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Biomedical subjects

J A Kahn

Publications and source records attributed to J A Kahn.

At least 37 records · Page 2Linked to original sources
PubMed1996

Practice management, health maintenance, and the use of computers in today's medical office.

It is clear that a successful medical practice needs a competent caring physician as well as office personnel who understand how to manage an office. The successful management of a practice helps achieve the goals that the physician and practice manager have established. This article has introduced ideas about how to manage and evaluate a practice. Adoption of some or all of these ideas helps provide more comprehensive and satisfying care for the physician and his or her patients.

Management Information Systems↗
PubMed1993

[Fertilization in vitro--how large a proportion of couples will have a child?].

In Norway, the efficacy and the efficiency of IVF treatment for infertile couples have been questioned. Information about this topic is important for the general public, the infertile population, the gynaecologists and the health authorities. We have followed a cohort of 485 infertile couples accepted for in vitro fertilization treatment. During a 14 month period starting 1 January 1989 a total of 214 women have either delivered or are pregnant in the second or third trimester. This number represents 44% of the 485 women accepted for IVF treatment, irrespective of whether they were treated or not, and 50% of the couples who completed at least one IVF cycle. There was no difference in cycle efficiency (pregnancy rate) between the first to third cycle, but this was significantly lower in cycle 4-6. There was no difference in delivery rate between groups of patients with different diagnoses of female infertility, but an additional male factor reduced the delivery rate significantly. Replacement of cryopreserved/thawed embryos gave a 5% increase in the delivery rate per couple included in the study, and an increase of 13% in the number of deliveries.

Birth Rate↗
PubMed1993

The efficacy and efficiency of an in-vitro fertilization programme including embryo cryopreservation: a cohort study.

A cohort of 485 couples starting their first in-vitro fertilization (IVF) attempt between January, 1989 and February, 1991 inclusive, were followed until June 1, 1992. A total of 1086 treatment cycles were initiated (mean 2.2, range 1-6). Of these, 235 (21.8%) cycles were cancelled, giving a total of 851 embryo replacements (mean 1.7, range 1-5). After IVF treatment, 189 women have either delivered or have an ongoing pregnancy in the second or third trimester. This gives a baby take-home rate of 17.4% per started cycle and 22.2% per embryo replacement. For 91 (18.6%) of the couples, the treatment was abandoned prior to completion of the three scheduled IVF attempts and 57 (11.7%) of these had no completed IVF cycles. In the group of couples with reduced sperm quality, the delivery rate was significantly lower than that of the other groups. A total of 193 women had embryos cryopreserved in at least one IVF cycle; 124 of these women started a frozen embryo replacement cycle and 88 had at least one cycle with replacement of frozen/thawed embryos, resulting in 25 deliveries/ongoing pregnancies. Due to the Norwegian law on assisted procreation 65 (33.7%) of the women have had their frozen embryos thawed and discarded after 12 months of storage. The cryopreservation programme, with the limitations of the Norwegian law, gives a 5.2% increase in the baby take-home rate for women entering the IVF programme, an increase of 13.2% in the number of ongoing pregnancies/deliveries and an 11.6% increase in number of children/viable fetuses.(ABSTRACT TRUNCATED AT 250 WORDS)

Cryopreservation↗
PubMed1993

Fallopian tube sperm perfusion (FSP) versus intra-uterine insemination (IUI) in the treatment of unexplained infertility: a prospective randomized study.

Prospective randomization of 60 couples with unexplained infertility was performed for treatment either with intrauterine insemination (IUI), using a volume of 0.5 ml of the inseminate, or Fallopian tube sperm perfusion (FSP), using a volume of 4 ml of inseminate. The protocols for ovarian stimulation and induction of ovulation were the same in the two groups. The two groups were similar concerning age of the female at the start of treatment and the number of follicles > 15 mm diameter, the serum oestradiol concentrations and the endometrial thickness on the day of human chorionic gonadotrophin (HCG) administration. The mean (+/- SD) number of motile spermatozoa inseminated was significantly higher in the FSP group than in the IUI group (52 +/- 5 x 10(6) and 28 +/- 3 x 10(6) respectively). In the FSP group, 30 women were given a total of 52 treatment cycles; 14 clinical pregnancies occurred in this group, giving a pregnancy rate of 26.9% per cycle and 46.7% per woman. In the IUI group, 28 women were given a total of 51 treatment cycles; five clinical pregnancies occurred, giving a pregnancy rate of 9.8% per cycle and 17.9% per woman. The pregnancy rates per cycle and per woman in the FSP group were significantly higher than in the IUI group (P < 0.05, chi-square test). This study indicates that in the treatment of couples with unexplained infertility, Fallopian tube sperm perfusion (FSP) is more successful than intra-uterine insemination (IUI).

