Biomedical subjects

I Bukovsky

Publications and source records attributed to I Bukovsky.

At least 91 records · Page 5Linked to original sources

PubMed1995

Uterine fluid human decidua-associated protein 200 and implantation after embryo transfer.

Uterine fluid samples from 109 patients undergoing in-vitro fertilization and embryo transfer were obtained so as to examine the relationship between the uterine fluid concentration of human decidua-associated protein (hDP) 200 and the implantation rate. The sampling was performed on the day of embryo transfer with a Wallace catheter, used for the testing of cervical patency before embryo replacement. The implantation rate, as well as the pregnancy rate, demonstrated a significantly positive correlation with the concentration of hDP 200 in the uterine fluid, measured just before embryo transfer. These results indicate that hDP 200, identified as a rheumatoid factor secreted by the endometrium, may be involved in the implantation process.

Decidua↗

PubMed1995

Prevention of post-surgical adhesion formation using aspirin in a rodent model: a preliminary report.

Pelvic adhesions are one of the major factors which significantly and adversely affect surgery outcome due to intra- and postoperative morbidity and reduce future female fertility. Using a rodent model, we evaluated the efficacy of aspirin, a non-steroidal anti-inflammatory drug, in the prevention of adhesion formation. A total of 72 female Wistar rats received a standardized primary traumatic lesion to the right uterine horn. They were randomly divided into eight groups: group I (control) had no treatment and group II received a single pre-operative 0.70 mg aspirin. All the succeeding groups (III-VIII) received aspirin in doses of 0.35, 0.70, or 1.40 mg every 6 h for either 48 or 96 h in addition to the pre-operative aspirin (0.70 mg). All animals were killed 4 weeks later and adhesions were assessed using a modified adhesion scoring scale. The lowest adhesion score was found in the group treated with 0.35 mg of aspirin for 96 h, and the highest was found among the groups treated with either 0.70 or 1.40 mg for 48-96 h respectively (P < 0.05). These results are in line with the hypothesis that administration of a low dose of aspirin selectively inhibits the production of thromboxane A2, whereas basal prostacyclin biosynthesis is preserved. This phenomenon might contribute to reducing postoperative adhesion formation in a rat model. Thus, future studies into the prevention of adhesion formation may require the additional use of a non-steroidal anti-inflammatory drug, for which aspirin deserves further attention, before extrapolation into human therapy.

Animals↗

PubMed1995

Placental isoferritin patterns during normal first trimester and tubal gestations.

Placental isoferritin (PLF) has been shown to be involved in the down-regulation of the maternal immune system during pregnancy. In a prospective study, serum PLF concentrations were measured in 33 pregnant women with singleton, normal, ongoing first trimester gestations and compared with those of 22 women with tubal gestations. Diagnoses were based on endocrinological, sonographic, intra-operative and histopathological criteria. Venous blood was obtained from both groups for PLF determination before evacuation of the pregnancy products. beta-Human chorionic gonadotrophin (HCG), 17 beta-oestradiol and progesterone were determined at surgery for the tubal pregnancy patients. The mean +/- SD PLF concentrations were 18 +/- 14, 25.4 +/- 42.3 IU/ml among normal and tubal gestations respectively. Significant differences between normal and tubal pregnancies were found (P < 0.05). Based on PLF measurements, sensitivity (67%) and specificity (33%) values were found to be similar for the normal and ectopic pregnancies. No correlation was found between the other measured pregnancy hormones and PLF for the tubal pregnancy group. Low PLF concentrations among pathological gestations may reflect abnormal trophoblastic activity. The simultaneous assessment of PLF and beta-HCG concentrations which probably originate from different trophoblastic cells, is recommended for better diagnosis and monitoring of first trimester placental activity.

Adult↗

PubMed1995

Changes in uterine artery Doppler flow velocity waveforms during the third stage of labor.

