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Biomedical subjects

B Urman

Publications and source records attributed to B Urman.

At least 55 records · Page 3Linked to original sources
PubMed1994

Exogenous gonadotropin therapy in World Health Organization groups I and II ovulatory disorders.

OBJECTIVE: To analyze cumulative conception rates and the prognostic factors influencing them during exogenous human menopausal gonadotropin (hMG) therapy for World Health Organization (WHO) group I or II ovulatory disorders. METHODS: A retrospective review was conducted of 468 treatment cycles in 146 women with ovulatory disorders refractory to conventional therapy. Cumulative conception rates were calculated, and the effects of diagnostic group, age, gravidity, and duration of infertility were examined using the Cox proportional hazards model. RESULTS: The cumulative proportion pregnant following six hMG cycles in WHO group I (0.89) was significantly greater than in the hyperandrogenic subgroup of WHO group II (0.30) (95% confidence interval [CI] 0.2-0.7, P = .006) or the luteal phase defect subgroup (0.35) (95% CI 0.07-0.6, P = .02). Conception rates in WHO group I did not differ significantly from those in the normoandrogenic oligo-ovulatory subgroup of WHO group II (0.63) (95% CI 0.3-1.3, P = .6). Conception rates were not influenced by duration of infertility or primary versus secondary infertility. Women 35 years or older had significantly lower conception rates than those aged 27 years or less (P = .04, hazard ratio 0.3, 95% CI 0.1-0.8). CONCLUSIONS: Cumulative conception rates following exogenous gonadotropin therapy for women with refractory ovulatory disorders were both diagnosis- and age-dependent. Treatment with hMG approximated or surpassed normal fertility rates in women with WHO group I and normoandrogenic WHO group II oligo-ovulation, but was significantly less successful at correcting the underlying defect in women with hyperandrogenic anovulation and luteal phase defects.

Adult↗
PubMed1993

Circulating CA-125 levels in superovulated women are mainly derived from the ovaries.

A prospective study was designed to determine the individual contribution of the ovaries and the endometrium to total circulating levels of CA-125. Luteal phase CA-125 levels were measured in five women superovulated before and after vaginal hysterectomy performed for pelvic relaxation. The difference in the preoperative and postoperative luteal CA-125 levels of superovulated cycles were similar, suggesting a mainly ovarian source for the antigen although endometrial and other sites of contribution cannot be excluded in view of the small number of patients studied.

Adult↗
PubMed1993

Human follicular fluid from pre-ovulatory follicles in patients undergoing in-vitro fertilization inhibits the in-vitro growth of gram-positive micro-organisms.

In this study, we assessed the antibacterial activity of human follicular fluid obtained from patients undergoing oocyte aspiration for in-vitro fertilization and embryo transfer. Gram-positive and Gram-negative microorganisms and Candida albicans were added to the follicular fluid and broth cultures which served as controls. Follicular fluid was shown to be inhibitory against Gram-positive microorganisms; this inhibition was probably due to lysosyme and progesterone. Growth of Gram-negative micro-organisms and C. albicans were, however, supported by follicular fluid incubation.

Candida albicans↗
PubMed1993

Pelvic-peritoneal tuberculosis with elevated serum and peritoneal fluid Ca-125 levels. A report of two cases.

We report 2 patients with pelvic-peritoneal tuberculosis and elevated serum and peritoneal fluid levels of Ca-125. The first was a young and infertile women who had cul-de-sac nodularity and dysmenorrhea. The other was postmenopausal and presented with weight loss and ascites. While a preoperative diagnosis of endometriosis was made in the former, intraperitoneal malignancy was considered in the latter. The diagnosis of pelvic-peritoneal tuberculosis was reached by laparoscopic-directed biopsy in both patients. Serum levels of Ca-125 returned to normal limits following antituberculous drug treatment.

Adnexal Diseases↗
PubMed1992

Midtubal occlusion: etiology, management, and outcome.

OBJECTIVE: To assess the significance of pathological midtubal occlusion in infertility. DESIGN: Retrospective descriptive case review. SETTING: Tertiary referral center. PATIENTS: Sixteen women, 26 to 38 years of age presenting with infertility and diagnosed as having midtubal occlusion. INTERVENTIONS: Assessment of the etiology of the occlusive disease and yield of microsurgical tubotubal anastomosis. MAIN OUTCOME MEASURES: Histologic examination of occluded tubal segment and fertility outcome subsequent to anastomosis. RESULTS: Occlusion was because of tuberculous salpingitis (n = 6), resolved tubal pregnancy (n = 3), endometriosis (n = 2), chronic inflammatory reaction (n = 1), tubal cyst (n = 1), intratubal adhesions (n = 1), infant hernia repair (n = 1), and calcification (n = 1). Of eight women (including the patient with tuberculous salpingitis) who underwent tubal anastomosis only for midtubal occlusion, three had subsequent term deliveries, two had tubal pregnancies, and three women did not conceive. CONCLUSION: Midtubal occlusion of the tube because of an infectious process is rare. Excluding tuberculous salpingitis, microsurgical anastomosis yields satisfactory fertility, albeit with significant risk of ectopic pregnancy.

