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Biomedical subjects

E A Zbella

Publications and source records attributed to E A Zbella.

At least 19 recordsLinked to original sources

Uterine necrosis after uterine artery embolization for leiomyoma.

BACKGROUND: A potential complication of uterine artery embolization is diffuse uterine necrosis. CASE: A woman with a large uterine leiomyoma underwent elective uterine artery embolization and 2 months later developed diffuse uterine necrosis requiring exploratory laparotomy, total hysterectomy, and left salpingo-oophorectomy. CONCLUSION: Although elective uterine artery embolization is a procedure with a low reported rate of complications, diffuse uterine necrosis can occur.

Arteries↗

Intrafollicular insemination for male factor infertility.

Intrafollicular insemination is a promising new development that may have a major impact on ART, notably in the treatment of male factor infertility. Reported is the first successful intrafollicular insemination in the United States and the first successful intrafollicular insemination for male factor infertility. Although the results are encouraging, further investigations are currently underway to critically evaluate intrafollicular insemination.

Adult↗

Free alpha-subunit response to gonadotropin-releasing hormone in women with polycystic ovaries.

The response of glycoprotein hormone free alpha-subunit to gonadotropin-releasing hormone (GnRH) was evaluated in 12 women with polycystic ovaries (PCOs). Six of these women were premedicated for 3 days with micronized 17 beta-estradiol before receiving a 100-micrograms bolus of GnRH. In nonmedicated PCO patients, GnRH did not significantly alter basal free alpha-subunit levels. In four of the six PCO patients receiving estrogen premedication, a significant increase in free alpha-subunit was observed; these four patients had low progesterone levels at the time of the GnRH test. Among the six premedicated patients, two had elevated (greater than 4 ng/ml) progesterone levels, and the GnRH tests showed no significant effect on the levels of free alpha-subunit. The study revealed a dissociation between the free alpha-subunit responses to GnRH and the responses of luteinizing hormone; a closer relationship was observed between free alpha-subunit and follicle-stimulating hormone responses. It was concluded that the lack of a free alpha-subunit response to GnRH in PCO patients is not due to a primary inability of the pituitary gonadotroph to produce free alpha-subunit but is a consequence of an altered estrogenic milieu, and a free alpha-subunit response to GnRH may reflect the replenishment of both follicle-stimulating hormone and luteinizing hormone in the gonadotrope.

Adult↗

Biopsy in laparoscopically diagnosed endometriosis.

A series of 273 consecutive patients with the primary complaint of pelvic pain were laparoscopically diagnosed as having endometriosis. Peritoneal and/or ovarian biopsy was performed at the endometriosis site or sites in 115 patients. Histologic confirmation of endometriosis was established in 64% of those patients. The severity of the disease did not correlate with positive or negative biopsy results. Thus, the diagnosis of endometriosis may not be histologically confirmed, even in the presence of grossly visible disease. Therefore, diagnosis and treatment of the disease should not depend upon histologic confirmation.

Adult↗

Quantitation of proteinuria in pregnancy by the use of single voided urine samples.

The most commonly used method to measure urinary protein involves a 24-hour urine collection. In a study of 54 specimens, we found excellent correlation between the protein content of a 24-hour urine collection and the protein/creatinine ratio of a single urine sample (r = 0.9936; P less than .0001). We conclude that the protein/creatinine ratio of a single urine specimen represents a highly accurate method to assess renal function in the pregnant patient, and seems clearly more practical than the 24-hour urine collection.

Adolescent↗

Contraceptive practices of female physicians.

To evaluate a potential bias between methods of birth control used and prescribed by physicians, we surveyed sexually active female physicians in regards to their own methods of birth control. When the contraceptive practices of female physicians are compared to those of the general population, no difference in use of various contraceptive methods is found. Among female obstetrician-gynecologists, however, the intrauterine device continues to be a disproportionally popular method of contraception. It is concluded that no gender bias exists in prescribing patterns of contraceptives since contraceptive use in female physicians is identical to that of the general populations.

Adult↗

Pelvic peritoneal defects and endometriosis: further observations.

