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Biomedical subjects

Christian Fiala

Publications and source records attributed to Christian Fiala.

10 recordsLinked to original sources

Review of medical abortion using mifepristone in combination with a prostaglandin analogue.

Induced abortion is still a major health problem in the world and the most frequently performed intervention in obstetrics and gynecology with an estimated total of 46 million worldwide each year. Medical abortion with mifepristone and prostaglandin was first introduced in 1988 and is now approved in 31 countries. This combination of drugs has recently been included in the List of Essential Medicines by the World Health Organisation. The present review summarizes the development, physiology and the development of the currently used regimens.

Abortifacient Agents, Nonsteroidal↗

Acceptability of home-use of misoprostol in medical abortion.

INTRODUCTION: Home-use of misoprostol would reduce the number of visits and improve access to medical abortion. We evaluated acceptance of home-use of misoprostol among women and their partners. MATERIALS AND METHODS: One hundred women with up to 49 days of amenorrhea were given mifepristone, followed by misoprostol taken at home. RESULTS: Women chose home-use of misoprostol because it felt more natural, private and allowed the presence of a partner/friend. Two women had a vacuum aspiration due to incomplete abortion. Five unscheduled visits occurred. Ninety-six women were satisfied with their choice of home-use. The male partners were generally satisfied with their partner's choice of home-use and felt that their presence and support had been valuable. DISCUSSION: Our study shows a high acceptability among women and their partners and confirms the safety and efficacy of home-use of misoprostol. Women should be offered this choice to allow more flexibility and privacy in their abortions.

Abortifacient Agents, Nonsteroidal↗

A critique of the Montagnier evidence for the HIV/AIDS hypothesis.

In 1983 Luc Montagnier and his colleagues claimed to have discovered a novel retrovirus presently known as human immunodeficiency virus (HIV). By 1984 HIV was almost universally accepted to be the cause of AIDS. However, 20 years later, HIV cannot account for the phenomena for which the retroviral hypothesis was proposed, namely, Kaposi's sarcoma, decrease in T4 lymphocytes and thus the opportunistic infections in AIDS patients which were assumed to be the direct results of this decrease. Agents other than HIV to which patients belonging to the AIDS risk groups are exposed cause decrease in T4 cells. Neither have the main predictions of the HIV hypothesis been fulfilled. HIV seropositivity in the developed countries still remains restricted to the original high risk groups, no HIV vaccine exists, and no successful animal model has been developed. In this communication, we critically analyse the evidence which in 1983 was claimed to prove the existence of HIV. The phenomena which Montagnier and his colleagues considered proof for the existence of HIV are detection of reverse transcriptase activity; the presence of retrovirus-like particles in the culture; immunological reactivity between proteins from the culture supernatant which, in sucrose density gradients, banded at the density of 1.16 g/ml ("purified virus") and antibodies in a patient's (BRU) serum. Reverse transcriptase activity can be found in viruses other than retroviruses and in all normal cells. Reverse transcription can be brought about not only by the enzyme reverse transcriptase but also by normal, cellular DNA polymerases. Retrovirus-like particles are ubiquitous in cultures not infected with retroviruses, especially in conditions employed by Montagnier et al. From the reaction between proteins in the "purified virus" and antibodies in the patient serum Montagnier concluded that the proteins were HIV proteins and the antibodies were HIV antibodies. Since all antibodies are polyspecific, from such a reaction it is not possible to define the origin of even one reactant let alone both. Even if this were possible, since Montagnier's "purified virus" did not contain particles with the "morphology typical of retroviruses", the proteins cannot be retroviral. We conclude that, these phenomena are non-specific to retroviruses and thus cannot be considered proof for the existence of a unique retrovirus HIV.

Acquired Immunodeficiency Syndrome↗

Verifying the effectiveness of medical abortion; ultrasound versus hCG testing.

OBJECTIVES: The combination of mifepristone and misoprostol is an established method for termination of pregnancy. However, there is no general agreement about how best to evaluate the treatment outcome. STUDY DESIGN: In 217 women with an unwanted pregnancy below 49 days of amenorrhoea, ultrasound examination and serum hCG test were performed before treatment and at follow-up. RESULTS: Treatment was successful in 98.2%. At follow-up their hCG dropped to a mean of 3% (S.D. 3) of initial levels and the endometrium measured a mean of 10 mm (S.D. 4). Interpretation of endometrium was difficult in some cases because of inhomogeneous structure. Using hCG was reliable in 98.5% of successful abortions. For ultrasound the corresponding figure was 89.8% for the cases with a confirmed intrauterine pregnancy before treatment but only 66% if all pregnancies were included. CONCLUSION: Measuring serum hCG before treatment and at follow-up is more effective than ultrasound to confirm a successful medically induced abortion in early pregnancy.

Abortifacient Agents↗