Biomedical subjects

C Meuleman

Publications and source records attributed to C Meuleman.

31 records · Page 2Linked to original sources

PubMed1994

Human menopausal gonadotrophin increases pregnancy rate in comparison with clomiphene citrate during replacement cycles of frozen/thawed pronucleate ova.

In a prospective randomized study, the effect of two ovulation induction regimens on implantation rate of frozen/thawed pronucleate ova was investigated. Patients received either human menopausal gonadotrophin (HMG) or clomiphene/HMG. Ovulation induction was done on an individual basis using ultrasound and plasma 17 beta-oestradiol concentrations. Ovulation was induced with human chorionic gonadotrophin (HCG) when the leading follicle reached a diameter of 18 mm. Pronucleate ova had been frozen using the slow-freezing method of Lassalle et al. (1985) (Fertil. Steril., 44, 645-651) and were thawed in synchrony with the age of the endometrium. Both groups of patients were comparable for age, indication for in-vitro fertilization, pre-ovulatory 17 beta-oestradiol concentration, number of large follicles and number and quality of embryos transferred. The only difference found was that HCG was administered 1 day earlier in the HMG group compared to the clomiphene/HMG group (P < 0.01). Using univariate analysis, the pregnancy rate was higher in patients stimulated with HMG alone compared to those stimulated with clomiphene/HMG (27 versus 15% respectively; P < 0.03), when HCG was administered later in the menstrual cycle (P < 0.01) and when more and better quality embryos were transferred (P < 0.01). Using multivariate regression analysis, the influence of the stimulation on pregnancy rate was even more pronounced (P < 0.01) when the day of HCG administration and the number and quality embryos transferred were taken into account. Therefore, we conclude that HMG alone increases pregnancy rate compared to clomiphene/HMG during replacement cycles of frozen/thawed pronucleate ova. These data suggest that HMG results in a better endometrium receptivity for embryos.(ABSTRACT TRUNCATED AT 250 WORDS)

Chorionic Gonadotropin↗

PubMed1994

Flow cytometry analysis of lymphocyte subpopulations in peritoneal fluid of women with endometriosis.

PROBLEM: We investigated the lymphocyte subpopulations in peripheral blood (PB) and peritoneal fluid (PF) of women with and without endometriosis to evaluate if the decreased natural killer (NK)-mediated cytotoxicity in women with endometriosis was due to a quantitative defect or not. METHOD: The PB and PF mononuclear cells of 59 women undergoing a diagnostic laparoscopy for pain and/or infertility were analyzed by flow cytometry. RESULTS: The number and concentration of PF mononuclear cells (MC) was increased in women with endometriosis compared to women without endometriosis. The monocyte/macrophage marker (CD14) was expressed on 70.3 and 66.9% of PFMC of women with and without endometriosis, respectively. The CD4/CD8 ratio was inverted in the PF, and this was more pronounced in women with endometriosis. In the PF of women with endometriosis, 41.3% of the lymphocytes were CD8 positive, compared to 34.3% in women without endometriosis. The percentage of NK positive lymphocytes in PF, using three different monoclonal antibodies directed against NK cell markers (CD57, CD16, and CD56) were not different between women with and without endometriosis. In women with endometriosis, 12.7, 9.5, and 28.8% of lymphocytes were CD57, CD16, and CD56 positive, respectively. CONCLUSION: PFMC consisted mainly of phagocytic and human leukocyte antigen (HLA)-restricted or HLA unrestricted cytotoxic cells capable of reacting to various antigens entering the cavity from the lower genital tractus. Furthermore, the decreased NK activity reported in PB and PF of women with endometriosis was not likely to be caused by a quantitative defect, since the percentage of NK positive lymphocytes was not different between women with and without endometriosis.

Ascitic Fluid↗

PubMed1994

CO2-laser excision of endometriosis does not improve the decreased natural killer activity.

