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Biomedical subjects

E M Grimes

Publications and source records attributed to E M Grimes.

At least 19 recordsLinked to original sources
PubMed1990

Scrotal temperature and semen quality in men with and without varicocele.

The exact role of varicocele in human male infertility remains controversial. Fifty-five male partners of infertile couples randomly selected and 17 fertile semen donors were evaluated for semen quality, scrotal temperature, and presence of varicocele using clinical palpation and Doppler ultrasound. The incidence of varicocele was 42% in male partners of infertile couples and 41% in fertile semen donors. Left scrotal temperature was significantly (p less than .001) higher in infertile males with varicocele as compared to all groups. No significant differences were observed in the percentage of morphologically normal sperm in semen of males with and without varicocele. However, the incidence of tapered, elongated, and immature sperm was significantly higher in the infertile patient population with a varicocele. Measurement of scrotal temperature and assessment of sperm morphology may be used as predictors of the presence and deleterious effect of varicocele.

Body Temperature↗
PubMed1989

Sperm morphology: unstained and stained smears in fertile and infertile men.

Two semen specimens from 34 fertile donors and 82 male partners of infertile couples were evaluated for semen quality. Sperm morphology was evaluated with unstained specimens and following Papanicolaou staining. A significant difference (p less than 0.001) was found in the percentage of morphologically normal spermatozoa in stained and unstained semen smears. Fertile semen donors had a significantly (p less than 0.001) higher percentage of normal sperm than men of unproven fertility. When compared to the fertile donors, 78% of the infertile men had increased teratospermia. Papanicolaou staining appears to enhance sperm morphology and allow improved discrimination of sperm head abnormalities.

Fertility↗
PubMed1987

Endometriosis of the small bowel. Case reports and review of the literature.

Endometriosis has been reported with increasing frequency in the literature in recent years, particularly endometriosis in nongynecological sites. Primary endometriosis of the ileum is of particular concern due to the high incidence of small bowel obstruction. The treatment in the past has been castration and resection of the affected bowel, with no guarantee of cure. Two cases are presented which indicate that the hormonal therapy with Danocrine and laser vaporization of endometriotic lesions involving the ileum may alter the natural history of progressive ileal obstruction. A comprehensive review of the literature was undertaken which revealed 204 reported cases of endometriosis of the ileum. New recommendations regarding management of small intestinal endometriosis are proposed.

Adult↗
PubMed1985

Clinical significance of focal pelvic endometriosis.

Clinical findings in a group of infertile patients with endometriosis were reviewed to determine if minimal (focal) disease exerted an effect on reproductive outcome. Focal disease, defined as isolated implants less than or equal to 5 mm without pelvic adhesions or anatomic distortion, was found in 69 patients, with 35% manifesting menstrual dysfunction/anovulation. Patients with focal disease were divided into two groups: those treated with danazol (400-800 mg) daily for six months and those not treated. Conception occurred in 71% of the danazol-treated patients and 30% of the untreated ones. These results suggest that focal endometriosis does influence reproductive performance and that infertile patients with focal disease should be treated more aggressively with the available medical regimens, particularly when the infertility is of significant duration or when routine therapy has failed.

Danazol↗
PubMed1984

Pituitary microadenomas: diagnostic and therapeutic trends.

It can be categorically stated that any clinician who treats medical problems in women during the reproductive or the peripubertal years must be aware of risks of pituitary adenomas and available diagnostic and therapeutic modalities. Pituitary adenomas may present during the pubertal period in association with delayed or incomplete development of secondary sexual characteristics. Primary or secondary amenorrhea may be the most obvious clinical abnormality. Patients with menstrual irregularity or secondary amenorrhea are at risk of hyperprolactinemia and pituitary adenomas. At present, the exact risk is unknown. Patients who are at greatest risk appear to be those with hyperprolactinemia, galactorrhea, and amenorrhea. Patients with apparent functional hyperprolactinemia may be harboring small pituitary adenomas. This possibility should be considered when using bromocriptine therapy. Pregnancy in patients with pituitary adenomas may be either normal or complicated by pituitary tumor enlargement, hemorrhage, or visual disturbances. There is no known accurate predictor of individual risk. Patients conceiving spontaneously or after induced ovulation should be followed closely to detect and treat possible pituitary or visual complications, or both, as rapidly as possible, thereby avoiding serious permanent sequelae.

