Biomedical subjects
Publications and source records attributed to E Borko.
Selective reduction was performed in a patient with triplet pregnancy in the 9th week of gestation. Selective reduction of the fetuses to two was performed by puncture using vaginal ultrasound probe. No complications occurred and the patient was delivered of healthy twins.
This paper describes the results from a randomized clinical trial comparing the Collatex vaginal contraceptive sponge (a predecessor of the Today sponge) and Neo Sampoon foaming vaginal contraceptive tablets; the trial was conducted from 1979 to 1983 in four centers located in three countries (two in Yugoslavia and one each in Taiwan and Bangladesh). The sponge was associated with more insertion and retention problems than the tablet, especially in the two Asian centers. More Neo Sampoon users complained of a burning or stinging sensation. This complaint, however, seemed to be well-tolerated and was not a frequent reason for irregular use and/or discontinuation of use of the tablets. Clinically significant medical complications were rarely reported for either method. Sponge users were more likely to report irregular use than tablet users, primarily due to inconvenience of use. Rates of discontinuation at six months of use were also consistently higher among sponge users than Neo Sampoon users in the four centers. Life-table pregnancy rates at 12 months of use ranged from 3.8 to 18.2 per 100 sponge users and 6.2 to 29.9 per 100 Neo Sampoon users, based on data from the two Yugoslavian centers and the Taiwan center (data from the Bangladesh center were excluded from analysis of pregnancy rates). Practical implications of these findings are discussed.
A trial of the contraceptive sponge was conducted at two clinics (403 subjects) in Yugoslavia. Women were periodically followed up for 1 year. The 1-year method pregnancy rate (life-table) was 5.6 per 100 women. Rates of other events leading to discontinuation of sponge use were similarly low. There were no serious complications. The results of the study show that the contraceptive sponge may be successfully used by a population of women with limited experience with the use of vaginal contraceptive methods.
Neo Sampoon, a foaming vaginal tablet containing 60 mg of the spermicide menfegol, and the Collatex sponge (now marketed in the United States as the Today sponge), a dome-shaped polyurethane device that contains 1 g of nonoxynol-9, were compared in terms of effectiveness, safety, and acceptability. Both methods were new to the Maribor General Hospital, Yugoslavia, where the trial was conducted among 450 volunteers randomly assigned to one of the two methods. At 12 months, the life-table pregnancy rate per 100 women for the Neo Sampoon group was 12.8, compared with a rate of 10.4 among the sponge users (P greater than .10). After pregnancy, the second most frequent reason for termination was discomfort, with a 12-month termination rate due to this cause of 6.9 per 100 women in the Neo Sampoon group and 6.2 in the sponge group. Although fewer than a quarter of the volunteers had any experience with barrier methods before this trial, the life-table continuation rate was high in both groups, with more than 70% using their assigned method for the full 12 months. Also, upon conclusion of the study, 41% of the volunteers chose another barrier contraceptive method. Although the effectiveness of the sponge and Neo Sampoon is not comparable to that of the pill or IUD, both vaginal methods appear to be safe and acceptable additions to the range of contraceptive choices.
The authors have analysed changes in the thromboelastogram in 411 women on oral contraceptives and in 31 women on no hormonal contraception. Comparing the results they found no statistically significant differences because the control group was too small. In the group of women on hormonal contraception, statistically significant differences were recorded in those women whose thromboelastogram was analysed several times, the differences having been more pronounced in the women that had used hormonal contraceptives for a longer time. As the appearance of thrombo-embolic complications is a very complex process, the authors' opinion is that thromboelastogram cannot be considered as a routine method for predicting these complications.
To compare the efficacy and complications of using the 8 mm diameter metal and flexible plastic cannulae for performing abortions of pregnancies of 7--10 menstrual weeks' gestation by vacuum aspiration, a comparative study was conducted. Both types of cannulae were randomly assigned to 300 subjects in a study design where the physician who performed the abortion was not the same person who evaluated the subject after the abortion or at the time of the follow-up visit. All abortions were performed under paracervical block anesthetic after mechanical dilatation of the cervix to 8.6 mm. The rates of specific complications, blood loss and the need for secondary procedures to complete the abortion were not significantly different for the two types of cannulae. The amount of tissue obtained with a routine curette check following the vacuum aspiration, and the incidence of cannula obstruction were similar for the two types of cannulae.
Ninety-six patients with varicocele were followed for 4 years in a prospective randomized study. Seventeen patients were excluded from the study in accordance with exclusion criteria. In 26 patients varicocele was treated surgically and 12 patients were treated either by sclerosation or embolization. Forty-one patients with varicocele had no therapy. In 54 patients oligoasthenozoospermia and in 25 normozoospermia was certified. In the group of patients without treatment, the pregnancy rate in the women was higher (22/41, or 53.7%) than in the group receiving treatment (13/38, or 34.2%). The difference was not statistically significant. After therapy, sperm concentration increased and sperm motility improved also. The differences were not statistically significant. The study showed that varicocele therapy bears no influence on male fertility.
Eighty-nine oligozoospermic men, treated by clomiphene or tamoxifen or with no treatment at all, were evaluated during a 4-year follow-up period. Ejaculate volume, sperm concentration, and sperm motility were determined and concentrations of prolactin (PRL), estradiol, beta hCG, prostaglandin E2, zinc, and fructose were ascertained. Isoenzyme LDH-C4 activity and serum PRL and follicle stimulating hormone were also determined. During treatment there was only a minimum increase in sperm concentration. No improvement in sperm motility and no alteration in ejaculate volume were observed. The pregnancy rate was lower in the partners of patients receiving treatment (23.8%) than in the partners of those receiving none (29.6%). Statistically the difference is insignificant. After antiestrogen therapy, prolactin concentrations in serum decreased and zinc concentrations in seminal plasma increased. For the treatment of idiopathic oligozoospermia in infertile men, clomiphene and tamoxifen were ineffective medication.