Transabdominal Doppler velocity waveform measurements of the uterine arteries during the third stage of labor were performed upon 25 patients with uncomplicated vaginal deliveries and 5 with prolonged third stage in order to further assess third-stage mechanisms. Based on Doppler flow measurements, three phases of the third stage of labor were observed: (1) a latent phase with a systolic/diastolic ratio (S/D) and a pulsatility index (PI) of 2.14 +/- 0.49 and 0.89 +/- 0.17, respectively; (2) a contraction and detachment phase with an S/D and PI of 2.53 +/- 0.53 and 1.28 +/- 0.37, respectively, and (3) an expulsion phase with an S/D and PI of 2.20 +/- 0.34 and 0.91 +/- 0.20, respectively (p < 0.05). During the third stage of labor, it was shown that uterine contractions squeezed the uterine vessels as they traversed the myometrium, leading to an increase in the extrinsic resistance, which was reflected by high resistance flow. Following placental separation and changes in the placental-site wall, there was slight uterine relaxation resulting in decreased uterine vessel resistance. This observation encourages the authors to continue investigating the contribution of ultrasound and Doppler flow for studies of the postpartum period.

Adult↗

PubMed1995

Improved techniques for first-trimester fetal reduction using simultaneous abdominal and transvaginal ultrasonographic guidance. Preliminary report.

Simultaneous transabdominal injection of potassium chloride (KCl) assisted by transvaginal ultrasonographic guidance was evaluated in 5 patients who conceived due to various assisted reproductive techniques and ovarian stimulation. All 5 underwent first-trimester fetal reduction for multiplicity of high-order pregnancies. Four sets of triplets were reduced to twin, and 1 twin pregnancy was reduced to a singleton. Less than 2 ml of 2 mEq/ml KCl per fetus was needed for each case. No fetal or maternal complications nor technical failure attributable to the procedure were recorded. All pregnancies were delivered > or = 35 weeks of gestation. Transabdominal fetal reduction using simultaneous transvaginal ultrasonographic guidance for selective feticide combines the benefits of both the transabdominal and transvaginal approaches, mainly in selected cases in which some experts prefer the abdominal route, but find it technically difficult to practice. Further experience is needed to confirm our encouraging preliminary results before drawing any definitive conclusions.

Abdomen↗

PubMed1995

The level of human decidua-associated protein hDP-200, in uterine fluid and serum.

Prospective uterine fluid sampling in 140 patients was performed using a Wallace catheter. The levels of human decidua-associated protein (hDP)-200 in the uterine fluid and in the serum, and the total protein concentration in the uterine fluid were determined. Uterine fluid volumes were scored during the hysteroscopy and no correlation was found with the phase of the menstrual cycle. The total protein concentration in the uterine fluid did not vary significantly during the menstrual cycle. The hDP-200 levels in uterine fluid were significantly higher than those in the serum, although considerable individual variation in the level of uterine fluid hDP-200 was found.

Body Fluids↗

PubMed1995

Continence mechanism after colpo-needle suspension for stress urinary incontinence.

OBJECTIVE: To determine the mechanism by which continence is restored following the colpo-needle suspension procedure. STUDY DESIGN: During 1990-1991, 37 women underwent colpo-needle suspension for stress urinary incontinence. Urodynamic investigation was performed preoperatively and 6-12 months postoperatively, and the results of these tests were compared in order to define the changes that might be responsible for the restoration of continence. RESULTS: In comparing the preoperative and postoperative cystometric and uroflowmetric measurements, we found no significant differences in the values for bladder capacity, residual volume pressure rise on filling or standing, maximal urethral voiding pressure or peak flow rates. The urethral pressure profiles at rest did not result in statistically significant differences regarding urethral length or urethral pressure. The only such differences postoperatively were elevation of pressure. Transmission ratios on coughing and in the proximal half of the urethra were Q1, 100.3 (P < .001), and Q2, 100.4 (P < .002), respectively. CONCLUSION: Colposuspension appears to correct genuine stress incontinence by repositioning the proximal urethra in the intraabdominal pressure zone, causing restoration of positive pressure transmission to the proximal urethra.

