Biomedical subjects
Publications and source records attributed to D H Barad.
A retrospective review of 4,532 outpatient laparoscopic procedures was conducted to determine the frequency of dense bowel adhesions at the level of the umbilicus. The umbilicus is the classical site of entry for the laparoscopic trocar. Using direct trocar insertion in all cases we encountered four bowel injuries. Bowel adhesion to the insertion site was noted in one case.
Infertility surgeons who once exclusively used microsurgical techniques are now turning more and more to endoscopy. Although there are still few reports comparing laparotomy and endoscopic surgery, many of the series reported on in the last year used life-table analysis, which facilitates comparison. Many of the reports in the last year examined the efficacy of infertility surgery in women over the age of 40. This trend is likely to continue as the reproductive population ages. In the future, assisted reproductive technologies will represent the greatest challenge to all pelvic reconstructive surgery.
Ultrarapid freezing (URF) employs a short one-step exposure of preembryos to cryoprotectant followed by immersion into liquid nitrogen. Higher concentrations of dimethyl sulfoxide (DMSO) have been associated with improved embryo survival. We compared two different concentrations (3.5 and 4.5 M) of DMSO for freezing of mouse preembryos. The postthaw survival for mouse preembryos was 88% (3.5 M DMSO) and 93% (4.5 M DMSO), respectively (ns). Blastocyst formation occurred in 88% of the surviving URF preembryos. We also used URF to freeze a small series of human preembryos. Four of the thirty-eight patients became pregnant following transfer of URF preembryos. Two were term pregnancies and two are ongoing. URF is simpler and less expensive than other methods and its use with human preembryos warrants further evaluation.
We performed 2976 first-trimester abortions at our outpatient center in 1986. In 16 cases (0.54%), products of conception could not be confirmed histologically, although history, bimanual pelvic examination, and urine pregnancy test were suggestive of pregnancy. In 1987-1988, we prospectively evaluated 6689 women presenting for first-trimester abortions. Adding sonography and a semiquantitative serum hCG test to our earlier protocol, we were able to date and locate accurately 6510 pregnancies (97.3%) at the first visit. The remaining 179 patients (2.7%) required only one follow-up visit for final evaluation. This protocol reduced the number of visits for accurate evaluation of pregnancy and eliminated the risk of unnecessary curettage and unplanned second-trimester abortions.
Although substance P has been demonstrated in the nonhuman ovary, it has not previously been identified in normal human ovarian tissue. We examined ovarian surgical specimens from 30 women for the presence of immunoreactive substance P. With the use of a specific radioimmunoassay, immunoreactive substance P was identified in these ovarian extracts. The geometric mean of the immunoreactive substance P concentration was 0.55 pg/mg wet weight (95% confidence limits 0.04 and 6.15). Thecal and stromal concentrations of immunoreactive substance P were greater than those in the corpora lutea and tunica albuginea. Large follicles had a lower concentration of immunoreactive substance P than did small follicles. We conclude that the neuropeptide substance P is present in some normal human ovaries and may be a modulator of ovarian function.
Diagnostic laparoscopy is commonly performed on patients as part of a complete infertility investigation. Recently published protocols have investigated the efficacy of using empiric ovulation induction, intrauterine insemination, or both before beginning in vitro fertilization. Because many patients enrolled in these protocols will be exposed to both ovulation induction and diagnostic laparoscopy, the authors reasoned that it would be more effective to begin ovulation induction at the time of the proposed diagnostic laparoscopy in order to allow gamete intrafallopian tube transfer (GIFT) at the same time. Twenty-five nulliparous patients underwent diagnostic GIFT. There were eight continuing pregnancies in this group (32%). Diagnostic GIFT is a more effective use of the opportunity provided by laparoscopy than diagnostic laparoscopy alone.
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