Adenoma↗
PubMed1983

Disseminated gonococcal infections.

A four-year retrospective review of 55 patients with disseminated infections from Neisseria gonorrhoeae revealed that this complication occurs in young adults, with a predominance in women (80%). The most common manifestation of disseminated gonococcal infection was arthritis, which occurred in 47 patients (85.5%). The second most common manifestation of disseminated gonococcal infection was dermatitis, which occurred in 33 patients (60%). A thorough history, a careful physical examination, and a high index of suspicion are essential for the diagnosis. Disseminated gonococcal infection can be confirmed by isolation of gonococci from potential sites, including urethra, cervix, rectum, oropharynx, and blood. Early diagnosis and adequate therapy are necessary to prevent serious complications. The role of the gynecologist in preventing, diagnosing, and/or treating this disorder is emphasized.

Adolescent↗
PubMed1982

Ectopic pregnancy: a review of 147 cases.

From July 1, 1972, to June 30, 1979, 149 patients with ectopic pregnancy were treated at Truman Medical Center. The history and physical findings, diagnostic procedures, etiologic factors and patient management were reviewed. Abdominal pain (98.6%), amenorrhea (74.1%) and irregular vaginal bleeding (56.4%) were the most common presenting symptoms. Abdominal tenderness (97.3%) and adnexal tenderness (98%) were the most common physical findings. Culdocentesis was performed in 118 cases and was positive for nonclotting blood in 94.1%. In 115 cases (78.2%) the ectopic pregnancy was ruptured prior to the time of admission. The incidence of diagnostic error was 35.9%. There were no maternal deaths; however, the incidence of morbidity was 26.5%. Our data reemphasize the need for a high degree of suspicion and early utilization of definitive diagnostic procedures if the morbidity and mortality of ectopic pregnancy are to be reduced.

Adolescent↗
PubMed1981

Open laparoscopy with conventional instrumentation.

Forty women who had undergone previous abdominal surgical procedures were evaluated by open laparoscopy with a simple technique that required no special instrumentation. Gynecologic problems included infertility, suspected endometriosis and/or pelvic adhesions, ovarian cysts, and second-look laparoscopy after treatment for ovarian cancer. The technique was evaluated in regard to ease of performance in patients with various abdominal incisions. Conventional instrumentation was used. No significant side effects were experienced and anesthesia time was prolonged by no more than 10 to 20 minutes in most cases. Significant subincisional adhesions were found in 35% of patients. It is suggested that open laparoscopy in patients who have had previous abdominal surgery deserves reevaluation.

Abdomen↗
PubMed1980

Reproductive performance in women with sex chromosome mosaicism.

Among chromosomal analyses performed in 23 couples with a history of 2 or more spontaneous abortions, 5 women had mosaicism of the sex chromosomes, 46,XX/47,XXX, but all the men had normal 46,XY chromosomal complements. A review of the literature revealed that 75% of the fetuses of mothers with sex chromosome mosaicism were abnormal. Fifty percent of theses pregnancies ended in abortion and one third of the infants exhibited a chromosomal or physical abnormality. The possible effect of sex chromosome mosaicism on outcome of pregnancy is emphasized.

Abortion, Habitual↗
PubMed1977

The use of gonadotropins for the induction of ovulation in women with polycystic ovarian disease.

Ten infertile patients with polycystic ovarian disease were treated with 18 cycles of "pure" human pituitary follicle-stimulating hormone (HP-FSH) and 10 cycles of human menopausal gonadotropin (HMG) consisting of FSH and luteinizing hormone (LH) in a 1:1 ratio. Human chorionic gonadotropin was used to trigger ovulation when optimal follicular development was achieved as judged by urinary estrogen determinations. Of the 18 cycles utilizing HP-FSH, 14 were presumptively ovulatory, 2 were conceptual, and in 5 cycles ovarian enlargement was noted. Of the 10 HMG cycles, none was ovulatory, no conceptions resulted, and 6 instances of hyperstimulation were noted. Pretreatment serum LH levels were significantly higher than normal follicular phase values. These observations suggest that endogenous LH levels in patients with polycystic ovaries are quite adequate for follicular development so that the administration of exogenous LH is unwarranted. Furthermore, the data suggest that HP-FSH or low-LH-containing HMG may prove to be an additional safe and effective nonsurgical treatment modality for patients who are anovulatory because of polycystic ovaries.

