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Biomedical subjects

I S Fraser

Publications and source records attributed to I S Fraser.

At least 19 recordsLinked to original sources
PubMed1992

Laparoscopic salpingostomy with electrocautery in the management of tubal pregnancy.

From August, 1990 to May, 1991, all cases of tubal pregnancy presenting to King George V Hospital for Mothers and Infants were considered for laparoscopic salpingostomy. This procedure involved opening the affected Fallopian tube with diathermy, removal of ectopic tissue via the laparoscope, achieving haemostasis and leaving the tubal incision to heal by secondary intention. The procedure was undertaken in 35 patients and was successfully performed in 31 patients with an average operating time of 66.4 minutes (+/- 20.1 minutes). Average hospital stay was 2.1 days (+/- 1.3). This paper examines the technique and results of the initial learning curve for laparoscopic salpingostomy and finds that with knowledge of potential hazards and care in surgery, this operation can be safely carried out in a selected group of patients.

Adolescent↗
PubMed1991

A review of the use of progestogen-only minipills for contraception during lactation.

Progestogen-only minipills and other systems for releasing low doses of progestogens alone are widely used for contraception in breast-feeding women around the world. There is good evidence to confirm their acceptability and their lack of effect on milk production, neonatal growth and early development. In contrast, combined oral contraceptives frequently decrease milk production, and may produce minor changes in milk composition. However, even combined oral contraceptives do not appear to produce adverse effects on neonatal well-being and development, although minor reductions in initial growth rate may sometimes occur. Progestogen-only methods may also produce subtle changes in milk composition, although less than combined oral contraceptives. Steroids are transferred from plasma into milk in small quantities, but the amounts are usually very low or insufficient to allow detection in the infants using present-day assays. There has been theoretical concern that these tiny amounts of steroids might affect neonatal reproductive development, but this appears to be unwarranted. Progestogen-only methods are being widely used for post-partum contraception, and they appear to have particular advantages in this situation. They also have few disadvantages; a theoretical concern about a possible effect on later reproductive or sexual development has no evidence to support it. The present licensing situation in Australia, which lists lactation as a relative contraindication to progestogen-only contraceptive use, causes real concern to potential users and appears to lead to frequent errors in compliance.

Contraceptives, Oral, Hormonal↗
PubMed1991

A comparative treatment trial of endometriosis using the gonadotrophin-releasing hormone agonist, nafarelin, and the synthetic steroid, danazol.

A randomized and double-blind trial was carried out comparing intranasal nafarelin acetate (400 micrograms daily) and oral danazol (600 mg daily), given over 6 months, in the treatment of 49 patients with laparoscopically proven endometriosis. Both drugs produced a highly significant and similar reduction (of 60 to 70%) in objective American Fertility Society scoring, even in severe disease. No effect was seen on adhesions. Both drugs suppressed oestradiol levels to a similar extent, although nafarelin caused a substantial rise in the first 2 weeks after the initiation of therapy. Nafarelin suppressed LH substantially and FSH, testosterone and prolactin to a small degree, whereas FSH and LH increased slightly during danazol. Pregnancies occurred in 12 of 22 infertile women in the 12 months following nafarelin, and in 6 of 14 in the danazol group. Side-effects were reported at a similar rate with both drugs, but the pattern was different. Hot flushes were the predominant side effect with nafarelin, although oestradiol levels were not suppressed to the extent expected. Small amounts of spotting or light bleeding were experienced with both drugs, but these tended to decrease with time with nafarelin and increase with danazol.

Administration, Intranasal↗
PubMed1991

Randomized trial of 2 hormonal and 2 prostaglandin-inhibiting agents in women with a complaint of menorrhagia.

A series of 45 ovulatory women with a complaint of menorrhagia were randomized into 3 treatment groups, before receiving therapy with mefenamic acid in 2 cycles and 1 of 3 other agents in 2 cycles: naproxen (group 1; n = 14), a low dose monophasic combined oral contraceptive (group 2; n = 12) or low dose danazol (group 3; n = 12). Menstrual blood loss was measured in 2-4 control cycles and during therapy. Mefenamic acid reduced measured blood loss by 20%; 38%; and 39% in groups 1-3 respectively. Naproxen reduced blood loss by 12%; the oral contraceptive by 43%; and danazol by 49%. There was no statistically significant difference in blood loss reduction (mean of 2 cycles) between any of the treatments, although women on danazol experienced a dramatic and highly significant further reduction in blood loss after the first treatment cycle (p less than 0.003). These were all effective therapies in a majority of women, but some 'non-responders' were seen in each group. The 'non-responders' had a significantly lower pretreatment blood loss than responders. Several women in group 1 showed anomalous responses to prostaglandin inhibitors with consistent and substantial exacerbation of menorrhagia during therapy. A number of reasonable therapies exist for the medical treatment of menorrhagia, but because none is suitable for everyone management needs to be individualized for each patient.

Contraceptives, Oral, Combined↗
PubMed1990

Hysteroscopy and laparoscopy in women with menorrhagia.

