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Biomedical subjects

D Tulchinsky

Publications and source records attributed to D Tulchinsky.

At least 73 records · Page 4Linked to original sources
PubMed1977

Amniotic fluid testosterone and follicle-stimulating hormone in the determination of fetal sex.

To determine whether hormone analysis could be used for accurate determination of fetal sex, we measured testosterone (T) and follicle-stimulating hormone (FSH) in 130 amniotic fluid samples at midgestation. The mean unconjugated T in amniotic fluid of 73 patients carrying male fetuses was 202 pg. per milliliter (95 per cent confidence limits [CL]: 70 to 580) and all but three had levels higher than 90 pg. per milliliter. The mean amniotic fluid unconjugated T for 49 patients carrying female fetuses of 41 pg. per milliliter (95 per cent CL: 11 TO 125) was fivefold lower than that for the male fetuses and all but three patients carrying female fetuses had amniotic fluid T levels of 90 pg. per milliliter or lower. The mean amniotic fluid FSH of 0.7 ml. U. per milliliter (95 per cent CL: less than 0.5 to 3.4) for subjects with male fetuses was tenfold lower than that for patients with female fetuses. Amniotic fluid FSH levels less than 2.0 ml. U. per milliliter were found in 88 per cent of patients carrying male fetuses and in only one patient with a female fetus, and levels greater than 10 ml. U. per milliliter were found in those with female fetuses only. In eight patients (7 per cent of cases), neither amniotic fluid T nor FSH determinations were indicative of fetal sex. Measurement of unconjugated T and FSH in amniotic fluid may be an adjunct to other methods of determining fetal sex.

Amniotic Fluid↗
PubMed1977

Dexamethasone levels in treated pregnant women and newborn infants.

Dexamethasone concentration was measured in plasma and amniotic fluid by radioimmunoassay using a rabbit antiserum raised against DX-hemisuccinate-albumin. Recoveries of added tracers averaged 70% after paper chromatography. The within- and between-assay coefficients of variation averaged 10%. The lower limit of detection was 0.2 mug/dl when 0.4 ml of plasma was assayed. Ten healthy pregnant women at term had cesarean sections 8 to 11 hours following administration of 8 mg of DX orally. DX levels in maternal vein, in umbilical vein and artery, and in amniotic fluid averaged 2.2, 2.9, 2.6, and 2.5 mug/dl, respectively. Although cortisol levels were markedly suppressed, the total relative glucocorticoid activity in blood of fetuses treated with DX far exceeded that of the untreated group.

Amniotic Fluid↗
PubMed1977

Serum 17 alpha-hydroxyprogesterone in patients with gestational trophoblastic neoplasms.

Serum 17alpha-hydroxprogesterone (17-OHP), progesterone (P), and human chorionic gonadotropin (hCG) levels were measured by specific radioimmunoassay in 19 patients undergoing laparoscopy or laparotomy with either unevacuated molar pregnancy or nonmetastatic gestational trophoblastic neoplasms (GTN), in 10 normal pregnant patients at equivalent gestational age (7-21 weeks), and in 4 patients with metastaic GTN following hysterectomy and bilateral salpingo-oophorectomy. All patients with theca lutein cysts had significantly elevated serum 17-OHP levels compared to those in 1) normal pregnancy, 2) patients with GTN and normal-size ovaries, 3) patients with metastatic GTN in the absence of ovaries (P less than 0.02). Levels of serum 17-OHP but not P correlated with the degree of ovarian enlargement (r = 0.87, P less than 0.05). Serum P concentrations in patients with theca lutein cysts, although higher than the levels in cases of GTN with normal-size ovaries, were not significantly different from the levels in normal pregnancy (P greater than 0.05). Serum hCG levels in patients with theca lutein cysts, though higher than the normal pregnancy levels (P less than 0.05), were not significantly different from those in cases of GTN with normal-size ovaries and GTN without ovaries (P greater than 0.05). Under the conditions studied, no correlation was observed between serum hCG and P levels in our cases of GTN. Increased serum 17-OHP level in a patient with GTN suggests the presence of theca lutein cysts.

Castration↗
PubMed1977

Vaginal absorption of estrone and 17beta-estradiol.

In order to study estrogen absorption from the vagina, 0.5 mg of unconjugated estrone (E1) or 17beta-estradiol (E2) was administered vaginally to 10 postmenopausal patients. A 29-fold increase in plasma E2 and a 4-fold increase in plasma E1 concentrations were observed 1 hour following the vaginal deposition of 0.5 mg of E2. Maximal decreases of 25% and 37% in plasma levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), respectively, were observed at 5 hours following treatment. One hour after vaginal administration of 0.5 mg of E1, a 24-fold increase in plasma E1 and a 3.7-fold increase in E2 were observed. These increases were associated with a 30% decrease in plasma FSH and LH. These data indicate that the vaginal administration of E2 or E1 may be used to achieve physiologic blood levels of these estrogens. They further suggest that vaginal estrogens not be used in patients in whom systemic estrogen therapy is contraindicated.

