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Biomedical subjects

D R Mishell

Publications and source records attributed to D R Mishell.

At least 235 records · Page 13Linked to original sources
PubMed1976

Male pseudohermaphroditism consistent with 17,20-desmolase deficiency.

A 16-year-old phenotypic female with XY genotype presented an unusual form of nonfamilial male pseudohermaphroditism. Seemingly a normal girl during childhood, the patient failed to undergo pubertal changes presenting with scant pubic hair, absent axillary hair, lack of breast development, retarded bone age and primary amenorrhea. Neither uterus nor adnexa were palpable above the blind-ending vagina. Serum testosterone and estradiol were barely detectable by radioimmunoassay, while LH and FSH reached castrate levels. Two small testes were removed from the pelvic sidewalls which, on biopsy, showed atrophy and hyalinization of seminiferous tubules, but clusters of Leydig cells without signs of hypertrophy or hyperplasia. Administration of testosterone resulted in urinary nitrogen retention and a decrease in serum LH and FSH. Radioimmunoassay of various serum or plasma steroids and gas chromatographic determination of urinary steroids prior to and following ACTH stimulation yielded results which permitted to rule out 20,22-desmolase, 3beta-hydroxysteroid dehydrogenase, 17-hydroxylase and 17beta-hydroxysteroid dehydrogenase deficiency. Low plasma dehydroepiandrosterone sulfate (DHEA-S) and androstenedione (delta4 A) concentrations, low urinary 17-ketosteroid and particularly low dehydroepiandrosterone (DHEA) excretion and the minimal rise of plasma DHEA-S and delta4 A and of urinary DHEA in response to ACTH in conjunction with a normal response of other serum and urinary C-21 steroids are consistent with 17,20-desmolase deficiency. Direct confirmation of this defect, however, seems impossible in the absence of in vitro studies of testicular steroidogenesis.

17-Ketosteroids↗
PubMed1976

Pelvic tuberculosis.

Pelvic tuberculosis (TBC) was diagnosed in 20 patients studied during the years 1971 to 1975. Fourteen patients were born outside the United States. The most frequent presenting complaints were infertility (14 patients), pelvic pain (6), and amenorrhea (4). Only 5 patients gave a history of previous treatment for TBC. Results of pelvic examination were normal in 11 patients; results of chest X-rays were normal in 15. Sixteen patients had endometrial biopsies, 10 of which showed granulomatous endometritis. Fifteen patients had hysterosalpingograms, all of which yielded abnormal results, and 14 were indicative of TBC. Cultures were positive for Mycobacterium tuberculosis in 6 of 16 patients. Genital TBC should be considered as a possible cause of infertility, especially in foreign-born patients. Although a conclusive diagnosis can be made only from a positive culture or histologic specimen, hysterosalpingography is a very useful aid in establishing the diagnosis.

Adolescent↗
PubMed1976

Colpotomy drainage of pelvic abscess.

Sixty-five patients who had a pelvic abscess drained by colpotomy or rectal incision were studied. The minority of the patients (28) developed the abscess after a hospital-acquired infection (Group I) while the other 37 patients developed the abscess after a community-acquired infection (Group II). Except for those patients who developed an abscess after hysterectomy, about one-third of the patients in both groups required a subsequent major operative procedure because of residual infection or symptoms. Of the 40 patients in whom there was a possibility of conceiving following the drainage procedure, 4 (10%) conceived at a later date.

Abscess↗
PubMed1975

Effect of intrauterine devices on sperm transport in the human being: preliminary report.

This investigation was designed to determine the effect of the intrauterine contraceptive device (IUD) on the early phase of sperm transport. Previously we have shown that in normal midcyle subjects the maximal number of sperm recovered from the oviducts occurred between ten and 45 minutes after vaginal insemination. Four normal subjects, three of whom had IUD's in situ for at least eight months (copper T, Dalkon shield, and loop) and one a loop for one month, were studied in a similar manner. All subjects were inseminated at midcycle and had bilateral abdominal salpingectomies 15 to 30 minutes after insemination. No sperm were present in the oviducts of any of the subjects. The results of this study indicate that the IUD interferes with sperm transport in the human being. Additional subjects are now being studied at different time intervals after insemination in order to determine the entire effect of the IUD upon sperm transport.

Adult↗
PubMed1975

Serum prolactin patterns in early human gestation.