The results of the IVF/GIFT programme for 1989 in Maribor are presented. During this period 4 clinical pregnancies were attended by the IVF procedure and one by GIFT and ZIFT each. In the IVF procedure the highest percentage of pregnancies was obtained in the group of women with the tubal factor of infertility (n = 34) where 4 clinical pregnancies on 22 ET were registered (18.1%). Cycle synchronisation with contraceptives, followed by stimulation with CC-HMG proved to be the most successful protocol for the cycle stimulation. With this protocol, pregnancy was attained in 4 of 19 stimulated cycles (21.0%). In the spontaneous cycles (n = 17) no pregnancy was registered.
At the Outpatient Unit for Infertile Couples 47 male patients coming for conjugal infertility consultations were examined. Routinely at least three spermiograms were analysed for each patient. LDH-C4, beta HCG and LH concentrations were determined in the seminal fluid and the FSH concentration in the serum. A significant correlation was established between LDH-C4 and beta HCG and LH in the seminal fluid. The coefficient of correlation between LDH-C4 in the seminal fluid and FSH in the serum was significantly negative, but this correlation was less significant.
Zinc, acid phosphatase and fructose in seminal fluid as well as FSH and LH in serum were determined in 223 men who were examined because of conjugal infertility. The concentrations of zinc, fructose and acid phosphatase in the seminal fluid of patients with normozoospermia (zinc 2.02 nmol/L; fructose 12.65 nmol/L; acid phosphatase 534063.49 U/L, oligozoospermia (zinc 2.09 nmol/L; fructose 12.79 nmol/L; acid phosphatase 553390.24 U/L) and azoospermia (zinc 2.10 nmol/L; fructose 12.56 nmol/L; acid phosphatase 599137.93 U/L) do not differ essentially. The average concentrations of zinc and acid phosphatase in the seminal fluid of patients with azoospermia and high concentrations of FSH and LH were significantly larger (zinc 2.58 nmol/L; acid phosphatase 683500.0 U/L) than those in patients with azoospermia and normal concentrations of FSH and LH (zinc 1.61 nmol/L; acid phosphatase 508750.0 U/L). In patients with normal gonadotropin levels, extremely low fructose concentrations in seminal plasma and congenital aplasia of seminal ducts, the concentrations of zinc in seminal plasma were enormously high.
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In the seven years period (1973-1980) 176 patients were operated because of tubal infertility. Before the operation all the investigations necessary for the detection of the cause of infertility were carried out, including the examination of the husband's semen. In the 176 patients the most frequent indication for operation was ampullar occlusion, most often combined with adhesions, less frequent findings are only adhesions diagnosed by HSG and/or laparoscopy. Patients operated because of tubal infertility conceived in 57 cases or 32.38%. Pregnancy following operation was most frequent in patients in which adhesiolysis and implantation were performed, and less frequent in patients following salpingostomy. 55% of all pregnancies occur in the first year after the operation.
During a period of 15 years, 71 cases of genital tuberculosis were diagnosed. Out of the two had postmenopausal tuberculous endometritis and were hospitalized for postmenopausal bleeding. The diagnosis was confirmed by the histological examination of the tissue obtained from the uterus.
Ovulation was stimulated in 56 cycles, namely in 16 cycles with clomiphene, in 19 with clomiphene and HCG, and in 16 cycles with clomiphene, HMG and HCG. In three women there was no LH or estradiol increase following ovulation stimulation with clomiphene, but in two women stimulated by the two remaining methods there was a spontaneous LH peak before the application of HCG. Using the radioimmunologic method once a day the concentrations of LH, estradiol and SHBG in serum were determined. The concentrations of SHBG in serum do not change in all three methods of ovulation stimulation. The mean concentrations of SHBG vary between 47 and 54 mumol/l during the entire preovulatory phase of the stimulated cycle. All of these cycles were ovulatory since the preovulatory E2 peak is clearly expressed in all three methods of ovulation stimulation.
From 1978 to April 1980, 36 laparoscopic sterilization procedures were completed at the Gynecological Department in Maribor. For tubal occlusion in 16 cases Tupla clips and in 20 cases the Tubal Falope ring were used. It appears that the incidence of complications and other technical difficulties is somewhat more frequent with clips. There have been no pregnancies in all these cases.
In 26 patients with clinical varicocele, in 20 patients with "subclinical" varicocele, and in 90 clinically normal patients, measurements of the plasma follicle stimulating hormone (FSH), luteinising hormone (LH), prolactin (PRL) and testosterone were made. In 13 patients pre-operative and post-operative measurements were also performed. The difference in the serum testosterone values in patients with varicocele and in those without varicocele was not statistically significant. The level of FSH and LH markedly higher in the group of patients with subclinical varicocele than in the group with clinically expressed varicocele (p less than 0.05). The difference in the values of FSH, LH, PRL and testosterone in the serum and seminal plasma of clinically normal patients with thermographically verified scrotal hyperthermia due to the reflux into the pampiniform plexus and in those with euthermia was not statistically significant if the quality of the semen was similar.
Presented are the results of bacteriologically examined ejaculates from 113 patients who had never had any symptoms of inflammation in the genital tract region. In 40.7% of them Staphylococcus epidermidis was found in the ejaculate next to other bacteria meant to be the cause of the inflammation of the genital tract in men. A comparison was made of the bacteria in the urine voided before ejaculation and in the cervix and vagina of the patients' views with the species in the semen.