Biomedical subjects
Publications and source records attributed to J Gerris.
A 35-yr-old G7P6A0 presented at 28 weeks of gestation with an acute polyhydramnios. On ultrasonographic examination the diagnosis of trisomy 18 in the fetus was suspected. This was confirmed by chromosome analysis of the cultured amniocytes. The value of a systematic ultrasonographic examination, especially in every abnormal pregnancy, is briefly discussed.
The clinical and metabolic effects of equine estrogen and dydrogesterone combined therapy were investigated in twenty healthy women aged 45 to 59 years with menopausal complaints. Equine estrogens (0.625 mg per day) were given for 2 months, then dydrogesterone (20 mg daily) was cyclically added for 12 days per month, during an additional period of 6 months. The combination was very efficacious in reducing complaints, with a limited number of side effects. Blood pressure, body weight and cervical smears were unaffected. No influence on glucose tolerance, liver or blood coagulation parameters was seen. A VLDL cholesterol decrease of 41% and an increase in apo AI concentrations of 41% was observed. Total, HDL and LDL cholesterol remained almost unaltered, as well as the total:HDL cholesterol ratio. We conclude that the use of the equine estrogen-dydrogesterone combination provides an efficacious, acceptable and probably safe therapy for menopausal complaints.
Pregnant women treated with intravenous beta-sympathomimetics for acute or chronic tocolysis often show cardiovascular side-effects, mainly tachyarrhythmias, and electrolyte disorders, mainly hypokaliemia. Both create a potential hazard at the moment of induction of general anesthesia. For these patients one will use drugs exhibiting minimal hemodynamic side-effects and no oxytocic activity. Barbiturates as induction agent, and intravenous analgesics for maintenance of anesthesia after extraction of the neonate represent the safest solution. A short delay of ten minutes between administration of the beta-mimetic and induction of anesthesia avoids the coincidence of the maximal cardiovascular effects of the beta-mimetic with the stress of induction, and allows adequate preoxygenation of the patient.
A rare case of acute hyperthyroidism during pregnancy is described and the management is discussed. Prompt subtotal thyroidectomy may be superior to the use of antithyroid drugs in particular circumstances. Fetal outcome of hyperthyroid mothers is discussed in the light of recent long-term follow-up studies and immunogenetic data. Women considered to be hyperthyroid are at high-risk for obstetrical and neonatal problems: early diagnosis of this condition is of paramount importance.
The uterine inhibitory effect and potential maternal and fetal side effects of two beta-mimetic compounds, ritodrine hydrochloride and fenoterol hydrobromide, were compared in a randomized trial. The drugs were administered by intravenous infusion to 24 healthy term nulliparous women during effective first-stage labour; each of them received fenoterol (1, 2, or 4 microgram/min) or ritodrine (100, 200, or 400 microgram/min). There was no difference between the drugs in the intensity of the uterine inhibition. However, for a similar inhibitory effect, the duration of tocolysis was longer after ritodrine. During the intrapartum and neonatal periods, neither compound induced any change in the fetal parameters investigated, and their effects on maternal parameters were comparable.
Thirty-three gravidas undergoing chronic tocolysis with ritodrine were assessed with respect to potential drug-induced cardiotoxic effects. The immunological and electrophoretic determination of serum creatine kinase activity gave no indication of such effects. The results of this study confirm the significant increase reported for the serum activity of the MB, BB, and MM creatine kinase isoenzymes during the post-partum period. In most cases no difference was found between the isoenzyme distribution pattern characterizing acute myocardial infarction and normal labor, and therefore the measurement of serum creatine kinase activity during labor has no value for the diagnosis of acute myocardial infarction.
A randomized study to evaluate the effect of natural estrogens on the unripe uterine term cervix was conducted. One hundred and five term gravidas were studied, of whom 70 were treated with 180 mg 17 beta-estradiol or 250 mg estriol (treated women) and 35 were treated with gel only (control group). In all subjects the distented Foley catheter used for the instillation was left in situ. Twelve hours after the instillation there was no apparent difference in mean cervical progress between treated women and controls and the rather unexpected degree of cervical ripening is atributed to the intra-uterine balloon catheter. The procedure could not be shown to have any untoward effect on the mother or the fetus.
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Pre-induction ripening of the unfavorable cervix was attempted in 104 normal term gravidas by means of a single extra-amniotic instillation of a viscous gel containing 0.5 mg prostaglandin E2. The procedure was highly successful and no adverse effect on mother or fetus was observed.
