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Biomedical subjects

D R Tredway

Publications and source records attributed to D R Tredway.

At least 37 records · Page 2Linked to original sources
PubMed1979

Hypothalamic-pituitary responses to high concentrations of gonadal steroids in a three-month-old infant with a feminizing gonadal stromal tumor.

A 3-month-old female infant feminized by an ovarian stromal tumor is presented. Clinicopathologic aspects of such tumors occurring in infancy are discussed. In addition, the evaluation of hypothalamic-pituitary function preoperatively and postoperatively are presented. In the preoperative, high-steroid environment, both basal and stimulated secretion of follicle-stimulating hormone (FSH) was suppressed. Secretion of luteinizing hormone (LH) was normal. Following surgical castration, stimulated secretion of both gonadotropins clearly increased. These findings suggest an active but less sensitive negative feedback mechanism for FSH than for LH during infancy, i.e., high concentrations of gonadal steroids are necessary to maximally suppress FSH secretion while normal steroid concentrations appear to maximally suppress LH secretion. Developmental changes in hypothalamic-pituitary sensitivity to negative feedback controls are discussed in light of these findings.

Female↗
PubMed1979

A reassessment of the fractional postcoital test.

The present investigation was designed to reassess the fractional postcoital test (PCT). Specifically, the study addressed the question of whether the internal cervical mucus sperm count is significantly different from the sperm counts at other cervical levels. By means of standardized methodology, 25 normal postcoital tests were perfoemed on 22 couples. Cervical mucus from three different levels within the endocervical canal was examined for total count, motility, and sperm morphology. No significant difference could be found in these three parameters among any of the cervical levels (p greater than 0.05). Significantly fewer abnormal sperm were found in the cervical mucus when compared to the total abnormal forms in the semen (p less than 0.001). Therefore, while the fractional PCT is a reflection of cervical sperm, this study indicates that the three different cervical levels in the fractional PCT (internal-mid-external) are equally effective in the interpretation of the postcoital test.

Cell Count↗
PubMed1979

A reciprocal translocation (X;11) in a female with gonadal dysgenesis.

A 24-year-old female patient was referred for evaluation of primary amenorrhea. Endocrine studies showed elevated gonadotropins, consistent with gonadal failure. At laparoscopy, a normal nulligravid uterus, normal fallopian tubes, and bilateral streak gonads were observed. Histologic studies showed that the left gonad consisted entirely of fibrous tissue, confirming the presence of streak gonads. Chromosome banding studies of peripheral blood and cultures of tissue from the left gonad demonstrated a 46,X,rcp(X;11)(q22;q13) karyotype. A review of reports of X-autosome reciprocal translocations indicated that abnormal gonadal development is associated with break-points in the mid-region of the long arm of the X chromosome.

Adult↗
PubMed1978

Spontaneous pregnancy during the infertility evaluation.

Of 299 patients evaluated for infertility between July 1, 1974, and December 31, 1976, 21 (7.2%) became pregnant during the initial evaluation prior to any recognized therapy. A comparative analysis was made between these 21 couples and the 223 completely evaluated infertility couples. No significant difference in sexual, psychiatric, or menstrual history was found. There was a significantly increased incidence of low coital frequency in the pregnancy group (P less than 0.01). The mean duration of infertility was also significantly less (1.6 years versus 2.9 years) in the pregnancy group. It is concluded that the majority of patients who become pregnant during an evaluation for infertility do so because of prior low coital exposure. There was no evidence in this study to support the concept that psychophysiologic factors were altered in these 21 couples during the initial clinical visits.

Age Factors↗
PubMed1978

Continued clinical experience with an increasing dosage regimen of clomiphene citrate administration.

Between August 1, 1975, and July 31, 1977, 60 patients with infertility and ovulatory dysfunction were evaluated at the Naval Regional Medical Center, Oakland. Of these, 15 had incomplete work-ups or were lost to follow-up. Of the remaining 45 patients, 2 (4.5%) failed to ovulate at a maximal dose of 250 mg of clomiphene for 5 days with 10,000 units of human chorionic gonadotropin. Of the 43 (95.5%) who did ovulate, 33 conceived. Of these 33 patients, 9 (27%) required greater than 100 mg of clomiphene and/or longer than three ovulatory cycles to conceive. Of the 10 patients who did not become pregnant, additional infertility factors were present in 5. When these 5 were eliminated, the corrected pregnancy rate was 87% (33 of 38). The spontaneous abortion rate was 12.2% and there were no multiple gestations. These results would further emphasize that clomiphene can be used safely and effectively at doses greater than 100 mg or for longer than three ovulatory cycles.

