Fetal nuchal translucency test for Down's syndrome.
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Down Syndrome↗
Biomedical subjects
D Lolis
Publications and source records attributed to D Lolis.
Vaginoscopic approach to outpatient hysteroscopy.
STUDY OBJECTIVE: To evaluate a new method of outpatient hysteroscopy. DESIGN: Prospective observational study. SETTING: Departments of Obstetrics and Gynecology, Medical School of Ioannina, Greece, and Brooklyn Hospital Center, Brooklyn, New York. PATIENTS: Three hundred twenty-four women, 316 of whom were symptomatic and 8 asymptomatic. INTERVENTIONS: Hysteroscopic vaginoscopy with directed endometrial biopsies. MEASUREMENTS AND MAIN RESULTS: The procedure was successful and well tolerated in 211 (65%) women. In 90 (27.9%) women, the procedure was successful but with significant pelvic pain, and in the remaining 23 (7.1%) it was complicated by either vagal reaction or complete intolerance. Hysteroscopic findings were in agreement with histopathologic results in 290 (89.5%) patients. In all 12 women with endometrial adenocarcinoma, hysteroscopic findings were identical with histopathologic results. CONCLUSION: The vaginoscopic approach is effective for outpatient hysteroscopy.
Adult↗
Feto-maternal bleeding following coelocentesis.
The potential risk of feto-maternal haemorrhage following coelocentesis was examined in 17 singleton pregnancies at 6-11 weeks of gestation by measuring maternal serum concentration of alpha fetoprotein (AFP) before and 1 and 10 min after the procedure. There was no significant difference between the maternal serum AFP concentration before coelocentesis (median 7.5, range 4.5-21.5 IU) compared to the values at 1 min (median 8.6, range 3.9-17.8; Z = -0.504, P = 0.614), and 10 min (median 7.5, range 5.7-20.6; Z = -0.432, P = 0.666) after the procedure. These findings demonstrate that coelocentesis is not associated with significant feto-maternal haemorrhage.
Female↗
Prenatal diagnosis of beta-thalassaemia by coelocentesis.
Coelomic fluid and placental tissue were obtained from four women undergoing termination of pregnancy at 7-9 weeks gestation for psychological reasons. All four women and their partners were known carriers of beta-thalassaemia and DNA analysis in their blood identified the mutation carried by each of them. Allelespecific polymerase chain reaction and denaturing gradient gel electrophoresis techniques were used to detect and identify the mutations in the DNA extracted from the coelomic cells and placental tissue. Three fetuses were found to be carriers of either the paternal or maternal mutation, while one was found to be affected by beta-thalassaemia. There was concordance in the results obtained from the chorionic villi and coelomic cells. Amplification of the apolipoprotein B gene variable number tandem repeats (VNTR), in the DNA of the coelomic cells showed normal sagregation of alleles in the fetuses, thus excluding maternal contamination. The results of this study demonstrate that coelocentesis may be a reliable alternative technique for the diagnosis of beta-thalassaemia from as early as 7 weeks gestation.
Alleles↗
Aplastic anemia. Report of a case with recurrent episodes in consecutive pregnancies.
BACKGROUND: Aplastic anemia complicating normal pregnancy is a rare event, associated with increased risks for both mother and fetus. CASE: A 30-year-old woman in her fifth pregnancy experienced the complications of aplastic anemia and preeclampsia. The patient had a history of four unsuccessful previous pregnancies also complicated by aplastic anemia, but she was free of the disease in the intervals between the pregnancies. During this last pregnancy she presented at 31 weeks' gestation with symptoms and signs of severe aplastic anemia and preeclampsia. A cesarean section was performed, and a normal infant was born. Supportive therapy, growth factors, prednisolone and intravenous immunoglobulin were administered, and the patient's general condition improved two weeks after delivery. CONCLUSION: Aplastic anemia may occur during consecutive pregnancies. The gestational age at the onset of the disease and the severity of the symptoms determine the outcome of the pregnancy.
Adult↗
Effect of follicle stimulating hormone or human chorionic gonadotrophin treatment on the production of gonadotrophin surge attenuating factor (GnSAF) during the luteal phase of the human menstrual cycle.