OBJECTIVE: We recently described a decreased lymphocyte-mediated cytotoxicity to autologous endometrium and to natural killer-sensitive targets in women with endometriosis. The purpose of the present study was to investigate whether the defect remained after CO2-laser excision of the endometriotic lesions. DESIGN: In 15 women with endometriosis the cytotoxicity assays were performed before and three to four months after complete removal of the endometriotic lesions with CO2-laser excision. CA-125 serum levels were measured before and after laser laparoscopy, in order to confirm that endometriosis had been treated properly. RESULTS: After removal of the endometriotic lesions the decreased natural killer activity (K562-assay) and the impaired cytotoxicity of autologous and even heterologous lymphocytes to the endometrium remained unchanged, and those cytotoxicity assays were still significantly decreased compared to the women without endometriosis. CA-125 serum concentrations, however, were still significantly decreased three to four months after CO2-laser excision of the endometriosis. (paired Student's t-test p < 0.007). CONCLUSIONS: These data suggest a primary deficiency in natural killer activity in women with endometriosis and are in accordance with our clinical experience as endometriosis is relapsing frequently after treatment.

Carbon Dioxide↗

PubMed1994

Transforming growth factor-beta activity is increased in peritoneal fluid from women with endometriosis.

OBJECTIVE: To investigate the presence of transforming growth factor-beta in peritoneal fluid of women with and without endometriosis. METHODS: Fifty-two peritoneal fluid samples, obtained during laparoscopies performed for tubal ligation (n = 10), infertility (n = 38), or pain (n = 4), were examined for the presence of transforming growth factor-beta using the Mv1Lu cell growth inhibition assay. At laparoscopy, 26 women had endometriosis. The other 26 women had no endometriosis; 16 of them had infertility, and ten who had no pelvic pathology at tubal sterilization served as fertile controls. RESULTS: The concentration of transforming growth factor-beta was increased in the peritoneal fluid from women with endometriosis (11.4 +/- 3.3 ng/mL) compared to both the fertile control group without endometriosis (1.1 +/- 0.29 ng/mL) and the infertile control group without endometriosis (3.6 +/- 1.4 ng/mL). Twenty-five of the 52 women (48%) demonstrated levels of transforming growth factor-beta higher than 2 ng/mL. Patients with endometriosis were significantly more likely to have elevated concentrations of transforming growth factor-beta than were women without endometriosis (16 of 26, 61.5%, versus nine of 26, 34.6%). CONCLUSIONS: These findings demonstrate the presence of transforming growth factor-beta in peritoneal fluid. Elevated levels in women with endometriosis could be important in the pathophysiology of this disease.

Ascitic Fluid↗

PubMed1993

CA 125 in the management of endometriosis.

CA 125 is expressed by eutopic and ectopic endometrium. In women with advanced endometriosis, plasma concentrations are increased towards the end of the luteal phase and during menstruation but not during the follicular and early luteal phases. In women without endometriosis, such cyclic changes of CA 125 in plasma are not observed. In women with cystic ovarian endometriosis, plasma CA 125 concentrations are markedly elevated. Measurement of CA 125 in ovarian cyst fluid is the method of choice to differentiate a cystic corpus luteum from an ovarian endometriotic cyst, a frequent and difficult clinical problem. CA 125 can be used to diagnose deeply infiltrating endometriosis with a sensitivity of 36% and a specificity of 87%. These figures underestimate the clinical importance, since plasma CA 125 concentrations are mainly important for the diagnosis of deeply infiltrating endometriosis types II and III, which are the most severe forms and which are clinically easily missed. Because of the strong association of deep endometriosis and pelvic pain, the assay of CA 125 in plasma may be advocated in all women with unexplained pelvic pain as an aid in the diagnosis of deeply infiltrating endometriosis. Following surgical excision of endometriosis, CA 125 can be used to monitor the completeness of surgery.

Antigens, Tumor-Associated, Carbohydrate↗

PubMed1993

Angiogenic activity of peritoneal fluid from women with endometriosis.