Female↗

PubMed1994

Ultrasonic antepartum assessment of a classical Cesarean uterine scar and diagnosis of dehiscence.

Prior classic incision through the uterine corpus carries the most significant risk of catastrophic uterine rupture and subsequent maternal and fetal morbidity or mortality. A trial of labor is not carried out in this group of patients, but the risk of uterine rupture exists during the antepartum period. An accurate and prospective method for diagnosing the presence of uterine defects or documenting their absence would be clinically useful. Our unusual case emphasizes the obvious need for antepartum sonographic scans of the classic uterine scar, starting from the third trimester to term, using the high-frequency (> 5 MHz) transducer.

Journal Article↗

PubMed1994

The effect of sampling technique on measurement of fetal blood pH and gases--an in vitro system.

OBJECTIVE: Fetal scalp blood for intrapartum pH monitoring is usually collected aerobically in small volumes and may therefore be affected by the mode of sampling. The effect of specimen collection and handling on measured index values of fetal blood acid-base balance was evaluated in an in vitro simulated system. STUDY DESIGN: The system consisted of an air-tight syringe filled with either arterial or venous fresh cord blood and an attached needle with a blunted tip. The rate of blood drop formation at the tip was determined by a variable-speed infusion pump. Two techniques, simulating actual scalp blood sampling, were evaluated: (1) commonly used technique--aspiration of individual drops into a glass tube, transfer into a syringe, and measurement and (2) direct technique--collection as a continuous column of blood into a capillary and subsequent measurement. RESULTS: Control acid-base values obtained before and immediately after completion of each test were not significantly different. Significant changes from control values were noted when sampling by the commonly used technique: mean arterial pH (7.21 to 7.26 and 7.24) and PO2 (19 to 25 and 23 mm Hg) increased, whereas PCO2 decreased (56 to 44 and 47 mm Hg) at slow and fast drop rates, respectively. Changes in venous blood samples were of similar direction and magnitude. Absolute changes from control during sampling by the commonly used technique averaged 21% +/- 2% and 15% +/- 1% (+/- SEM) for slow and fast drop rates, respectively (p < 0.01). On the other hand, sampling by the direct technique did not have a significant effect on measured acid-base values at slow and fast drop rates: absolute changes from control averaged 4.5% +/- 0.4% and 4.7% +/- 1.3% (+/- SEM), respectively. CONCLUSIONS: The mode of fetal scalp blood sampling and handling affects measured acid-base index values. Such changes reflect aeration of small blood volumes and may result in falsely elevated capillary scalp pH. This effect may be prominent when blood drops are slow forming or difficult to obtain.

Acid-Base Equilibrium↗

PubMed1994

Safety of midtrimester pregnancy termination by laminaria and evacuation in patients with previous cesarean section.

OBJECTIVE: The objective of this study was to retrospectively assess whether there was an increased perioperative risk in midtrimester pregnancy termination by laminaria and evacuation associated with a previous uterine scar. STUDY DESIGN: From 1978 to 1993 1064 patients underwent midtrimester (14 to 22 weeks) pregnancy termination by means of laminaria and evacuation. Of these, 70 patients had a previous uterine scar and are the subjects of this study. RESULTS: There were no major operative complications, such as anesthetic complications, perforations, or cervical lacerations, in the entire series. Mean operative time (minutes) for induced abortion was statistically similar in the unscarred compared with the scarred uteri groups (8.03 +/- 4.40 vs 7.46 +/- 4.42, respectively) and was statistically different when the indication for evacuation was missed abortion (6.08 +/- 1.86 vs 4.81 +/- 2.11, respectively; p < 0.005). This difference in operative time could be explained by the number of laminaria tents used in each group. Atony with hemorrhage occurred in two patients who underwent induced abortion, and disseminated intravascular coagulation occurred in eight missed abortion cases, but none had scarred uterus. CONCLUSION: Previous cesarean section scar does not seem to increase the perioperative risk of late termination (14 to 22 weeks) by the laminaria and evacuation technique.