Congenital or acquired defects in the mesentery are rare, and defects of the supporting structures and in the peritoneum of the pelvis are even more uncommon. Such pelvic peritoneal defects have been associated with endometriosis; however, the extent of this association has been unclear. In the present study, 309 patients had a diagnostic laparoscopy performed for pelvic pain in a prospective manner over a 2-year period. A total of 53 patients were found to have pelvic peritoneal defects. Seventy-nine percent of this group with peritoneal defects had associated endometriosis. Of the 309 patients undergoing laparoscopy, 148 patients were diagnosed as having endometriosis. Twenty-eight percent of this group with endometriosis had pelvic peritoneal defects. We conclude that when such defects are found at laparoscopy, the presence of endometriosis should be investigated thoroughly.

Adolescent↗

Competitive studies with dehydroepiandrosterone sulfate and 16 alpha-hydroxydehydroepiandrosterone sulfate in cultured human choriocarcinoma JEG-3 cells: effect on estrone, 17 beta-estradiol, and estriol secretion.

The estradiol (E2) to estriol (E3) ratio during human pregnancy depends on fetal liver hydroxylation of fetal adrenal dehydroepiandrosterone sulfate (DHEAS) and conversion by the trophoblast of DHEAS and 16 alpha-hydroxy-DHEAS (16 OH-DHEAS) to estrone (E1), estradiol (E2), and estriol (E3), respectively. It is not known whether the conversion of DHEAS into E1 and E2 influence the conversion of 16OH-DHEAS into E3 and vice versa. To examine this question, we studied these interactions in human choriocarcinoma JEG-3 cells. In serum-free medium (Dulbecco's Modified Eagle's Medium), JEG-3 cells secreted hCG [27 +/- 3 (+/- SEM) ng/mg cellular protein X 24 h] and progesterone (22 +/- 2.5), but neither C-19 nor C-18 steroids. The addition of DHEAS resulted in secretion of E1 and E2; at a concentration of 500 ng DHEAS/ml, the secretion of E1 (1 +/- 0.16) and E2 (11 +/- 3.1) was maximal, while E3 remained undetectable. The addition of 1000 ng 16 OH-DHEAS/ml resulted in maximum E3 secretion (13 +/- 1.8), while E1 and E2 remained undetectable. The addition of increasing concentrations of DHEAS to cultures exposed to 1000 ng 16OH-DHEAS/ml caused a decrease in E3 secretion and increased secretion of E1 and E2. Conversely, addition of increasing concentrations of 16OH-DHEAS in cultures exposed to 500 ng DHEAS/ml resulted in inhibition of E1 and E2 secretion and increased E3 secretion. A concentration of 16OH-DHEAS that inhibited the conversion of DHEAS into E1 and E2 neither altered the intracellular to extracellular steroid ratios (approximately 0.1) nor reduced the secretion of DHEA, androstenedione, and testosterone. The inhibitory effect of 16OH-DHEAS was minimal at low DHEAS concentrations (favoring the secretion of E1 and E2) and was greatly enhanced at concentrations of DHEAS that induced maximum E1 and E2 secretions. The results indicate that in trophoblastic cells, the metabolism of DHEAS can modulate E3 secretion, and the metabolism of 16OH-DHEAS can modulate the secretion of E1 and E2; and this regulatory mechanism appears to take place at the level of the aromatase system.

Cells, Cultured↗

Limb salvage in recurrent vulvar carcinoma after rupture of femoral artery.

Bypass procedures in patients with gynecologic malignancies have been used rarely. Successful external iliac-femoral bypass to avoid amputation in a patient with a rupture of the femoral artery due to recurrent vulvar cancer is reported. It is suggested that vascular bypass procedures may be considered as alternatives to surgical amputation in the management of a few selected patients with recurrent vulvar cancer and vascular injury.

Blood Vessel Prosthesis↗

Vaginal douching. Pros, cons, and proper technique.

Vaginal douching is not necessary in routine feminine hygiene. When performed infrequently it is not harmful, but frequent douching may lead to recurrent vaginitis and mucosal irritation or ulceration. Douching should not be performed during pregnancy.

Female↗