Adult↗
PubMed1992

The outcome of in vitro fertilization and embryo transfer in women with polycystic ovary syndrome failing to conceive after ovulation induction with exogenous gonadotropins.

OBJECTIVE: To assess the outcome of in vitro fertilization and embryo transfer (IVF-ET) in women with refractory polycystic ovarian syndrome (PCOS). DESIGN: Retrospective case series with an age-matched control group. SETTING: Ovulation induction and IVF programs in a tertiary referral center. PATIENTS AND INTERVENTIONS: Nine patients with PCOS who failed standard ovulation induction treatment (clomiphene citrate plus greater than or equal to 6 ovulatory human menopausal gonadotropin [hMG] cycles) underwent 19 cycles of IVF-ET. Forty age-matched tubal factor patients who completed 40 cycles of IVF-ET served as a control group. OUTCOME MEASURES: Demographic features and IVF-ET cycle characteristics were compared using Student's t-test and Fisher's exact test. RESULTS: Cycles of IVF-ET in patients with PCOS were associated with higher estradiol levels (5,222 versus 4,009 pmol/L), lower hMG requirements (15.8 versus 19.6 vials), greater numbers of oocytes (7.6 versus 5.6), and lower fertilization rates (56% versus 75%) compared with tubal factor cycles (P less than 0.05). However, the number of embryos transferred (3.9 versus 4.0) and the clinical pregnancy rate per embryo transfer (24% versus 25%) did not differ significantly between the two groups. CONCLUSION: These results suggest that conception failure after six or more ovulatory hMG cycles in patients with PCOS does not adversely affect subsequent IVF performance.

Adult↗
PubMed1992

Laparoscopic CO2 laser uterine nerve ablation for treatment of drug resistant primary dysmenorrhea.

Twenty women with drug-resistant primary dysmenorrhea were subjected to laparoscopic CO2 laser uterine nerve ablation. Menstrual pain assessed by a linear analog pain score showed a reduction of 33%, decreasing from 7.5 +/- 0.5 preoperatively to 5.0 +/- 1.7 postoperatively. The procedure was free of major complications and should be considered as a second-line therapeutic option in women who have failed medical treatment using nonsteroidal antiinflammatory agents or OCs.

Adult↗
PubMed1992

Management of overstimulated gonadotrophin cycles with a controlled drift period.

In an attempt to avoid cancellation, 40 cycles which were biochemically overstimulated with exogenous gonadotrophins (oestradiol level inadvertently exceeding 5400 pmol/l) in 32 patients with polycystic ovarian syndrome, classified as Group II according to the World Health Organization, were managed by a controlled drift period. This involved a schedule where further human menopausal gonadotrophin (HMG) injections were withheld but monitoring continued with daily assays of serum oestradiol and frequent follicular ultrasound examinations. The mean oestradiol level at the start of the drift period was 9249 +/- 3465 (SD) pmol/l and dropped by 64.3 +/- 25.3% to 2945 +/- 1817 pmol/l at the end of 2.8 +/- 1.5 days of drift interval (range 1-8 days) at which time human chorionic gonadotrophin was administered. There was a significant increase in the size of the lead follicle and number of follicles greater than 14 mm in diameter during the drift period. The clinical pregnancy rate per cycle was 25% (10/40). The multiple pregnancy rate was 50% (5/10), and 2.5% (1/40) of the cycles were complicated by severe ovarian hyperstimulation syndrome (OHSS). These data indicate that cycles inadvertently overstimulated with gonadotrophin can be managed with a controlled drift period as an alternative to cancellation, yielding favourable pregnancy rates. The multiple pregnancy rate was 50%, twins in all instances and the rate of severe OHSS was 2.5%, which were within the range reported in the literature for HMG-stimulated cycles.

Chorionic Gonadotropin↗
PubMed1992

Laparoscopic surgical treatment of tubal pregnancy. A safe, effective alternative to laparotomy.

This study analyzed the intraoperative morbidity, postoperative course, postoperative hospital stay and fertility outcome in 216 consecutive tubal pregnancies treated with either laparoscopy (n = 98) or laparotomy (n = 118). Among the 98 cases treated with laparoscopy, the procedure was successfully completed in 95 (97%). In three cases laparotomy had to be performed to conclude the procedure. Retained trophoblast was observed in 3.8% of cases treated conservatively with laparoscopy and 1.3% of cases treated conservatively with laparotomy (P greater than .05). The total anesthesia time, amount of postoperative analgesia required and postoperative hospital stay were significantly less in cases treated with laparoscopy (P less than .001). The subsequent fertility outcome was similar in both groups. Laparoscopic treatment of tubal pregnancy is a safe and effective alternative to laparotomy, yielding similar fertility outcomes and requiring significantly less postoperative analgesia and a significantly shorter hospital stay.