Abortion, Induced↗

PubMed1994

Investigation of the uterine cavity in recurrent aborters.

To prospectively compare the diagnostic ability of both HSG and diagnostic hysteroscopy in recurrent aborters, an HSG followed by a diagnostic hysteroscopy was performed in 106 patients during an investigation into recurrent abortions. The uterine cavity findings on HSG and at hysteroscopy were compared. Among the 60 abnormal HSG patients, intrauterine pathology was demonstrated in 37 (34.9%). Among the 46 normal HSG patients, a normal uterine cavity was found in 33 (31.3%). The sensitivity of the HSG in revealing intrauterine abnormalities was therefore 79% and its specificity 60%. In 23 pathologic HSG, no abnormalities were seen by hysteroscopy. In 13 cases, hysteroscopy demonstrated mild intrauterine findings overlooked by HSG. The false-positive rate was 38% and the false-negative rate was 28%. Hysterosalpingography showed a high false-positive rate, especially in the intrauterine adhesions group. In view of the low specificity and high false-positive and false-negative rates, we believe that hysteroscopic evaluation of the uterine cavity is superior to HSG in recurrent abortions.

Abortion, Habitual↗

PubMed1994

Development of children born after ovarian superovulation induced by long-acting gonadotropin-releasing hormone agonist and menotropins, and by in vitro fertilization.

The use of a gonodotropin-releasing hormone (Gn-RH) agonist in an in vitro fertilization (IVF) program raises the question of any influence on the physical, neurologic, and mental development of the children. We compared the development of children born after long-acting Gn-RH agonist treatment with that of children born after spontaneous pregnancies. Children from singleton pregnancies and > or = 28 months of age were examined by a pediatric neurologist and a psychologist who did not know to which group the children belonged. The General Cognitive Index test was used. Each group included 30 children. Five children cooperated only partly. Physical and neurologic findings were normal in all children, except that one in the group born after in vitro fertilization had diffuse hypotonia, attention-deficit hyperactivity disorder, and hyperactivity. The General Cognitive Index for the 26 children in the study group and the 29 children in the control group who fully cooperated were 102 +/- 13.3 and 106 +/- 13.5, respectively (p = 0.37). The verbal perception, motor, and memory indexes were not significantly different. We conclude that the long-acting Gn-RH agonist had no clinically identifiable influence on the development of these children.

Adult↗

PubMed1994

Ultrasonic control without hormone determination for ovulation induction in in-vitro fertilization/embryo transfer with gonadotrophin-releasing hormone analogue and human menopausal gonadotrophin.

A total of 114 patients admitted to an in-vitro fertilization-embryo transfer programme for the first time, were randomly assigned to the study group or controls. Gonadotrophin-releasing hormone analogue (GnRHa) and human menopausal gonadotrophin (HMG) were used for ovulation induction. The study patients were followed up merely by ultrasonography and the controls by ultrasonography and serum determinations of oestradiol, progesterone and luteinizing hormone (LH). There was no significant difference in the duration and total amount of HMG used for ovulation induction (10.9 versus 11.5 days and 34.8 versus 37.9 ampoules, respectively). The number of oocytes retrieved (11.7 versus 13.4) and the numbers of embryos replaced (2.6 versus 2.8) and cryopreserved (1.9 versus 3.3) were also similar. Pregnancy rates were similar. Pregnancy rate per ovum retrieval was 22.2 versus 25% and per embryo transfer 27.2 versus 26.5%. Oestradiol patterns were also similar. The rate and severity of ovarian hyperstimulation syndrome were virtually identical. We conclude that 'ultrasound-only' monitoring of ovulation induction in IVF cycles treated by GnRHa-HMG in the long protocol is as effective and safe as the conventional ultrasound and hormone determination, but far simpler, swifter and more cost-effective.