Aged↗
PubMed1976

[Hemorrhoids].

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Hemorrhoids↗
PubMed1976

Dehydroepiandrosterone sulfate loading test in the diagnosis of complicated pregnancies.

To assess placental and fetoplacental function, 50 mg of dehydroepiandrosterone sulfate was administered intravenously to 11 normal obstetric patients at 35 to 40 weeks and to 36 high-risk patients at 35 to 43 weeks of pregnancy. Plasma estradiol converted from dehydroepiandrosterone sulfate by the placenta increased in all patients after infusion, with maximal concentrations of 28 to 65 ng per milliliter 30 to 60 minutes after infusion (P less than 0.01). Plasma estetrol, produced by the fetus from estradiol, increased in all patients with maximal concentrations of 0.8 to 3.2 ng per milliliter four hours after infusion (P less than 0.01). In complicated pregnancies a subnormal rise of estradiol and estetrol was highly suggestive of fetal distress whereas a normal rise was associated with no fetal distress. The simultaneous determination of estradiol and estetrol after dehydroepiandrosterone sulfate infusion may reflect placental and fetoplacental function, and may be used as an adjunct to other methods of assessing fetal well-being.

Birth Weight↗
PubMed1976

Amniotic fluid cortisol after premature rupture of membranes.

Total amniotic fluid cortisol concentration was studied in 12 patients at 24 to 34 weeks of gestation after premature rupture of membranes of one to eight days duration. Rupture of the membranes of less than 24 hours duration was associated with normal amniotic fluid cortisol concentrations. Rupture of membranes for more than 24 hours was associated in 10 of 12 patients with higher than normal amniotic fluid cortisol levels. The rise in amniotic fluid cortisol concentrations following premature rupture of the membranes may reflect increased fetal or maternal cortisol production or both, and could explain enhanced lung maturation in such infants.

Amniotic Fluid↗
PubMed1976

Total and free thyroxine and triiodothyronine in normal and complicated pregnancy.

Serum concentrations of total and free thyroxine (T4 and FT4) and total and free triiodothyronine (T3 and FT3) were measured in normal pregnant women, in patients with toxemia of pregnancy, and in patients with gestational trophoblastic disease (GTD). In normal pregnancy, FT4 and FT3 levels remained normal while T4 and T3 levels were elevated. In patients with pre-eclampsia, the mean serum T3 concentration was significantly lower than that of normal pregnancy and the serum FT3 concentrations in three out of nine patients were below the normal pregnancy range. The mean serum T4 and FT4 concentrations in patients with pre-eclampsia were, however, significantly higher than those in normal pregnant women. In patients with GTD without signs of hyperthyroidism, the mean serum total and free T4 concentrations were 43 and 92% higher than those in normal pregnancy (P less than 0.02), and many patients had levels above the range of values observed in normal pregnant women. The mean serum total and free T3 concentrations in GTD patients without signs of hyperthyroidism were not different from those of normal pregnancy (P less than 0.05). In the single GTD patient with hyperthyroid crisis, the s. erum FT4 concentration was within the range seen in GTD patients without signs of hyperthyroidism. Her serum FT3 concentration was, however, much higher than the ranges in normal pregnancy or in GTD patients without clinical hyperthyroidism. Higher than normal FT4 levels were found in patients with and without elevated hCG levels.

Female↗
PubMed1976

Placental sulfatase deficiency: a case study.

A pregnancy with placental sulfatase deficiency was suspected when a 36-year-old patient at 41 weeks of gestation was found to have extremely low urinary estriol excretion and an otherwise normal prenatal course. The maternal plasma levels of estriol and estradiol 17-beta (E2) were extremely low and estetrol (E4) was undetectable (less than 40 pg/ml), whereas dehydroepiandrosterone sulfate (DS) was normal. THE AMNIOTIC Fluid DS concentration was 22-fold higher than the mean of normal pregnancy, while that of dehydroepiandrosterone (D) and androstenedione (A) was normal. Following intravenous infusion of 50 mg DS, no rise of plasma E2 was noted and plasma E4 levels remained undetectable. At 42 weeks of pregnancy, after induction of labor failed, a healthy male infant was delivered by cesarean section. The umbilical vein (UV) and umbilical artery (UA) levels of DS were extremely high, and those of E2 and E4 were subnormal. The UA level of A was normal and the levels of D and testosterone were slightly elevated. In vitro studies of placental microsomes and the 10,000 x g supernantant confirmed the diagnosis of placental sulfatase deficiency. The infant at 6 months of age had normal growth and development and normal peripheral plasma DS concentration.

Adult↗
PubMed1976

Plasma cortisol and cortisone in pregnancies with normal and anencephalic fetuses.