OBJECTIVE: To investigate the presence of angiogenic factors in peritoneal fluid (PF) and follicular fluid (FF). DESIGN: The PF samples of 48 women with (n = 24) or without (n = 24) endometriosis were investigated. Angiogenesis was assayed using the chorioallantoic membrane of 11-day-old fertilized chicken embryos. Glass fiber prefilters impregnated with the fluids were placed on the chorioallantoic membrane. MAIN OUTCOME MEASURE: The vascular reaction was analyzed by an independent observer after 72 hours. RESULTS: There was a positive reaction in 58.3% of the PF from women with endometriosis and in 12.5% of the women without endometriosis. No correlation was found between the angiogenic response and the severity of endometriosis. The reaction remained after charcoal treatment of the PF. Positive reaction was found in three of six FF samples. CONCLUSION: The PF of women with endometriosis contain more angiogenic factors than PF from women without endometriosis. This angiogenic activity could be important for the further outgrowth and progression of the lesions.

Angiogenesis Inducing Agents↗

PubMed1993

The ovarian hyperstimulation syndrome in in-vitro fertilization: a Belgian multicentric study. II. Multiple discriminant analysis for risk prediction.

The considerable overlap of distributions of values for different parameters between control and ovarian hyperstimulation syndrome (OHSS) populations makes any single variable inefficient for risk prediction. Combinations of variables were studied in a discriminant function in order to increase predictivity and decrease the false negative rate. Such analyses were performed on two groups of in-vitro fertilization (IVF) patients: all OHSS cases (n = 128) (group A) and only severe OHSS cases (n = 92) (group B). Progressive introduction and automated stepwise selection of variables were applied to both groups. The best prediction (78.5%) was obtained in group A under post-oocyte retrieval conditions using log oestradiol, slope of log oestradiol increment, human menopausal gonadotrophin (HMG) dosage, number of oocytes retrieved and ratio of luteinizing hormone/follicle stimulating hormone (LH/FSH), in the formula. The corresponding false negative rate was 18.1%. However, effective prevention of OHSS implies the ability to withhold human chorionic gonadotrophin injection. Therefore a formula for pre-oocyte retrieval conditions was established yielding a prediction rate of 76.1% with a false negative rate of 18.1%. To be validated, such formulae have to be applied to another population of IVF cases used as a 'testing-set'.

Belgium↗

PubMed1993

Immunosuppressive activity of peritoneal fluid in women with endometriosis.

OBJECTIVE: To investigate the immunosuppressive effect of peritoneal fluid and follicular fluid on both natural killer-mediated cytotoxicity and phytohemagglutinin-induced lymphocyte proliferation. METHODS: The peritoneal fluid of women with endometriosis was compared to both fertile and infertile control fluids. Lymphocytes were pretreated for 2 or 20 hours with peritoneal or follicular fluids, and their cytotoxicity toward K562 tumor cells was measured. We also investigated the phytohemagglutinin-induced stimulation of lymphocytes cocultured with peritoneal or follicular fluid. RESULTS: Peritoneal fluid from women with endometriosis had a significantly greater immunosuppressive effect on natural killer-mediated cytotoxicity and on phytohemagglutinin stimulation of lymphocytes compared to peritoneal fluid of fertile women without endometriosis (P < .01 and P < .05, respectively). Using the peritoneal fluid of infertile women without endometriosis, these differences were significant only when compared to women with severe endometriosis. Inhibition of the natural killer activity increased when the incubation period was prolonged from 2 to 20 hours (P < .04). There was no correlation between the immunosuppressive effect of peritoneal fluid and the volume of peritoneal fluid, the day of the menstrual period, or estradiol, progesterone, prostaglandin E2, or prostaglandin F2 alpha levels. In peritoneal fluid, the factor responsible for inhibition of natural killer activity was not removed with charcoal treatment. In follicular fluid, on the other hand, the inhibition of natural killer activity decreased significantly after treatment with charcoal. CONCLUSION: Natural killer activity is suppressed by the peritoneal fluid of women with severe endometriosis; this may be important in the pathogenesis of endometriosis. The factor responsible for the inhibition of natural killer activity in peritoneal fluid is different from that in follicular fluid.

