Biomedical subjects
Publications and source records attributed to E O Akande.
A case of three consecutive repeated ectopic pregnancies is presented in a 36-year-old woman who was being managed for infertility. The first two ectopic pregnancies occurred in the right fallopian tube, and both were treated conservatively. All three ectopic pregnancies were confirmed histopathologically. The aetiology, symptoms and management of the case are discussed, and the literature is reviewed.
A pregnancy in a patient with ventriculoperitoneal (VP) shunt was recently managed at the authors's institution. Review of the literature showed only six previous case reports. The management of this uncommon neurosurgical condition in pregnancy is presented along with a review of the literature. We conclude that pregnancy in a patient with a VP shunt for maternal hydrocephalus, generally has a normal outcome and that the function of the shunt is unaffected by pregnancy.
Plasma total cholesterol, triglycerides and high-density lipoprotein cholesterol levels were determined in 70 pregnant women immediately after delivery and in the cord blood of their babies; 62 non-pregnant women served as controls. The mean lipid levels were significantly higher in the pregnant women than in the non-pregnant women. The lipid levels in the cord blood were much lower than those in the maternal blood but were not different from values which have been reported from the developed countries; they were independent of socio-economic class. The total and high density lipoprotein cholesterol levels were related to socio-economic status both in the pregnant and non-pregnant women, but the ratio of high density lipoprotein cholesterol to total cholesterol and triglyceride levels were not. The cord blood lipid levels were also independent of socio-economic class.
Blood glucose, serum insulin and free fatty acid levels were determined in 60 pregnant and 44 non-pregnant women. The mean blood glucose level was significatnly lower in pregnant women than in non-pregnant women but there were no significant changes during pregnancy. The mean serum insulin and free fatty acid levels were not significantly different from the levels for the non-pregnant women, there was also no significant change in their mean levels throughout pregnancy.
Fifteen patients with proven iron-deficiency anaemia treated with intramuscular injections of Ferastral, iron-poly (sorbitol-gluconic acid) complex, have been studied. Fourteen showed a satisfactory rise in haematocrit. No local or systemic complications were observed. One patient with iron-deficiency anaemia due to a bleeding malignant lesion did not achieve a satisfactory haematocrit level although the bone marrow showed iron repletion following the injection. It is concluded that Ferastral is an effective drug in the treatment of iron-deficiency anaemia.
Plasma levels of estrogen were measured daily by radioimmunoassay for 28 consecutive days in 12 healthy euthyroid women and 15 thyrotoxic women (10 with hypomenorrhea and 5 with amenorrhea) before commencement of therapy (except in one case) in an effort to increase understanding of the relationship between the thyroid gland and ovarian function. The results show that the patterns of plasma estrogen in thyrotoxic women with hypomenorrhea were similar to those in euthyroid women, although the levels in the thyrotoxic women were significantly elevated (P less than 0.001). Thyrotoxic women with amenorrhea also had a markedly elevated plasma estrogen level with a persistence of a sharp peak of estrogen but without the secondary estrogen rise associated with corpus luteum function. This suggests a failure of the positive feedback effect of estrogen on the hypothalamopituitary axis with resultant failure of ovulation.
Serum total and free cholesterol, phospholipids and erythrocyte free cholesterol levels were determined at four-weekly intervals from the first trimester until term in pregnant Nigerian women from three different socio-economic levels. The results showed a similar pattern of serum lipids in all three groups with a similar percentage increase at the peak levels. Serum phospholipids and total cholesterol levels were not significantly increased after the second trimester in contrast to report of a progressive hyperlipaemia in pregnant women of Western countries. Erythrocyte free cholesterol levels showed a mirror image of those of serum free cholesterol.
Plasma levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), oestrogen and progesterone were measured daily in 15 thyrotoxic women in the reproductive age for 28 to 30 consecutive days before commencement of therapy and for a similar period following restoration of the euthyroid state. Five of these patients had secondary amenorrhoea whilst the other 10 had hypomenorrhoea. Twelve healthy volunteer eythyroid women of similar age and parity, with no history of menstrual abnormality, served as controls. The levels of both gonadotrophins (LH and FSH) and oestrogen were found to be significantly raised in all thyrotoxic patients in comparison with levels in the euthyroid female controls (P less than 0.001). "Mid cycle" LH and FSH peaks were present in thyrotoxic patients who were still menstruating whilst they were absent in those who developed amenorrhoea. Plasma oestrogen concentration rose to a peak on the day before the surge of LH (and FSH) in all euthyroid frmale controls as well as in thyrotoxic patients who were still menstruating. In contrast, oestrogen peaks occurred without ensuing LH (and FSH) peaks in thyrotoxic patients who had developed amenorrhoea, suggesting a failure of the positive feed-back mechanism. The levels and patterns of plasma progesterone in thyrotoxic subjects who were still menstruating were similar to those of euthyroid controls. However, no significant circulating plasma progesterone was detected in thyrotoxic subjects who were amenorrhoeic. The levels and patterns of all of these hormones (gonadotrophins, oestrogen and progesterone) became normal after restoration of euthyroid state and normal menstruation.
In an effort to determine the influence of hypothyroidism on the hypothalamopituitary-ovarian axis plasma levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), oestrogen and progesterone were measured daily for 10 to 14 consecutive days in five women with hypothyroidism. In all subjects investigated the levels of all the hormones measured were low in comparison with the values in euthyroid women. FSH/LH ratios were, however, higher in hypothyroid women than in both phases of the menstrual cycle in euthyroid controls. It is postulated that changes in the FSH/LH ratio may be related to the low levels of oestrogen and probably to failure of ovulation in hypothyroid women.
Plasma levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), oestrogen, testosterone and sex-hormone-binding globulin (SHBG) were determined in 15 thyrotoxic women in the reproductive age before and after treatment with carbimazole. The levels of these hormones and SHBG were compared with those of 12 euthyroid healthy female volunteers of comparable age and parity. Plasma gonadotrophins (LH and FSH), oestrogen, testosterone and SHBG were all markedly elevated in thyrotoxic subjects but became normal when the euthyroid state and normal menstruation were restored after treatment. From the results a hypothesis is suggested that related the hormonal disturbance primarily to a thyroid hormone-induced rise in SHBG levels.
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