duplex Doppler evaluation.

Of 398 patients in whom there was a clinical suspicion of ectopic pregnancy, 96 (24%) were found to have the condition. Of the 96, 70 underwent duplex Doppler imaging. A viable ectopic fetus was seen in 10 of 70 (14%), and an extrauterine sac without an identifiable fetus was seen in an additional 27, giving a sensitivity for imaging alone of 53%. Fetal heart activity was detected with Doppler in 13 (19%). High-velocity flow, which suggested the presence of an ectopic pregnancy, was detected in 38 of 70 (54%) patients (total preoperative sensitivity, 73%). In the 91 patients who did not have an ectopic pregnancy, duplex Doppler imaging of the intrauterine contents alone allowed an ectopic pregnancy to be excluded in 29 (32%) on the first examination and in a further 21 on the second scan (specificity, 55%). Nine vascular adnexal masses were falsely considered to be ectopic pregnancies (specificity, 90%). The positive predictive values were 47% for imaging alone and 85% for Doppler. The negative predictive values were 60% for imaging alone and 81% for Doppler.

Adult↗
PubMed1989

Ultrasound and infertility.

The development of ultrasound has provided the clinician with the opportunity to visualize the pelvic reproductive organs noninvasively. The use of ultrasound for the diagnosis and treatment of infertility has progressed rapidly to become an integral part of the management of the infertile woman. Examinations for each component of the reproductive tract have been refined. Thus, the diagnosis of uterine, tubal and ovarian pathology has been facilitated by the use of sonography. Ovarian follicular development is monitored effectively with ultrasound and has resulted in the widespread use of the technique in both spontaneous and induced cycles of ovulation. The development of the transvaginal ultrasound probe, with its better resolution, has enabled the clinician to routinely recover oocytes for in vitro fertilization without the risk of general anesthesia in a surgical procedure and has also enhanced the clinician's ability to diagnose early ectopic pregnancy.

Fallopian Tubes↗
PubMed1988

Salpingoscopy: an adjunctive technique for evaluation of the fallopian tube.

The success of tubal surgery is dependent upon both the nature and extent of tubal damage as well as the expertise of the surgeon. The present study describes the new technique of salpingoscopy to further appraise the status of tubal health by examination of the endosalpinx, utilizing readily available equipment. There were no complications during salpingoscopy attributable to the endoscopic procedure itself, except for a minimal amount of bleeding occasionally noted on the tubal serosa at the site of forceps stabilization. A discordance of 23.5% was noted overall between the fimbrial appearance at surgery and salpingoscopic examination. This new technique of tubal evaluation may eventually help the reproductive surgeon to more accurately counsel the patient in the choice between tubal reconstructive surgery or IVF-ET, one of the most difficult decisions in reproductive surgery today.

Endoscopes↗
PubMed1988

Transvaginal ultrasonography for the diagnosis of ectopic pregnancy.

The transvaginal (TVU) and transabdominal (TAU) ultrasound approaches were compared in their ability to identify by direct visualization the adnexal mass of ectopic pregnancy. There were 22 patients who had a surgically proven ectopic pregnancy. The TAU approach identified the adnexal mass in 50% and the TVU approach in 91% of the patients (P less than 0.01). Below both previously reported threshold titers for the expected TAU intrauterine sac visualization, at 6500 mIU and 3600 mIU, respectively, the TVU approach allowed the identification of significantly more ectopic adnexal masses than the TAU approach. The results of the present study demonstrate the increased efficacy of TVU over TAU in the direct identification of the adnexal mass associated with ectopic gestation.

Abdomen↗
PubMed1988

Instrumentation in hysteroscopy.

The use of diagnostic and operative hysteroscopy has evolved rapidly over the past decade to become an integral part of gynecologic care. The hysteroscopies and ancillary equipment are readily available commercially, and the techniques can be mastered, as is true of any surgical technique, with an appropriate amount of supervised practice. With a good basic understanding of the types of equipment available and their appropriate uses, the maximum utility of the hysteroscopic technique can be fully realized in an environment of safety.

Endoscopes↗
PubMed1987

The nonsurgical management of ectopic pregnancy.

The nonoperative management of unruptured tubal ectopic pregnancy by either chemotherapy or expectant observation may be appropriate in a select group of patients, as outlined above. The routine use of these management modalities as a replacement for conservative surgery is not yet justified.

Abortifacient Agents, Steroidal↗
PubMed1981

The relationship between loss of dopamine nerve terminals, striatal [3H]spiroperidol binding and rotational behavior in unilaterally 6-hydroxydopamine-lesioned rats.

The relationship between the destruction of dopamine-containing nerve terminals, specific binding of [3H]spiroperidol and contralateral rotation in response to L-DOPA, was studied in rats with unilateral lesions of the nigrostriatal dopamine (DA) system, induced by intracerebral injections of the neurotoxin 6-hydroxydopamine (6-OHDA). Animals with significant rotational behavior in response to L-DOPA had both a greater amount of specific binding of [3H]spiroperidol in the lesioned striatum compared to the non-lesioned striatum, and at least 90% destruction of DA terminals in the lesioned striatum (less than 10% of control uptake). The nonrotators to L-DOPA had considerably less destruction of DA terminals and no significant increase in specific binding on the lesioned side. The data from this study suggest that before L-DOPA is effective as an inducer of contralateral rotational behavior, there must be both unilateral damage to the DA terminals greater than 90%, and increased specific binding.

Animals↗