OBJECTIVE: Although there is much in-vivo evidence for the existence of a gonadotrophin surge attenuating factor (GnSAF), its source and identity remain unknown. We have studied the control of GnSAF production by FSH and hCG during the luteal phase of the cycle. DESIGN: Normally cycling women were investigated in three cycle. Starting on day 5 after the midcycle LH peak, the women received i.m. injections of placebo (1st cycle control), hCG at a dose of 750 IU per day (2nd cycle) and FSH at a dose of 225 IU per day (3rd cycle) for five consecutive days. The response of LH to a single i.v. dose of 10 microg GnRH (GnSAF bioactivity) was investigated several times during the experimental period. PATIENTS: Six normally ovulating women with long-standing unexplained infertility were studied. The women were used as their own controls during the cycle treated with placebo. MEASUREMENTS: Pituitary response to GnRH was calculated as the net increase in LH at 30 minutes (deltaLH) above the basal value. RESULTS: Serum concentrations of FSH and hCG increased significantly during the second and 3rd cycles respectively. Compared with the control cycles, deltaLH was significantly attenuated as early as 12 hours from the onset of FSH injections. In contrast, basal concentrations of oestradiol (E2) and immunoreactive inhibin started to increase 48 hours after the first injection of FSH, while progesterone values remained similar to those in the controls. During treatment with hCG, no attenuation was seen in deltaLH values, while those of E2, progesterone and inhibin showed a significant increase. CONCLUSIONS: These results demonstrate that during the luteal phase of the human menstrual cycle, FSH, but not LH, stimulates the production of gonadotrophin surge attenuating factor. It is suggested that the source of gonadotrophin surge attenuating factor at that stage of the cycle is a cohort of small follicles rather than the corpus luteum.
Adult↗
Chromomycin A3-staining as an indicator of protamine deficiency and fertilization.
Mature mammalian spermatozoa have a compact and stable nuclear structure conferred by protamines instead of histones, which are present in all other cellular types. Chromomycin A3 (CMA3) is a useful tool for the detection of protamine deficiency in sperm chromatin. The purpose of this study was to correlate the percentage of spermatozoa staining positively for CMA3 with sperm parameters and in-vitro fertilization of human oocytes. Spermatozoa were collected from 56 fertile and 18 infertile men, and washed twice in PBS, fixed in two changes of methanol : acetic acid (3 : 1 v : v) spread on rinsed slides treated with APES and dried. Twenty-four of the semen samples were subjected to both Percoll and swim-up, and were stained subsequently with CMA3. CMA3-stained spermatozoa were expressed as a percentage in a count of 200 spermatozoa. A substantial variation in the percentage of CMA3-stained cells was observed in ejaculated human spermatozoa, varying between 8% and 77%. A strong negative correlation (r = -0.64, p < 0.001) was found between sperm count and the percentage of CMA3-stained spermatozoa. No correlation was found between CMA3-stained spermatozoa and their motility, while excessive sperm morphological abnormalities were related positively to CMA3-staining. Spermatozoa in samples exhibiting low (8-62%) CMA3-staining had significantly higher fertilizing rates in vitro than did samples exhibiting high (49-77%) CMA3-staining. The mean percentage of CMA3-stained spermatozoa after swim-up or Percoll preparation (26% vs 31%) did not differ significantly. These results demonstrate a close relationship between CMA3-staining, fertilization and sperm count, and suggest potential application of this marker for the prediction of sperm quality and fertilizing capacity.
Chromomycin A3↗
Preliminary results with administration of recombinant human erythropoietin in sickle cell/beta-thalassemia patients during pregnancy.
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Adolescent↗
Changes in pituitary response to gonadotropin-releasing hormone following bilateral ovariectomy in women treated with follicle-stimulating hormone.
Superovulation- induction in women attenuates the pituitary response to gonadotropin-releasing hormone (GnRH). The aim of this study was to assess the duration of the suppressing activity of the ovaries on the pituitary. Eighteen normally ovulating women received treatment with follicle-stimulating hormone (FSH, 225 IU/day) on cycle days 2, 3 and 4. On cycle day 4, six women underwent hysterectomy plus bilateral ovariectomy (group A), another six women underwent hysterectomy without ovariectomy (group B) and the remaining six women underwent no operation (group C). The women of group C were also investigated during a preceding untreated spontaneous cycle (group D). The response of luteinizing hormone (LH) to an intravenous injection of 10 micrograms GnRH was investigated on cycle days 2, 3, 4 (2 and 12 h after clamping of the infundibulopelvic and/or round ligaments), 5, 6 and 7 in all four groups. The response of LH to GnRH at 30 min (delta LH) was significantly attenuated as early as 12 h from the onset of FSH treatment (groups A, B and C), while estradiol and inhibin concentrations started to increase later (group C). In group C (no operation), the attenuation of delta LH values continued throughout the study period, while in groups A and B the initial attenuation was followed by a marked increase in delta LH values within 2 h from the operation. The increase in group A was twice the value in group B. Following this, delta LH values in group B were attenuated again within the next 24 h, while in group A they remained for the rest of the postoperative period significantly higher than in group B. In conclusion, it was found that the factor that mediates the suppressing effect of superovulated ovaries on the pituitary has a short-lasting (< 2 h) attenuating activity in the circulation.