Adult↗
PubMed1993

Formation of antisperm antibodies in women treated with fallopian tube sperm perfusion.

Fallopian tube sperm perfusion (FSP) is a combination of ovarian stimulation and intra-uterine insemination using a large volume (4 ml) of inseminate containing 10(7)-10(8) spermatozoa. The inseminate will flush the Fallopian tubes and some of it will end up in the pouch of Douglas. In the present study, we have investigated whether the FSP method will result in the formation of serum antisperm antibodies in the female. A total of 184 treatment cycles were given to 128 women. The indications for treatment were: unexplained infertility (n = 35), various infertility diagnoses (n = 28) and donor insemination (n = 65). Prior to treatment, 11 (8.6%) women had a positive tray-agglutination test (Friberg) and/or a positive immunobead test. After completing one to four treatment cycles, another six (4.7%) women had developed serum antisperm antibodies. The antibodies induced by the treatment were of isotype IgM and directed against the tail-tip of the spermatozoa. Two of the women, who prior to the treatment had antisperm antibodies, showed an increase in antibody titre during treatment. There was no statistically significant difference in the pregnancy rate between the women with antisperm antibodies and the women without. In our opinion, the small risk of developing antisperm antibodies is no contra-indication for treating infertile couples with FSP.

Adult↗
PubMed1993

Modulation of insulin receptor, insulin receptor substrate-1, and phosphatidylinositol 3-kinase in liver and muscle of dexamethasone-treated rats.

Insulin rapidly stimulates tyrosine kinase activity of its receptor resulting in phosphorylation of its cytosolic substrate, insulin receptor substrate-1 (IRS-1), which in turn associates with phosphatidylinositol 3-kinase (PI 3-kinase), thus activating the enzyme. Glucocorticoid treatment is known to produce insulin resistance, but the exact molecular mechanism is unknown. In the present study we have examined the levels and phosphorylation state of the insulin receptor and IRS-1, as well as the association/activation between IRS-1 and PI 3-kinase in the liver and muscle of rats treated with dexamethasone. After dexamethasone treatment (1 mg/kg per d for 5 d), there was no change in insulin receptor concentration in liver of rats as determined by immunoblotting with antibody to the COOH-terminus of the receptor. However, insulin stimulation of receptor autophosphorylation determined by immunoblotting with antiphosphotyrosine antibody was reduced by 46.7 +/- 9.1%. IRS-1 and PI 3-kinase protein levels increased in liver of dexamethasone-treated animals by 73 and 25%, respectively (P < 0.05). By contrast, IRS-1 phosphorylation was decreased by 31.3 +/- 10.9% (P < 0.05), and insulin stimulated PI 3-kinase activity in anti-IRS-1 immunoprecipitates was decreased by 79.5 +/- 11.2% (P < 0.02). In muscle, the changes were less dramatic, and often in opposite direction of those observed in liver. Thus, there was no significant change in insulin receptor level or phosphorylation after dexamethasone treatment. IRS-1 and PI 3-kinase levels were decreased to 38.6 and 65.6%, respectively (P < 0.01 and P < 0.05). IRS-1 phosphorylation showed no significant change in muscle, but insulin-stimulated IRS-1 associated PI 3-kinase was decreased by 41%. Thus, dexamethasone has differential effects on the proteins involved in the early steps in insulin action in liver and muscle. In both tissues, dexamethasone treatment results in a reduction in insulin-stimulated IRS-1-associated P I3-kinase, which may play a role in the pathogenesis of insulin resistance at the cellular level in these animals.

Amino Acid Sequence↗
PubMed1993

Treatment of unexplained infertility. Fallopian tube sperm perfusion (FSP).

PATIENTS AND METHODS: Fifty-one couples with unexplained infertility were enrolled in the fallopian tube sperm perfusion (FSP) program. FSP is in short a combination of ovarian hyperstimulation, ovulation induction and intrauterine and intrafallopian tube insemination using a sperm suspension of 4 ml volume. RESULTS: One hundred cycles were started; 93 of these were completed, resulting in 27 pregnancies (29.0% per cycle). The pregnancy rate in the first treatment cycle (41.2%) was significantly higher than in the subsequent treatment cycles (14.3%, p < 0.01). Total pregnancy loss was 22.2% (2 ectopic pregnancies and 4 spontaneous abortions). The multiple birth rate was 14.2% (two sets of twins and one set of triplets). Twenty-two couples not conceiving following a maximum of three FSP treatment, were offered IVF treatment. Forty-three IVF cycles were started resulting in 27 embryo replacements in 15 patients. Seven pregnancies occurred in six couples. In 11 of the couples treated, IVF treatment revealed a possible explanation for the infertility; development of multiple small follicles following ovarian hyperstimulation, empty follicle syndrome and partial or total fertilization failure. Only in five of the couples who did not conceive, no cause for the infertility could be found. CONCLUSIONS: In the treatment of couples with unexplained infertility, the FSP procedure seems to give a birth rate of about 40% in less than two treatment cycles. FSP is less invasive and less expensive than alternative procedures such as GIFT, ZIFT and IVF and does not require the expertise and facilities for culturing of human oocytes and embryos.