Plasma cortisol (F), cortisone (E), and progesterone (P), were measured in the umbilical vein (UV), umiblical artery (UA), and maternal peripheral vein (MPV) of 17 normal patients, and of 8 patients carying anencephalic fetuses. The plasma F in MPV of patients undergoing vaginal delivery after labor of spontaneous onset was significantly higher than that of patients delivered by elective cesarean section, whereas the plasma F concentrations in the UA or UV of the 2 groups were not statistically different from each other. The anencephalic fetuses had UA plasma F and E concentrations which were significantly lower than those of normal fetuses, suggesting that a main portion of UA cortisol and cortisone originates in the fetal adrenal. The UV and MPV plasma F and E concentrations of patients carrying anencephalic fetuses did not differ, however, from those of normal patients, suggesting that these UV corticoids are derived mainly from maternal sources. The amniotic fluid cortisol levels of the patients carying anencephalic fetuses were lower than those observed in the normal pregnancies, suggesting that amniotic fluid cortisol is derived mainly from fetal sources.

Anencephaly↗
PubMed1976

Omental torsion.

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Abdomen, Acute↗
PubMed1975

Hormones in human pregnancy. IV. Plasma progesterone.

The plasma concentration of progesterone (P) has been measured by radioimmunoassay in maternal peripheral vein (M.P.V.) at early pregnancy and in M.P.V. umbilical artery (U.A.) and umbilical vein (U.V.) at term pregnancy. In early preganacy marked hour-to-hour fluctuation of plasma progesterone was noted. At term pregnancy plasma P levels of U.V. were higher than those of U.A. and the umbilical venous arterial differences of plasma P did not differ between male and femal fetuses. Administration of hydrocortisone and ACTH to patients scheduled to undergo cesarean section had no effect on M.P.V., U.A., and U.V. plasma P concentration. On the basis of the differences between U.V. and U.A. plasma P concentrations and reported umbilical flow it was estimated that the secretion rate of P into the fetal circulation is approximately 23 mg. per 24 hr. and would amount to approximately 10 per cent of the reported total daily production rate of P at term pregnancy. The fraction of P which is unbound to the plasma proteins was estimeated by equilibrium dialysis at 37 degrees C. The per cent unbound P in M.P.V. plasma of pregnant patients at term was not different from that of nonpregnant patients but was 40 per cent lower than that in umbilical cord plasma (P LESS THAN 0.01), and the ratio between the concentrations of unbound P and estradiol in M.P.V. increased as pregnancy progressed. Plasma P in re-eclamptic patients who subsequently sustained intrauterine fetal death had no value in assessing placental function.

Adrenocorticotropic Hormone↗
PubMed1975

Total cortisol in amniotic fluid and fetal lung maturation.

Total cortisol was determined by radioimmunoassay in 48 samples of amniotic fluid obtained at various stages of normal pregnancy. Before the 34th week, all cortisol levels were less than 40 ng per milliliter. At 35 to 40 weeks the mean value was 2.4 times higher than that at 20 to 34 weeks. In pregnancies greater than 40 weeks, a further increase in total amniotic-fluid cortisol was observed, and values greater than 120 ng per milliliter were found only in patients of this group. A good rank correlation between cortisol and lecithin/sphingomyelin ratio was found in 43 samples (r = 0.83, p less than 0.001). No respiratory-distress syndrome of the newborn occurred when total amniotic-fluid cortisol was greater than 60 ng per milliliter (16 patients). Total amniotic-fluid cortisol may reflect initiation of fetal lung maturation, and may help identify pregnancies with a gestation period of over 40 weeks.

Amniotic Fluid↗
PubMed1975

Plasma estetrol as an index of fetal well-being.

Estetrol (15alpha-hydroxyestriol or E4) is considered to be a specific product of fetal liver and has been suggested as a good indicator of fetal well-being. The concentration of unconjugated estetrol (E4) was measured by rapid and specific radioimmunoassay in 1 ml of maternal plasma. E4 levels prior to the 18th week of pregnancy were often undetectable (smaller than 50 pg/ml). The mean plasma E4 level at term of 1.2 ng/ml was 7-fold higher than that observed at 24 weeks of gestation, and no diurnal variations were found. E4 levels in fetal plasma at term were 12-fold higher than those in maternal plasma and no fetal arterial venous differences were found. Umbilical vein but not maternal plasma levels of patients undergoing vaginal delivery were higher than those undergoing cesarean section (P smaller than 0.05) suggesting increased adrenal output of E4 precursors during labor. In patients with severe Rh-isoimmune disease plasma E4 levels were not helpful in assessing fetal well-being. However, in patients with chronic hypertension or pre-eclampsia, subnormal plasma E4 concentrations always preceded intrauterine fetal death. Plasma E4 appears to be a good indicator of fetal well-being in patients with hypertensive disease of pregnancy.

Amniotic Fluid↗