Adult↗
Successful conservative treatment of catamenial pneumothorax with GnRH agonist.
A thirty four year old woman with recurrent catamenial pneumothorax is described. Pleural endometriosis was suspected and cytologic examination of fluid drained from the right pleural cavity showed glandular cell clusters of probable endometrial origin. The patient received a long-acting GnRH agonist (Triptorelin-Arvekap-Ipsen) 3.75 mg/month I.M. for nine months and remains asymptomatic with regular periods 12 months after discontinuing the treatment.
Adult↗
High HbF in pregnancy is associated with the Xmn I polymorphism at the -158bp of the G gamma-globin gene.
HbF was measured in the peripheral blood of 354 women during the first trimester of pregnancy. In those (n = 6) with HbF > 3% and in 30 randomly selected pregnant women with normal HbF values, analysis of the G gamma content and the Xmn I polymorphism was performed. The frequency of the Xmn I polymorphism was significantly higher (P < 0.001) in the group with high HbF (0.67) compared to the control group (0.10). The G gamma chain content evaluation revealed a newborn ratio in all 6 high HbF subjects. Six months after delivery, HbF was measured in all women with high HbF during pregnancy, revealing normal values. These results suggest that the presence of the Xmn I polymorphism is a strong inducer for the elevation of HbF during pregnancy.
Deoxyribonucleases, Type II Site-Specific↗
Amniotic fluid prealbumin as a potential marker of fetal abnormalities.
Normal amniotic fluid prealbumin (PAB) levels between 16 and 41 weeks of pregnancy are demonstrated in 175 samples from various gestational ages. PAB was measured quantitatively by immunonephelometry and qualitatively estimated by electrophoresis while total protein content was measured by colorimetry. The percent of PAB values in the total protein content is inversely correlated to the gestational age. Fetal abnormalities and abnormal conditions in pregnancy diagnosed in the second trimester and early third trimester (16-32 weeks) show significantly (p < 0.01) higher than expected PAB values (25.9 +/- 4.6 mg/l, range 19.5-35.6, n = 23) in comparison to normal fetuses and normal pregnancies of the same age (13.6 +/- 3.6 mg/l, range 4.3-19.8, n = 87). The remaining 65 samples of normal third trimester amniotic fluid were evaluated in comparison to the second trimester normal values, and inverse correlation in respect to advancing pregnancy was observed. PAB values were corrected for the total protein content and the resulting ratio had the lowest variation compared to PAB and total protein values. It is proposed that PAB, although not specific for a particular disorder, expressed as a ratio of the total protein content is a potential biochemical marker for certain fetal defects and complications of pregnancy.
Amniotic Fluid↗
Gamma-chain heterogeneity in Greek (delta beta)zero-thalassemia.
A molecular and biochemical population study of (delta beta)zero thalassemia in central Greece is described. The molecular study was focused on the type of the deletion and the status of G gamma-XmnI polymorphism, whereas the biochemical approach was centered on the G gamma/A gamma ratio as well as the frequency of the A gamma T chain in the fetal hemoglobin of 19 delta beta-thalassemia heterozygotes and 3 homozygotes. This study includes individuals from the mountainous district of Epirus (northwestern Greece) where the trait was found to be concentrated along the river Arachthos. The Sicilian (delta beta)zero thalassemia deletion was found in all subjects tested by direct PCR. The levels for the G gamma-chain presented values ranging from 29 to 83% of the total gamma-chain content. Thirteen heterozygotes had the adult G gamma/A gamma ratio (mean G gamma: 35% +/- 10) of whom 10 were XmnI-negative (- / -), 6 had the newborn ratio (mean G gamma: 70% +/- 9) and were XmnI-positive, while homozygotes had equal amounts of G gamma and A gamma. Five of the 19 heterozygotes were A gamma T-positive with low levels of this A gamma-chain variant, suggesting an in-trans to the delta beta-thalassemia determinant production.
Adolescent↗
Seckel syndrome in a family with three affected children and hematological manifestations associated with chromosome instability.
In the present communication we report on a family with three children affected by Seckel-syndrome with mental deficiency, microcephaly, micrognathia and severe growth deficiency. All patients had chromosome instability, which was employed for the prenatal diagnosis of a fourth fetus suspected as a potential Seckel syndrome patient, and one of them had additional hematological disorders. As this condition has been previously characterized as a Seckel syndrome subgroup we report our data concerning this distinct entity.
Abnormalities, Multiple↗
[Iatrogenic injuries to the distal ureter during gynecologic interventions].