Adult↗
PubMed1975

Pituitary gonadotropin responses to synthetic luteinizing hormone-releasing hormone in patients with typical and atypical polycystic ovary disease.

Synthetic luteinizing hormone-releasing hormone (LH-RH) was administered intravenously to 17 women with polycystic ovary disease (PPCO), 16 women with hypothalamic amenorrhea (HA), and nine women with normal cycles. The serum levels of follicle-stimulating hormone (FHS) and luteinizing hormone (LH) were measured at frequent intervals before and after LH-RH injection. The PCO patients were arbitrarily divided into two groups on the basis of ovarian morphology. The eight patients with large, "typical" PCO's (Type I) showed a greater LH response and a lower FSH response to LH-RH than did the nine patients with smaller, "atypical" PCO's (Type II). The LH response in Type I co was also greater than that in HA, but the FSH response in both types of PCO was significantly less than that in HA. The gonadotropin responses to LH-RH in Type I PCO were quite similar to those occurring in normal women during the two to three days prededing ovulation. The results suggest that excessive LH secretion and/or impaired FSH secretion may be etiologically significant in PCO but do not clearly differentiate whether the stimulus for this pattern of gonadortopin secretion occurs at the hypothatamic or pituitary level.

Amenorrhea↗
PubMed1975

Induction of timed ovulation with synthetic luteinizing hormone-releasing hormone in women undergoing insemination therapy. I. Effect of a single parenteral administration at midcycle.

Synthetic LH-RH was administered by various routes to 19 patients during 37 treatment cycles in an attempt to trigger ovulation in association with insemination therapy. Thirty-five cycles were ovulatory; four pregnancies occurred, but two of them ended in spontaneous abortion. In 20 cycles, the hyperthermia response occurred one to three days after LH-RH administration, suggesting that ovulation occurred as a direct consequence of administered LH-RH. Low levels and delayed peak secretion of progesterone were found in two patients who had serial progesterone determinations during the luteal phase after LH-RH administration. Ovulation timing with LH-RH appears feasible, but efforts to ensure the availability of a mature follicle are required.

Abortion, Spontaneous↗
PubMed1975

The sequence of pituitary responses to synthetic luteinizing hormone releasing hormone (LH-RH) throughout the normal menstrual cycle.

Thirty-one ovulatory women between 20 and 33 years of age were given 150 mug of synthetic LH-RH during different phases of the menstrual cycle. Five patients were studied during the early follicular phase (days 4-7); 10 patients during the late follicular phase (days 9-12); 6 patients during the "LH Surge"; 5 patients during the early luteal phase (days 14-16); 3 patients during mid-luteal phase (days 17-21); and 2 patients during late luteal phase (days 22-27). Oestrogen, progesterone, FSH and LH levels were determined from 30 min prior to LH-RH administration to 90 min thereafter in all cases. LH response to LH-RH increased progressively during the follicular phase. Enhanced pituitary responsiveness to LH-RH occurred at mid-cycle for both LH and FSH and maximum LH responses occurred during the "LH Surge" and early luteal phase. LH responses during the mid and late luteal phases were similar to late follicular phase responses. There were no significant differences between FSH responses during the early follicular, late follicular, mid-luteal and late luteal phases. Maximum pituitary responsiveness appears to occur in a gonadal steroid milieu of high oestrogen levels in association with rising but low progesterone levels. Progesterone or a crucial oestrogen: progesterone ratio may in fact potentiate pituitary release of LH during the early stages of corpus luteum formation. Pituitary responsiveness to LH-RH correlates positively with basal LH and oestrogen levels during the menstrual cycle and with the oestrogen:progesterone ratio during the luteal phase.

Adult↗