Ascitic Fluid↗

PubMed1992

The natural killer activity of peritoneal fluid lymphocytes is decreased in women with endometriosis.

OBJECTIVE: To investigate the local natural killer (NK) activity of the peritoneal fluid mononuclear cells (PFMC). DESIGN PATIENTS: In a prospective way, the NK activity (K562-assay) was measured in peripheral blood (PB) and peritoneal fluid (PF) of 44 women who underwent a laparoscopy for infertility and/or pain at the University Hospital of Gasthuisberg, Leuven, Belgium. MAIN OUTCOME MEASURE: The NK activity of peripheral blood mononuclear cells and PFMC, the number and concentration of PFMC, the percentage of lymphocytes versus macrophages by May-Grünwald-Giemsa staining and the estradiol and progesterone concentration of the PF were correlated together and with the severity of endometriosis. RESULTS: We demonstrated that there is a significant NK activity in PF and that this activity is decreased in women with endometriosis. This defect was more pronounced in the follicular phase of the cycle compared with the postovulatory phase. In PB of the same 44 women, the decreased NK activity correlated with the severity of the disease. This confirms our previous report on another 34 women. CONCLUSIONS: The NK activity is decreased in women with endometriosis and correlated significantly with the severity of the disease in both the PB and PF of women with endometriosis.

Ascitic Fluid↗

PubMed1992

CA 125 concentrations in ovarian 'chocolate' cyst fluid can differentiate an endometriotic cyst from a cystic corpus luteum.

In a prospective study, the concentrations of CA 125, 17 beta-oestradiol and progesterone were assayed in 52 consecutive ovarian cysts, laparoscopically suspected to be endometriomas. Cysts with dark brown 'chocolate' fluid (n = 42) were excised by CO2-laser endoscopy. Cysts with clear fluid were diagnosed by pathology as follicular cysts (n = 5) or pseudoperitoneal cysts (n = 5). Fluids (n = 53) aspirated during echo-guided puncture for in-vitro fertilization (IVF) were assayed simultaneously. Of the 42 women undergoing a cystectomy, the clinical diagnosis of an endometrioma was confirmed by pathology in only 68%, the other cases being corpora lutea (27%) or follicular cysts (5%). Cyst fluids from corpora lutea had lower CA 125 concentrations (< 1000 IU/ml) together with high 17 beta-oestradiol concentrations (> 2000 pg/ml) and/or high progesterone concentrations (> 100 ng/ml). Endometriotic cysts had either very high CA 125 concentrations (> 10,000 IU/ml) as occurred in 78% or lower CA 125 concentrations (< 1000 IU/ml) together with low 17 beta-oestradiol and/or progesterone concentrations. 'Chocolate' fluid-containing cysts aspirated during IVF had similar concentration profiles of CA 125, 17 beta-oestradiol and progesterone and the diagnoses derived from these concentrations were not contradicted in 19/27 women undergoing a laparoscopy within 4 months. In eight women, however, with high CA 125 concentrations in their cyst fluid, no endometriotic cysts were found at laparoscopy. Only 68% of cysts containing 'chocolate' material were endometriotic cysts and CA 125 could be useful in making this diagnosis. This method is recommended when dark brown fluid is aspirated in IVF.

Antigens, Tumor-Associated, Carbohydrate↗

PubMed1991

Evaluation of gas chromatographic columns for the determination of methylmercury in aqueous head space extracts from biological samples.