Anovulation↗
PubMed1977

Effect of intramuscular triamcinolone acetonide on the human ovulatory cycle.

The effect of intramuscular triamcinolone acetonide (TCA-A) on pituitary gonadotropins and ovarian hormones was studied in a normally menstruating woman. Serum levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), as well estradiol 17-beta (E2) and progesterone (P), were determined daily in a normal "ovulatory" pretreatment cycle. A total of 160 mg of TCA-A was then administered in four injections over two and a half months. Daily serum levels of LH, FHS, E2, and P were again measured during a period beginning thirty days after the last injection of TCA-A. Cyclicity of all these hormones was absent after treatment. Both LH and FSH were suppressed in the first half of the post-treatment period when compared with the pretreatment ovulatory cycle. A potent corticosteroid such as TCA-A is apparently capable of producing anovulatory cycles in humans by disruption of cyclic pituitary gonadotropin secretion.

Estradiol↗
PubMed1977

Gonadotropin secretion and hypothyroidism.

Hypothyroidism is generally associated with hypogonadotropism. Occasionally, however, increased gonadotropin concentrations are encountered. The mechanisms, presumably hypothalamic, which determine the gonadotropin shift are unclear. A case report of hyperprolactinemic hypothyroidism with associated hypergonadotropism is presented. The previous literature is reviewed. It appears that hypothyroidism is generally associated with a decrease in the gonadogropin secretion. However, hypothyroidism with exxagerated hTSH secretin and hyperprolactinemia can be associated with increased gonadotropin secretion.

Adult↗
PubMed1976

Effect of clomiphene citrate upon amount and duration of human menopausal gonadotropin therapy.

Human menopausal gonadotropin (HMG) was given to 10 patients who failed to ovulate after treatment with clomiphene citrate. Prior to one or more treatment courses, 200 mg. of clomiphene were administered daily for 5 days; at least one other treatment course was not preceded by clomiphene. Before therapy, progesterone in oil was administered and serum FSH, LH, and estrogen were measured. Those patients who had normal serum FSH levels and had withdrawal bleeding following progesterone had a reduction in amount and duration of HMG requirements for those patients with low serum FSH who did not withdraw. Thus, sequential clomiphene-HMG therapy is of benefit only for those women with normal serum FSH levels and is the treatment of choice.

Adult↗
PubMed1976

The interpretation and significance of the fractional postcoital test.

The investigation was designed to objectively determine the clinical usefulness of the fractional postcoital test. Forty-three normal subjects had midcycle cervical mucus collection at various times after insemination. There was a significant correlation between the number of motile sperm at the internal os level and the total sperm count within the cervical mucus. The median internal os count was 15 motile sperm per high-power field with a lower 95% confidence limit of five motile sperm per high-power field. Therefore, the fractional postcoital test is useful clinically as it is a physiologic indication of sperm transport in cervical mucus.

Adult↗
PubMed1976

Improved glucose control in nonhospitalized pregnant diabetic patients.

Methods for management of diabetic pregnancy in the outpatient setting require strict glucose control. To assess the effect of diet and injection of short and intermediate acting insulin on glucose, diabetic patients tested their urine daily for glucose and had biweekly serum glucose tests. A brief metabolic ward study in 9 diabetic patients during the third trimester yielded hourly glucose determinations. These results defined the range of serum glucose over a 24-hour period. Glucose data on 6 normal third trimester women also came from hourly glucose values. Glucose results of normal and diabetic subjects were similar. A 16th subject with diabetic eye, renal, and foot complications is included as a case report to illustrate management technics. Infants of the diabetic women had no perinatal mortality, morbidity, or macrosomia and thus differ from an earlier study where glucose was not strictly controlled. The data suggest hospitalization can be short and low perinatal morbidity and mortality are possible with this outpatient method of management of the pregnant diabetic patient.

Birth Weight↗
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

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↗