British Columbia↗
PubMed1992

The effect of short-interval laparoscopic lysis of adhesions on pregnancy rates following Nd-YAG laser photocoagulation of polycystic ovaries.

Laparoscopic Nd-YAG laser photocoagulation of the ovaries was performed in 40 anovulatory women with clomiphene citrate-resistant polycystic ovary disease. Following this procedure, the subjects were randomly assigned to have either a second-look laparoscopy with lysis of adhesions within 3-4 weeks of the initial laparoscopy (N = 19) or expectant management (N = 20). One patient assigned to the laparoscopy group refused the procedure. Minimal and mild adhesions that did not distort the normal tubo-ovarian relationship were encountered in 13 patients (68%) in the second-look laparoscopy group; these adhesions were easily lysed using sharp or blunt dissection. The pregnancy rates over 6 months were similar in the two groups (47% in the second-look group and 55% in the expectant-management group; P greater than .05). These data suggest that early laparoscopic lysis of adhesions does not improve short-term conception rates following laparoscopic Nd-YAG laser photocoagulation of polycystic ovaries.

Adult↗
PubMed1991

Effect of hyaluronic acid on postoperative intraperitoneal adhesion formation and reformation in the rat model.

The local application of 0.25% or 0.4% HA before the induction of a measured laser injury on the rat uterine horn was associated with a significant reduction (P less than 0.05) in postoperative IP adhesions when compared with the group of animals pretreated with the diluent vehicle PBS or received no pretreatment. However, 0.4% HA, when applied in a similar manner, was ineffective in reducing reformation of adhesions after microsurgical adhesiolysis.

Animals↗
PubMed1991

Effect of hyaluronic acid on postoperative intraperitoneal adhesion formation in the rat model.

OBJECTIVE: The aim of this study was to determine the effectiveness of hyaluronic acid solution in preventing intraperitoneal (IP) adhesions. DESIGN AND SETTING: The study design was prospective, randomized and blinded and involved 83 rats. INTERVENTIONS: Measured serosal injury was inflicted using a CO2 laser on the right uterine horn of the rat. Animals randomized to groups 1 and 2 received either 0.4% hyaluronic acid or its diluent phosphate-buffered saline (PBS) intraperitoneally before and after the injury. In groups 3 and 4, the same solutions were used only after the injury. Postoperative adhesions were assessed at second-look laparotomy. Histologic assessment of the fresh laser injury was carried out on uteri pretreated with hyaluronic acid, PBS, or nothing. MAIN OUTCOME: Pretreatment with hyaluronic acid was associated with a significant reduction in postoperative adhesions and a significantly decreased crater depth. CONCLUSIONS: Hyaluronic acid appears to reduce postoperative IP adhesion formation by coating the serosal surfaces and decreasing the extent of initial tissue injury.

Animals↗
PubMed1991

Elevated serum testosterone, hirsutism, and virilism associated with combined androgen-estrogen hormone replacement therapy.

Nine postmenopausal women with symptoms and signs of androgen excess due to long-term use of an injectable androgen-estrogen combination were studied retrospectively. Cosmetically disturbing hirsutism was the major complaint in eight subjects. Other symptoms included hot flushes, decreased libido, mood changes, depression, and postmenopausal bleeding in the one patient with an intact uterus. Seven women had clitorimegaly; the clitoral index ranged from 45-120 mm2 (normal up to 35). Serum total testosterone levels were elevated in eight women, ranging from 5.7-14.9 nmol/L (normal up to 2.43). The androgen-estrogen combination was discontinued and oral or transdermal estrogen replacement was instituted. In five women followed serially for 16-24 months, elevated testosterone levels required 12-20 months to return to the normal premenopausal range.

Adult↗
PubMed1990

Comparison of clinical and surgical-pathologic staging in patients with endometrial carcinoma.

In that accurate staging is essential to proper management of patients with endometrium cancer, preoperative clinical staging was compared with surgical-pathological staging in 160 patients with endometrium cancer. One hundred fifty-two patients had clinical stage I, and eight had clinical stage II disease. Overall, the clinical stage was changed in 26.9% of patients. The incidence of inaccurate staging was 25% for clinical stage I and 62.5% for clinical stage II disease. Endocervical curettage was found to have a 12.5% false-positive rate and an 8.6% false-negative rate. The extent of malignant disease for endometrium cancer (clinical stages I-II) cannot be adequately and accurately assessed with clinical staging because there is a high rate of discordance between clinical and surgical-pathologic staging.

Clinical Competence↗