Menstrual blood loss was measured in 139 of 182 women who had hysteroscopy after a complaint of menorrhagia, and a preliminary diagnosis of dysfunctional uterine bleeding. Laparoscopy was also performed in 117 of these women; only 51% did not have evidence of organic pelvic disease. In those with menstrual blood loss of less than 60 ml, 75% had no abnormality, compared with only 44% and 36%, respectively, in the moderately heavy and excessively heavy groups. All those with polypoidal or submucous leiomyomas exhibited moderately heavy or excessively heavy bleeding, and so did many of those with superficial intramural or subserous myomas. The highest rate of detection of endometriosis was in women with moderately heavy blood loss, rather than excessive or normal (54% compared with 29% and 23%, respectively), and such women were more likely to have mild stage disease than severe. Other pelvic abnormalities such as adenomyosis, endometrial polyps, pelvic inflammatory disease, and some rarities were also characterized. It is contended that the era of routine, blind diagnostic curettage is now passed, and should be replaced by outpatient or office hysteroscopy accompanied by directed biopsy or curettage.

Adolescent↗
PubMed1990

Polymers of prolactin and their clinical significance.

Elevated levels of prolactin are known to cause a range of disturbances of ovarian function. However, in a small number of women, sustained hyperprolactinemia has been found by chance in association with apparently normal ovarian function and normal fertility. In these women the dominant form of circulating prolactin has been found by gel chromatography to be a polymeric form of large molecular size, 'big-big' prolactin (BBPRL), with similar immunoreactivity to monomeric prolactin (PRL) but much lower biological activity. In a few cases an intermediate polymeric form, 'big' prolactin (BPRL), has also been described. The exact nature and biological significance of polymeric forms of prolactin remain unclear. It has been shown that concentrations of BBPRL in the circulation in individual women change more slowly and less profoundly than concentrations of PRL in various physiological and pharmacological situations. Minor changes occur during the menstrual cycle, while increases of PRL and BBPRL occur progressively during pregnancy. In pregnancy PRL rises much more than BBPRL. Acute stimulation with metoclopramide, TRH, or suckling favors the production of PRL, although BBPRL also rises to a small extent. During treatment with bromocriptine the proportion of PRL in the circulation is markedly reduced, while BBPRL falls to a much lesser extent. Further study is required before it can be proved that BBPRL and BPRL have no biological significance. There is much controversy regarding the structure and mechanism of production of polymeric forms of prolactin. There is no evidence of a circulating factor in serum which binds several molecules to form BBPRL.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1990

Treatment of ovulatory and anovulatory dysfunctional uterine bleeding with oral progestogens.

Six anovulatory and 10 ovulatory women with dysfunctional uterine bleeding (DUB) were treated with cyclical oral progestogens (norethisterone or medroxyprogesterone acetate). Anovulatory women were treated from day 12-25 and ovulatory from day 5-25, in doses of 5-10mg 3 times daily. Measured menstrual blood loss was effectively reduced from control to treatment cycles in both anovulatory (control cycle 131ml; treatment 80 and 64ml) and ovulatory women (control cycles 110 and 113ml; treatment 76 and 71 ml). Three women with ovulatory DUB did not show a useful response. Duration of bleeding was reduced in both groups and the pattern of loss changed. These regimens are effective forms of management for most women with ovulatory or anovulatory DUB.

Adolescent↗
PubMed1989

Serum CA-125 levels in women with endometriosis.

Forty-two women with laparoscopically-confirmed pelvic endometriosis (assessed according to the American Fertility Society modified classification) had serum levels of the cell-surface antigen CA-125 measured before, during and after medical therapy with nafarelin acetate or danazol combined with follow-up laparoscopic surgery or laparotomy. Serum levels before treatment (39.3 [SE 6.6] U/ml) were elevated above accepted normal levels in many subjects, and these were highly significantly suppressed during medical therapy with both nafarlin and danazol (13.1 [SE 1.5] U/ml at 5 months); t = 3.198; p = 0.002). Levels tended to rise following therapy but a clear correlation between a rise in serum CA-125 and recurrence of disease was not demonstrated. In 3 individuals treated with nafarelin a dramatic rise in serum CA-125 levels was seen after 2 weeks of therapy. This did not correlate with any exacerbation of symptoms or with any rise in serum oestradiol or with pretreatment AFS scoring. Serum CA-125 levels provide a potential approach to the monitoring of treatment and recurrence in a substantial proportion of women with endometriosis, although preliminary evidence suggests that there will be individual exceptions to any broad correlations.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1989

Blepharophimosis plus ovarian failure: a likely candidate for a contiguous gene syndrome.

We describe four females from three families with blepharophimosis, epicanthus inversus, and ptosis who were found to have premature ovarian failure. In two families the inheritance was autosomal dominant and in one it was a new mutation. Two females had, in addition, dysmorphic facial features which have been described in other cases. We suggest that the aetiology of the blepharophimosis ovarian failure syndrome is a contiguous gene syndrome.

Adult↗