Surgical injury to the ureter is an important problem that confronts the urologist, the gynecologist and the general surgeon. The authors report 20 cases of iatrogenic pelvic ureteral injuries (22 ureters) observed after gynecological surgery between January 1985 and January 1995. The ureter was injured during ligation of the lumbo-ovarian vascular pedicle because it was inadequately protected during the operation. Open surgery and double pigtail stent insertion using retrograde route were used for treatment. The iatrogenic ureteral injury was in 18 patients unilateral and in the remaining 2 patients both ureters were damaged. As regards treatment, the authors recommend immediate repair, whenever the lesion is noticed at operation. In the post-operative period, ureteral stent or double pigtail stent insertion using balloon dilatation or ureteroscope, may be a successful conservative treatment. If the damage is only diagnosed subsequently, they recommend a ureterovesical implantation, using the psoas hitch bladder procedure or the Boari-Cassati-Küss procedure if the lesion is in the lower ureter or a transuretero-ureterostomy if it is in the upper ureter.
Adult↗
Incomplete excision of CIN in conization: further excision or conservative management?
The aim of this study was to investigate the experience of the further management in 112 cases with histological diagnosis of incomplete excision of CIN in cone biopsy. Two groups of women were studied. The women in the first group (n = 78) had a second excision while the women in the second group (n = 34) underwent conservative management with cytology and colposcopy. The histologic, cytologic and colposcopic findings in the women of both groups were compared. From the first group 38% had a second cone, 62% an hysterectomy; in 5 cases the second cone was followed by hysterectomy and the histology was negative in 75% and 65%, respectively. No indication of residual disease was found within 2-10 years of follow-up in any of the women in the second group. According to our study and being aware of the natural history of CIN, we can conclude that the decision for further excision should not be based exclusively on the histology report of involved margins, but should only be taken after careful cytological and colposcopic selection of the cases.
Adult↗
Effect of follicle stimulating hormone treatment on the pituitary response to luteinizing hormone-releasing hormone in post-menopausal women.
To study the role of exogenous follicle stimulating hormone (FSH) in the attenuation of luteinizing hormone (LH) response to luteinizing hormone-releasing hormone (LHRH) during ovulation induction in women, 10 healthy post-menopausal women were treated with FSH (225 IU/day) for 5 days and normal saline (2 ml/day) for another 5 days. The two regimens were given consecutively in a 10 day experiment. The regimen for the first 5 days was randomly chosen and was given to the women in an alternate way. The response of LH to an i.v. injection of 10 micrograms LHRH was investigated twice on day 1 (i.e. before the onset of treatment and 12 h later) and once on days 2, 5 and 10 of the experiment (0900 h). Basal FSH and LH values before the onset of treatment on day 1 were similar in the five women who started with the saline and the five who started with the FSH regimen. Basal FSH values increased significantly during treatment with FSH, while LH and oestradiol values remained unchanged throughout the whole experiment. LH increment 30 min post-LHRH did not change significantly either during the first 24 h or during the whole experiment regardless of the starting regimen. These results demonstrate that in post-menopausal women the response of LH to LHRH is not affected by exogenous administration of FSH. It is suggested that exogenous FSH does not show activities on gonadotrophin secretion similar to those ascribed to a gonadotrophin surge attenuating factor.
Female↗
Modulation of the action of gonadotrophin surge-attenuating factor by gonadotrophin-releasing hormone.
Gonadotrophin surge-attenuating factor (GnSAF) is a putative non-steroidal ovarian factor which attenuates the luteinizing hormone (LH) surge in superovulated women through the reduction of the pituitary response to gonadotrophin-releasing hormone (GnRH). The mechanism of action of GnSAF on gonadotrophin secretion was further studied by investigating six normally ovulating women in two cycles--a spontaneous and a follicle-stimulating hormone (FSH)-treated cycle. The response of the pituitary to five consecutive pulses of GnRH was investigated in late follicular phase (follicle size 15 mm) of both cycles. GnRH pulses, 10 micrograms each, were injected i.v. every 2 h and LH was measured in blood samples taken before and 30, 60 and 120 min after each pulse. FSH was injected daily at the fixed dose of 225 IU starting on cycle day 2. Peak values of LH increment occurred 30 min after each pulse. However, maximal LH increment occurred in both cycles after the second GnRH dose. In the FSH cycles the response of LH to the first three pulses was significantly attenuated compared with the spontaneous cycles, while the response to the fourth and fifth pulses was similar in the two cycles. In both cycles, LH increment 30 min post GnRH (net increase above the previous value) was similar after the fourth and fifth pulses. Serum concentrations of oestradiol and immunoreactive inhibin, although higher in the FSH cycles, remained stable throughout the GnRH experimental period in both cycles. These results demonstrate that multiple submaximal doses of GnRH can override the attenuating effect of GnSAF on LH secretion.(ABSTRACT TRUNCATED AT 250 WORDS)
Estradiol↗