Adult↗

PubMed1994

Human decidua-associated protein 200 levels in uterine fluid at hysteroscopy.

Hysterosocpic intrauterine findings and levels of human decidua-associated protein 200 (hDP 200) in the uterine fluid were recorded in 116 women investigated for infertility or recurrent abortions. The levels of hDP 200 were significantly higher in the presence of submucous myomas or endometrial polyps, and lower in the presence of intrauterine adhesions in comparison to those in normal uterine cavities. hDP 200, an immunoglobin secreted by the endometrium, may be involved in implantation and placentation and its level in the uterine cavity is influenced by the presence of intrauterine pathology.

Abortion, Habitual↗

PubMed1994

A new colpo-needle suspension for the surgical treatment of stress incontinence: a 2-year follow-up.

Sixty-three patients with urinary stress incontinence underwent a new colpo-needle suspension procedure. It differs from the other transvaginal bladder neck suspension procedures by using the fixed and stable Cooper ligament as the fixation point for the suspension sutures rather than the unstable and compressible anterior abdominal wall. At 2-year follow-up we obtained a 90.5% cure rate of urinary stress incontinence. We consider the procedure suitable for all patients with genuine stress incontinence. Long-term follow-up is required for further evaluation of this new technique.

Adult↗

PubMed1994

Transvaginal aspiration of ovarian cysts: prognosis based on outcome over a 12-month period.

The success of transvaginal aspiration of ovarian cysts in terms of cyst dimensions, location, and content and the age of the women was evaluated in 35 women aged 17 to 76 years old. Three parameters proved important in predicting the outcome of aspiration: age of the woman (higher age = poorer prognosis for cure), maximum diameter of the cyst (larger diameter = poorer prognosis), and location (left-sided cysts have a poorer prognosis). Prognosis based on outcome indicates aspiration of large cysts should be avoided in older women.

Adult↗

PubMed1994

Endometrial carcinoma developing after cervical amputation: the influence of cervical stenosis on prognosis.

The clinical presentation, surgico-pathologic findings and the outcome are described of seven patients with carcinoma of the endometrium, which developed remote after cervical amputation as a treatment for cervical elongation. In six patients, cervical stenosis prevented early uterine bleeding. Four patients when diagnosed, were in advanced surgical stages of the disease (Stages II and III) and all died thereafter. Three patients with surgical Stage I, had no evidence of disease 33, 96, 151 months, after diagnosis and treatment. The role of cervical stenosis in delayed diagnosis and treatment, and therefore poor prognosis is discussed. When cervical stenosis is anticipated, periodic ultrasonographic evaluation of the endometrium is justified, in order to prevent a delay in making a diagnosis of endometrial carcinoma.

Adenocarcinoma↗

PubMed1994

Enhancement of cytotoxic agent accumulation by Doppler flow sonication of human ovarian cancer cells.

The intracellular accumulation of adriamycin (ADR) by Doppler flow sonication was investigated in a human ovarian carcinoma line. Cytofluorometry was performed on cells treated by ADR (0.5, 1 and 2 micrograms/mL) alone, or in conjunction with Doppler flow sonication for 5, 10, and 15 minutes. Increased intracellular accumulation of ADR was observed in cells treated at each of these test intervals. Statistically significant increases in high permeability, due to Doppler sonication, were around 1.5 fold at each of the test intervals, with a maximum observed at 10 minutes of treatment. Examination of ADR dose effect showed that the most vigorous to Doppler sonication occurred at 1 micrograms/mL ADR. Although statistically non-significant, a trend towards the most prominent egect of 91.6% cell validity was noticed after 15 minutes of treatment. Our findings demonstrate that an improvement of ADR penetration into malignant cells can be obtained in this bioultrasound model. Wowever, caution is advised when extrapolating in vitro experimental results to in vivo phenomena.

Cell Membrane Permeability↗