Fallopian Tubes↗
PubMed1992

Fallopian tube sperm perfusion: first clinical experience.

We have developed an insemination method using a large (4 ml) volume of the inseminate. This method incorporates ovarian stimulation, isolation of an optimal number of motile spermatozoa and, finally, Fallopian tube sperm perfusion (FSP). In a clinical study, 139 couples with various causes of infertility, had a total of 239 treatment cycles. The pregnancy rate per treatment in groups with endometriosis, ovulation disorders, tubal impairment, combined male and female factors and subnormal sperm quality were low, ranging from 2.7% to 7.7%. In patients with unexplained infertility, the pregnancy rate per treatment was 26.9% and for this group, the pregnancy rate in the first treatment cycle was 37.3%. In the cervical hostility group, two pregnancies occurred after five treatments. FSP seems to be a favourable treatment for couples with cervical hostility or unexplained infertility. About half of the women in these groups conceived after three treatment cycles. FSP is easier to perform and is less expensive than other methods of assisted procreation, such as in vitro fertilization and gamete intra-Fallopian transfer.

Adult↗
PubMed1992

Fallopian tube sperm perfusion used in a donor insemination programme.

Ninety-six couples were enrolled in a programme of Fallopian tube sperm perfusion (FSP). FSP is a method combining ovarian stimulation, ovulation induction and intra-uterine insemination with a 4 ml volume of sperm suspension. Frozen/thawed donor semen was used in all cycles. A total of 196 treatment cycles were started and of these 172 were completed. Twenty cycles were cancelled because of maturation of too many follicles, a low ovarian response, or formation of ovarian cysts. Five of the women enrolled in the programme did not have any inseminations. Forty-eight pregnancies occurred (27.9% per cycle) among 45 women (49.5%). There were five spontaneous abortions and one ectopic pregnancy. Sixteen pregnancies are on-going (greater than 12 weeks) and 26 women have delivered (including two sets of triplets and one set of twins). The pregnancy rate declined from the first attempt (34.1%) to the fourth attempt (14.3%). The pregnancy rate was significantly higher in women with three to five mature follicles compared to women with two or fewer mature follicles (P less than 0.05). Cycles in which human chorionic gonadotrophin (HCG) was administered on day 11 or later had a higher pregnancy rate than cycles where HCG was administered on day 10 (P less than 0.01). There was no difference in pregnancy rates between insemination with 8-10 x 10(6) motile spermatozoa and insemination with greater than 30 x 10(6) motile spermatozoa. FSP used in a programme of artificial insemination by donor using frozen/thawed donor semen is relatively simple to perform and gives a high pregnancy rate per cycle.

Adult↗
PubMed1992

Interactive query workstation: a demonstration of the practical use of UMLS knowledge sources.

The Interactive Query Workstation (IQW) has been developed to provide clinicians with a uniform program interface for retrieving medical-related information from various computer-based information resources. These resources can vary in content (bibliographic databases, drug information, general medical text databases), function (article retrieval, differential diagnosis, drug interaction detection, or drug dosage and administration information), and media formats (local hard disk, CD-ROM, local area network, or distant telecommunication link). IQW allows modular addition of new resources as well as extension of previously installed resources. The National Library of Medicine's three Unified Medical Language System (UMLS) Knowledge Sources, the Metathesaurus (Meta), the Semantic Network, and the Information Sources Map (ISM) have been incorporated into many aspects of IQW. Meta provides information about medical terminology and aids IQW in isolating the basic concepts from a clinician's question. The Semantic Network provides information about the categorization of concepts and possible relations between concepts. It also assists IQW in determining which queries are appropriate for a set of concepts contained in the clinician's question. The ISM provides information about the content available from a computer-based resources and aids IQW in selecting an appropriate resource from which to collect information. The computer-based resource selection is performed without user intervention. This interactive demonstration shows an environment which increases the accessibility of medical information to clinicians by utilizing the three UMLS Knowledge Sources.

Information Storage and Retrieval↗