Biomedical subjects
Publications and source records attributed to C F Slabber.
In 6 cases antisperm antibodies were demonstrated in the serum of patients. Other causes of infertility were excluded. The patients were treated with corticosteroids; in 5 cases prednisone 5 mg three times daily for 3 months was used, while in 1 case methylprednisolone 96 mg daily for 7 days was used. In 5 patients the antibody titre declined. Three pregnancies resulted.
Two cases of giant neurofibroma of the vulva are described. The finding of a solitary neurofibroma in a patient who shows no other stigmata of multiple neurofibromatosis is unusual. Also unusual was the exceptional size of these tumors.
Intensive plasma exchange was performed with a continuous-flow centrifuge in 2 pregnant women severely immunized to the Rh(D) iso-antigen. Plasma exchange was started at 17 and 18 weeks of gestation and a total of 220 litres and 185 litres plasma was replaced with plasma protein fraction over a period of 14 and 12 weeks respectively. There was a marked lowering of the anti-D antibody concentration in one patient, and the expected increase in antibody level during pregnancy was prevented in the other. Serum IgG and IgA levels were decreased by the exchange, but the continuous hypogammaglobulinaemia had no adverse effects. The serum IgM concentration was also lowered, but plasma levels returned to normal between plasma exchange procedures. The successful outcome in both cases suggests that intensive plasma exchange may reduce fetal haemolysis and that it may be an useful adjunct to amniocentesis, intra-uterine transfusions and premature delivery in the prenatal management of haemolytic disease in newborn infants.
The aim of the present report is to standardize the postcoital test. A new method of evaluation is suggested by which the number of immotile and motile spermatozoa found in the cervical mucus after coitus is estimated. The estimation is based on the forward progression of the spermatozoa. A postcoital index value is determined from the motility status and number of spermatozoa, and by comparing the postcoital index values of a limited number of patients the authors tried to find an optimum cut-off index value as regards pregnancy.
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A male patient who had a reanastomosis after sterilization in 1972 was referred to our infertility clinic for an evaluation. Complete semen analysis and immunological investigations were done. Apart from oligozoospermia the patient had a profound sperm antibody activity in his seminal plasma and blood serum.
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Spermatozoal antibodies found in the sera of oligozoospermic and azoospermic men are often related to infertility or subfertility. In this study the sera of 36 such men were examined for the presence of sperm antibodies. During the routine analysis of the semen, note was taken of the type and degree of agglutination in the ejaculates. The semen and serum of 15 normozoospermic men were used as controls. The gelatin agglutination, micro-agglutination and tube-slide agglutination tests were compared. A correlation between the state of fertility and the presence of sperm antibodies was found. The presence of sperm antibodies is more likely to be a corollary than a cause of oligozoospermia or azoospermia.
A statistically significant reduction in maternal blood bupivacaine levels could be achieved by using a segmental epidural blockade and lower concentrations of bupivacaine. Since bupivacaine has certain potential disadvantages for the mother and the fetus, its dosage should be kept as low as possible. Significantly lower blood levels without loss of analgesic quality are obtainable by using segmental epidural blockade and a lower concentration of bupivacaine.
The fate of plastic catheters threaded into the epidural space was studied radiographically in a total of 125 catheters in 75 patients. The longer the segment of catheter, the less likely it is to reach the intended position, because it may curl up or become deflected. The most reliable technique for accurately placing an epidural catheter at any specific level is to enter the epidural space as close as possible to that level, so that the catheter does not need to be threaded for more than 2--3 cm.
In our laboratory we encountered problems interpreting the standard Friberg test. After an incubation period of four hours we could not interpret the test in 52 per cent of cases due to a high number of immobile spermatozoa and debris in the supernatant used as antigen in this test. By shortening the incubation period to two hours we could objectively interpret 76 per cent of cases. The applicability of the test was further improved by modifying the preparation of the antigen. Instead of using the supernatant of diluted semen, we "filtered" the motile sperm by means of the sperm penetration meter of Kremer. The capillary tube of the penetration meter was filled with virgin serum and incubated for one hour. After a four hour incubation this test could be applied in 80 per cent of cases, and after a two hour incubation period in all the cases. The reliability of this test was compared with the standard Friberg, the Kibrick and the Franklin-Dukes tests. The modifications did not alter the reliability of the test.
A couple with no demonstrable cause for their infertility, except for a pronounced antisperm activity in the blood serum of the female partner, were instructed to use a condom while our laboratory monitored the wifes antibody titer. The antibody activity declined sufficiently and an artificial husband insemination were performed after seven months of therapy. A precise report of the spermantibody activity over an eleven month period are given by the authors.
Three different techniques for epidural block were used and compared in an attempt to lower the incidence of fetal heart deterioration patterns occurring after the block. Segmental epidural block allowed of lower dosages of bupivacaine, but only when the patient knelt on all four was it possible to eliminate post-block fetal heart deterioration completely.
The principal aim of this study was to determine whether subjective estimations of sperm velocity in our laboratory could readily be translated into objective figures. The technique for measuring the progression of human spermatozoa in seminal plasma in objective fashion was the one used by Janick and MacLeod in 1970. We therefore compared our objective figures with those of these authors and found a remarkable correlation between their values and ours. However, we went a step further and standardized the different objective values found in the study. Three simple equations were determined, by means of which each laboratory will be able to standardize their subject scale for forward progression of the spermatozoa.
Despite preloading with fluid, a fall in the mean arterial pressure was recorded in 66% of patients after standard epidural analgesia. In 83% of patients in whom blood pressure fell, hypotension was classified as moderate or severe. In cases of severe hypotension the dermatome level of the block always surpassed T9. The maximal fall in blood pressure always occurred within the first 25 minutes after administration of the local anaesthetic agent.
The effect of lumbar epidural analgesia on uterine work output was studied in 36 women during labour. During the first 10 minutes after administration of the local anaesthetic agents there was a 46% loss of uterine activity. In 72% of patients uterine activity returned to normal within 30 minutes. Seventeen per cent of patients required additional oxytocic stimulation.
Pyridoxine has been reported as having an antilactogenic effect, presumably by suppressing prolactin secretion. We have measured serum prolactin levels during pyridoxine administration in two groups of hyperprolactinaemic subjects. In normal postpartum women, the postdelivery fall in serum prolactin levels did not differ significantly in treated and control subjects. In patients with chlorpromazine-induced hyperprolactinaemia and galactorrhoea, pyridoxine did not reduce the elevated levels. In neither group was milk production suppressed.
In the present situation where medical curricula are being re-examined by many medical faculties, the importance of obstetrics and gynaecology in the undergraduate curriculum has come under intense scrutiny. Obstetrics and gynaecology form a major part of the general practitioner's work, and should therefore form a major part of his medical training. The subject also stresses par excellence the importance of communication with patients, preventive medicine and special responsibility of the medical practitioner to the community. Every department of obstetrics and gynaecology must examine the contents of the course presented to its students. We must move away from the old mechanistic approach and concentrate on those aspects which are important in a modern society--antenatal and postnatal care, preventive measures, family planning, and sexual and psychological problems of our patients.