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The conventional sperm characteristics of density (millions per milliliter) and motility, scored in a semi-subjective way, were correlated with results of an on-going in vitro fertilization and embryo transfer program. No male infertility patients were included in this study. Individual characteristics of the "successful" ejaculates are described. Sperm densities in the original ejaculate of more than 10 X 10(6) spermatozoa/ml did not significantly improve outcome (P less than 0.01). In contrast, sperm motility seemed to play the most important role, since most pregnancies (12/14) occurred using sperm samples with greater than or equal to 60% total motility (P less than 0.001). The incidence of multipronuclear fertilization is also described and discussed. These data, which were collected during 1984 in the in vitro fertilization unit of Professor R. Schoysman and coworkers (Vilvoorde, Brussels), may help to make fertilization in vitro and embryo transfer a viable method in cases of mild male subfertility, and to provide guidance in preparing some couples for the combined use of husband and donor semen if a sufficient number of oocytes are obtained.
Although masturbation is the standard method for the collection of a sperm sample, both for diagnostic and therapeutic purposes, other approaches have been described and assessed. Production of semen using specially designed condoms has been shown to result in samples with better laboratory characteristics than samples obtained after masturbation or coitus interruptus. However, this has not resulted in a general acceptance and use of this approach, except in special circumstances where masturbation is impossible or unacceptable. Direct retrieval of spermatozoa from morning urine is another method which has been used to study spermache in boys, but not to treat infertility. Sperm production techniques such as vibro- and electrostimulation are dealt with elsewhere, as are surgical retrieval techniques used in azoospermia.
Sixty-three patients treated with exogenous gonadotropins for a total of 232 non-IVF cycles were monitored by serum E2 and/or total urinary estrogen excretion. The endocrine profile of follicular phase during HMG-HCG stimulation was evaluated with regard to an effect on the pregnancy rate. Six different follicular phase patterns were observed: A-profiles (daily exponential increase of sE2 or total urinary estrogen values followed by a sustained exponential increase on the day after HCG injection) seem to be necessary to obtain pregnancy, being followed by conception in 21.5% of all cases. Other profiles have lower conception rate (10%); no conception occurred when non exponential E2 rise was observed. The different responses are not related to total dosage of HLG administered. Patients who were treated for hypogonadotropic hypogonadism had a high pregnancy rate (80%) even in absence of post-HCG estrogen rise (G-endocrine profiles. Women aged 35 years must have significantly higher doses of gonadotropins to obtain A-profiles. Monitoring by E2 seems to be more adequate than the TUE only (conceptual pregnancy rate/cycle of 15.25%, versus 10.34%). In conception cycle, midluteal E2/P ratio never exceeds 50.
A positive correlation is found between the ATP concentration and the sperm motility characteristics. So ATP measurement may contribute to a better selection of patients; in vases of asthenospermia, a differential diagnosis between ultrastructural abnormalities and problems related to energy supply is possible without the expensive electron microscopy.
Chlamydia Trachomatis is the most important etiological agent of idiopathic epididymitis in men of 35 years or younger, whereas coliform bacteria are more frequent in older men. The Authors report their findings in a group of eighteen patients investigated in order to establish whether, years after the acute or subclinical infection, arguments could be found to hold Chlamydiae responsible for the origin of epidydimal infertility.
Up to now little or no attention has been paid to the tunica vaginalis fluid (TVF), that is usually found between the inner and outer layers of the tunica vaginalis of the testis. The aim of this work is to evaluate in 33 patients whether TVF may be considered to reflect to some extent male gametogenic function. Authors' data support the view that TVF is probably a transudate reflecting concentration of steroid hormone levels at the site of their action.
A twelve-year follow-up study covering 1291 infertile couples in whom the male suffered from idiopathic oligoteratoasthenospermia, reveals that spontaneous pregnancy rates are directly dependent on the mean density of motile spermatozoa per milliliter of ejaculate. The results are direct evidence for the fact that no lower threshold density exists below which pregnancy is impossible. Conversely, the duration of infertility provides an important prognostic element in a given couple's fertility work-up. Full diagnostic work-up of females married to oligospermic males is advocated. Any andrological therapy in O.T.A.-patients should yield results that are significantly better than spontaneous conception rates. Time itself is considered not only a diagnostic and prognostic tool, but an effective and cheap therapeutic.