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Biomedical subjects

D R Bromham

Publications and source records attributed to D R Bromham.

At least 19 recordsLinked to original sources
PubMed1997

Long-acting hormonal contraception.

For 30 years, the combined oral contraceptive pill has been an almost automatic choice for effective contraception in sexually active adolescent women. Nevertheless, consideration of the criteria of a hypothetical "ideal" contraceptive suggests that long-acting progestogen-only methods may have considerable advantages for some adolescents. These would include greater efficacy, easier compliance, avoidance of estrogenic side effects, and potentially greater privacy. The disadvantages of menstrual irregularity, progestogenic side effects including weight gain, and the initial greater medicalization of the method, particularly implants, must be weighed against the wishes and preferences of the adolescent. A number of studies of the uptake and utilization of these methods in adolescence have arisen, particularly from the United States. These are reviewed together with experience from programs in the United Kingdom.

Adolescent↗
PubMed1995

Materials, methods and results of the Norplant training program.

Norplant subdermal implants for contraception were introduced into UK clinical practice in October 1993. Use of Norplant requires providers to learn additional skills. A training program designed to give providers to opportunity to obtain these skills was designed and implemented through the co-operation of Hoechst Roussel, JHPIEGO and members of the UK medical profession. Uptake of training for Norplant provision has been widespread and Norplant has been established as a realistic contraceptive choice for women in the UK. Introduction of Norplant in the UK has raised many issues that go beyond clinical considerations.

Contraception↗
PubMed1995

Surrogacy: ethical, legal, and social aspects.

In considering the interrelated ethical, legal and social aspects of surrogacy we acknowledge that society has long accepted the delegation of various parenteral functions and explore the role of a surrogate in relationship to this as well as alluding to commoner comparisons with prostitution and adultery. In particular, the "birth mother" rule, the public antipathy to "commercial" surrogacy and restrictive legislation are explored and found to be inappropriate. It is concluded that the regulation, surveillance and assessment needed to ensure the best outcome for all concerned would perhaps be easiest achieved in programmes that are formally licensed under permissive legislation and adequately funded by "commercial" means.

Bioethics↗
PubMed1995

Updating the clinical experience in endometriosis--the European perspective.

In a large, double-blind, multicentre study, 269 patients with confirmed endometriosis were randomly allocated to receive either danazol (200 mg twice daily; n = 137) or gestrinone (2.5 mg twice weekly; n = 132) for 6 months. The two groups were comparable in terms of the staging of endometriosis by the American Fertility Society (1979) score. After the sixth month of treatment, repeat laparoscopy was performed. Clinical assessment, haematological and biochemical investigations were carried out during the 6 months of treatment and for a further 12 months' follow-up and are compared between the two groups. A total of 15 patients from the gestrinone group, including four patients with hirsutism, and 17 patients from the danazol group, including six patients with headache, withdrew because of adverse symptoms. An additional 22 patients, including 10 from the gestrinone group and 12 from the danazol group withdrew because of lack of efficacy, pregnancy, elevated hepatic function tests or for reasons unrelated to the trial. Total American Fertility Society scoring showed an improvement of 73.3% in 101 patients receiving gestrinone and 72.7% in 99 patients receiving danazol. The results showed a significant reduction in the severity of dysmenorrhoea by the third month in the danazol group and at 6 months in both groups. There was a significant (P < 0.001) increase in weight observed in both groups during treatment. Overall, the tolerability of danazol and gestrinone was good; however, significantly more patients with gestrinone complained of hirsutism while significantly more with danazol complained of leg cramps. During the 12 months of follow-up, mild, moderate or severe degrees of lower abdominal pain, dysmenorrhoea and deep dyspareunia all fluctuated, with no statistically significant increase in frequency in either group.

Danazol↗
PubMed1995

[Prevention of sexually transmitted diseases and unwanted pregnancies in Great Britain].

The encouragement to use condoms meant by the late 1980's, this method of contraception had come to reveal the contraceptive pill as the leading method in the United Kingdom. This swing from a medicalized method to a very readily available, non-medicalized method was superimposed on a trend of shift in contraceptive provision by family planning clinics to provision by general family doctors. The rate of women attending community family planning centres declined, and among those attending these clinics, the rate of condom users increased. Simultaneously, in England and Wales (where statistics on abortions are done every year) the number of unwanted pregnancies increased, the acceleration being noticeable in the mid-1980s. Two studies show that these unwanted pregnancies are frequent in young women using condoms; those women are likely to abandon condom use after such experience. The pill-condom, "Double Dutch", should reduce the number of unwanted pregnancies.

Abortion, Legal↗
PubMed1993

Is spermatozoan acrosin a predictor of fertilization and embryo quality in the human?