Several gas chromatographic columns were evaluated for the determination of methylmercury in aqueous solution. The goal of the study was to further decrease the detection limit of the recently developed method of head space gas chromatography with microwave-induced plasma detection (HS-GC-MIP) for the determination of methylmercury in biological samples. The columns were first evaluated using gas chromatography with electron-capture detection (ECD). At the same time, the column efficiencies for the determination of ethyl- and phenylmercury were also studied. Of the packed columns the stationary phase used previously in HS-GC-MIP, AT-1000, yielded the best results. Better results were obtained with two wide-bore thick-film fused-silica open tubular (FSOT) columns, one of which was suitable for aqueous injections (Superox-FA) and the other for benzene or toluene (RSL-300). With these FSOT columns, absolute detection limits at the sub-picogram level were reached. A new HS-GC-MIP system was then constructed, which was adapted for the use of FSOT columns. As more sensitive measurements were obtained with a Superox-FA FSOT column than with an AT-1000 packed column using the GC-ECD system in the first part of this study, the FSOT column was evaluated in this HS-GC-MIP system for the determination of methylmercury in real tissue samples. It was demonstrated that the use of an FSOT column gives only a small decrease in the detection limit compared with a packed column; reconditioning of the FSOT column is, however, a disadvantage in routine measurements.

Chromatography, Gas↗

PubMed1991

Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain.

In a 3-year prospective study of 643 consecutive laparoscopies for infertility, pelvic pain, or infertility and pain, the pelvic area, the depth of infiltration, and the volume of endometriotic lesions were evaluated. The incidence, area, and volume of subtle lesions decreased with age, whereas for typical lesions these parameters and the depth of infiltration increased with age. Deeply infiltrating endometriosis was strongly associated with pelvic pain, women with pain having larger and deeper lesions. Because deep endometriosis has little emphasis in the revised American Fertility Society classification and after analyzing the diagnoses made in each class, considerations for a simplifying revision with inclusion of deep lesions are suggested. In conclusion, suggestive evidence is presented to support the concept that endometriosis is a progressive disorder, and it is demonstrated that deep endometriosis is strongly associated with pelvic pain.

Aging↗

PubMed1991

Conservative laparoscopic treatment of ectopic pregnancies using the CO2-laser.

OBJECTIVE: To assess the feasibility of CO2-laser-endoscopic surgical treatment for large and/or ruptured ectopic pregnancies, and to compare the results with those of microsurgical salpingotomy. DESIGN: A retrospective review of all women treated for an ectopic pregnancy during a 6-year period, 1984-1989. During 1988 and 1989 treatment was randomized by the day of admission, depending only upon the surgeon in charge, some performing a linear salpingotomy (n = 42) and some a CO2-laser laparoscopy (n = 34) in all women haemodynamically stable. SETTING: Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven. SUBJECTS: 135 women with ectopic pregnancies of whom 76 were included in the randomized series between 1988 and 1989. Overall 11 were treated by pelvic lavage, 78 by laparotomy and 46 by laparoscopic procedures. MAIN OUTCOME MEASURES: Postoperative complications, duration of hospital stay. Cumulative pregnancy rates after the procedures. RESULTS: The two groups of women analysed in the randomized series were comparable for duration of amenorrhoea, diameter of the ectopic pregnancy and prevalence of 'ruptured' ectopics, but the duration of stay in hospital was much shorter (mean 2.9, SD 1.8 days) for the 34 women treated by laparoscopy than for the 42 women treated by laparotomy (mean 6.8, SD 1.6 days). The postoperative cumulative pregnancy rate was higher in nulliparous women with a history of infertility or pelvic inflammatory disease (PID), when treated with CO2-laser-laparoscopy (P = 0.009). The recurrency rate was low (less than 5% in both groups). Overall in the women treated by laparotomy, postoperative cumulative pregnancy rates were lower following excision or adnexectomy than after a microsurgical linear salpingotomy (P = 0.01). Four women treated by laparoscopy required a second procedure. CONCLUSION: Endoscopic treatment of large and/or ruptured ectopic pregnancies is feasible and resulted in a shorter hospital stay and, in nulliparous women with a history of PID or infertility, in higher cumulative pregnancy rates, than after microsurgical salpingotomies.

Endoscopy↗