The relation between levels of human prolactin (HPRL), other protein hromones, and estradiol in serum immediately prior to and for the first weeks after conception was determined. HPRL was measured by radioimmunoassay in serum samples obtained daily from these women during the menstrual cycle in which conception took place and for several weeks therafter. It was found that the concentration of HPRL initally increased above nonpregnant levels 32 to 36 days after the luteinizing hormone (LH) peak. The patterns of estradiol and HPRL were similar in early gestation, while there was no similarity between the patterns of HPRL and human placental lactogen. These results are in aggreement with other studies showing that high levels of estrogen influence HPRL secretion in the human subject.

Adult↗
PubMed1975

Log normal distribution of gonadotropins and ovarian steroid values in the normal menstrual cycle.

In the statistical analysis of the values of luteinizing hormone, follicle-stimulating hormone, estradiol, and progesterone obtained from normal menstrual cycles, a depature from normality was noted. Chi square, W test, and linear transformation were used to check the normality of the distributions. The results of this investigation showed that the distributions were not normal (Gaussian) but log-normal. By plotting the probit of the percentages of cumulative frequency on a log scale (probit-log), linearity of the data was obtained. This resulted in direct graphical estimations of values with a useful clinical range, which included the mean and the 95 per cent confidence interval.

Adult↗
PubMed1975

Clinical categorization of patients with secondary amenorrhea using progesterone-induced uterine bleeding and measurement of serum gonadotropin levels.

A group of ninety unselected women with secondary amenorrhea of at least six months' duration were studied retrospectively. By the use of intramuscular progesterone in oil, it was possible to categorize these patients according to their positive or negative uterine bleeding response. LH, FSH, and estradiol values in the 63 patients of the positive category had a log-normal distribution. LH values were found to be composed of two different populations; FSH and estradiol values were composed of only one population. Based on these LH determinations the entire positive category was then divided into two groups. Patients with high levels of LH (Group I) were clinically diagnosed to have polycystic ovarian disease. Patients with normal levels of LH (Group II) were diagnosed to have hypothalamic-pituitary dysfunction. The 27 patients who failed to have withdrawal uterine bleeding were placed in the negative category. These patients also were shown to have a log-normal distribution for LH, FSH, and estradiol. In contrast to the patients in the positive category, FSH values in these patients were made up of two different populations whereas LH and estradiol values showed only one population. Based on the FSH values these patients were divided into two groups, one with low and normal levels of FSH (Group III) and the second population with high levels of FSH designated as Group IV. Group III represented those patients with hypothalamic-pituitary failure and patients in Group IV were those with ovarian failure. Serial determinations of LH, FSH, and estradiol done prospectively on five consecutive days in 19 of the 90 patients did not give any further information in differentiating among the four groups.

Adult↗
PubMed1975

Clinical study of a progesterone-releasing intrauterine contraceptive device.

A double-blind clinical study was performed to determine whether the release of progesterone from an intrauterine contraceptive device (IUD) had any effect on IUD event rates. A total of 101 women received intrauterine contraceptive devices containing progesterone, resulting in the accumulation of 877 women-months experience; 100 women received IUD's without steroid, resulting in the accumulation of 780 women-months. The only significant difference was a higher incidence of pregnancy in those patients using devices which did not contain progesterone.

Adult↗
PubMed1975

Serum androstenedione levels during normal and human menopausal gonadotropin-induced human pregnancies.

17-Hydroxyprogesterone (17-OHP) and androstenedione (A) were measured frequently during the first trimester of five human pregnancies. Two were normally conceived and three were HMG induced. Of the HMG induced, two showed signs of hyperstimulation and one did not. 17-OHP and A patterns were very similar in the HMG-induced pregnancies from about days 25 to 60, after which the 17-OHP levels continued to drop. The A remained fairly constant after that time. In the normally conceived pregnancies the 17-OHP showed its characteristic rise and fall from about days 25 to 60, but A remained relatively constant throughout this period of time. The pattern of A in normal pregnancies is in marked contrast to that observed in HMG-induced pregnancies. Results from HMG-induced pregnancied may not, therefore, be always applicable to normal ones.

Androstenedione↗
PubMed1975

Significance of timing for the postcoital evaluation of cervical mucus.

This investigation was designed to determine the role of cervical mucus in the dynamic in vivo distirbution of transported spermatozia in the human reproductive tract. Forty-two normal subjects had midcycle cervical mucus collection at various times after insemination. Sperm were identified in the cervical mucus at the level of the internal as shortly after insemination. The numbers of sperm in cervical mucus were directly related to the numbers of sperm in the inseminate and were related to time from insemenation. In order to obtain optimal information, the postcoital examination for the presence of sperm should be performed within two and one-half hours after semen exposure. It was also determined that cervical mucus does serve as a reservoir for those sperm which are transported to the Fallopian tubes.

Adult↗