OBJECTIVE: To investigate whether acrosin is a more reliable criterion than conventional parameters for assessing semen samples. DESIGN: Total acrosin was estimated biochemically in semen samples obtained for routine screening for infertility and for IVF-ET procedures. SETTING: Assisted Conception Unit, St. James's University Hospital, Leeds, United Kingdom. PATIENTS: Four hundred sixty-three couples being investigated for causes of infertility, and 132 couples undergoing IVF-ET for any indication except antisperm antibodies between 1990 and 1991 were included in the study. INTERVENTIONS: Semen samples were collected as part of routine investigation. Samples from men with consistently high viscosity were collected in alpha-chymotrypsin. MAIN OUTCOME MEASURES: Total spermatozoan acrosin in motile spermatozoa and motile spermatozoan density in couples being assessed for IVF-ET and fertilization and embryo quality in those receiving treatment are considered. RESULTS: Total acrosin levels were less variable (within subject) than either total or motile spermatozoan concentration at ejaculation. Although severely oligozoospermic ejaculates had the lowest levels of total acrosin, overall, there was no significant correlation of spermatozoan concentration between total acrosin levels and percentage fertilization. CONCLUSIONS: Total spermatozoan acrosin activity correlates positively with fertilization rates but not with spermatozoan count. Motile spermatozoan density for insemination may be adjusted to achieve > 7.5 microIU acrosin per oocyte, without compromising fertilization or further embryo development to blastocysts in vitro.

Acrosin↗
PubMed1993

Intrauterine contraceptive devices--a reappraisal.

The intrauterine contraceptive device (IUD) is a highly effective and safe form of reversible contraception. It does not cause pelvic inflammatory disease, ectopic pregnancy or infertility; it could be used by most nulligravidae; in its latest form it can be used to treat excessive menstrual loss, and it acts by preventing fertilisation not implantation. These statements contrast sharply with many of our long-standing prejudices about the method. New IUDs contribute to this change in perception. Nevertheless, patients selection, limiting use to mutually monogamous relationships, care with fitting and access to expert help with problems (including rare failure pregnancies and removal difficulties) are all required to maintain the acceptability and usefulness of this method.

Adolescent↗
PubMed1992

Peripheral plasma met-enkephalin levels in ovulatory and anovulatory human menstrual cycles.

OBJECTIVE: To test the hypothesis that met-enkephalin has a role in human ovulation and that plasma levels may differ between ovulatory and anovulatory ovarian cycles. DESIGN: This is a descriptive study comparing levels of plasma met-enkephalin, gonadotropins, and ovarian steroids in 12 ultrasonically confirmed ovulatory cycles and 12 anovulatory cycles. SETTING: The study took place in the infertility clinic of a large teaching hospital receiving primary and tertiary referrals of both private and public sector patients. PATIENTS: All patients (n = 16) had infertility greater than or equal to 3 years and normal findings on previous investigation including evidence of ovulation. INTERVENTIONS: Ovarian cycles were defined using transabdominal ultrasound scanning. Biochemical analyses were by radioimmunoassay. MAIN OUTCOME MEASURES: The differences between plasma met-enkephalin levels in the two groups of cycles were compared. RESULTS: Met-enkephalin levels are significantly higher in ovulatory cycles with a significant peak in the 2 postovulatory days (Duncan's multiple range test; P less than 0.05). CONCLUSION: Human ovulation is associated with cyclic elevation of plasma met-enkephalin. Further studies are required to elucidate causality.

Anovulation↗
PubMed1991

Autonomy and its limitations in artificial reproduction.

We have examined the concept of autonomy and some of its limitations. The choice between comprehensive and paternalistically modified information giving is not necessarily easy and the competence of a patient to comprehend and give informed consent in medically complex issues may be limited. In extreme cases, such as mentally defective persons, the consent-giver is unarguably incompetent to directly exercise autonomy and a substitute consent-giver or decision-maker is required. In most circumstances decision-making should be devolved to patients as much as possible, notwithstanding the faulty heuristics frequently displayed. This is not only because autonomy is an important principle in its own right but because an internally inconsistent decision is still likely to be closer to an individual's theoretical ideal decision than a decision based on a substitute decision-maker's values. We can see from the examples discussed that there are many instances where principles, guidelines, rules or laws propounded for the benefit of one party may restrain autonomy, beneficence and justice done to another. We would not wish to see anarchy occur in any branch of medicine but is there evidence that restricting the autonomy of the parties involved will necessarily prevent that? We argue that restraint on the autonomy of individuals in reproductive medicine should be kept to a minimum and that society is strongest where individuals have the greatest freedom to follow their personal beliefs.

Advisory Committees↗
PubMed1991

Effect of cervical traction with a tenaculum on the uterocervical angle.

The effect of cervical traction on the uterocervical angle was measured radiographically in 24 women undergoing diagnostic curettage. A radio-opaque guidewire was inserted through the cervical canal into the uterine cavity and a lateral pelvic X-ray taken before and after traction. The traction force was measured with a spring-balance attached to the tenaculum. Cervical traction in a caudal direction (force 2 N) reduced the median uterocervical angle, from 75 degrees to 10 degrees (P = 0.001). Moderate cervical traction straightens the uterus and the routine use of a tenaculum theoretically makes insertion of an intrauterine device safer and the passage of an embryo transfer catheter less traumatic.

Cervix Uteri↗