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Biomedical subjects

J Halme

Publications and source records attributed to J Halme.

At least 37 records · Page 2Linked to original sources
PubMed1988

Sterilization reversal: results of 101 attempts.

One hundred one patients underwent reversal of sterilization. Among the 79 patients with a known outcome, the successful pregnancy rate was 35%. In contrast, the tubal patency rate was 91%. An analysis of standard preoperative fertility factors failed to reveal their predictive value. Total motile sperm counts of greater than 60 x 10(6) resulted in more successful pregnancies than counts below this number (p less than or equal to 0.005). The operating microscope did not have any advantage over loupes. Patients with one tube greater than 7 cm in length had a delivery rate of 75%, compared with 16% for those with shorter tubes (p less than or equal to 0.001). Eighty percent of patients with a distal segment of the anastomosis that included part of the isthmic tube had deliveries (p less than or equal to 0.029). In contrast, all ectopic pregnancies were associated with a distal segment consisting only of ampulla; the risk of ectopic pregnancy after patent ampullary anastomosis was 23% (p less than or equal to 0.05).

Fallopian Tube Patency Tests↗
PubMed1988

Peritoneal macrophages from patients with endometriosis release growth factor activity in vitro.

We studied the in vitro secretion of macrophage-derived growth factor (MDGF) activity by peritoneal macrophages from fertile and infertile women. Peritoneal fluid was obtained from 55 women undergoing laparoscopy for evaluation and treatment of infertility or for tubal sterilization. Isolated macrophages were plated in tissue culture wells and incubated in Dulbecco's Modified Eagle's Medium plus 0.2% lactalbumin hydrolyzate at 37 C for 24 h. Medium MDGF activity was assayed by determining the ability of medium to stimulate [3H] thymidine incorporation in BALB-c 3T3 fibroblasts. Macrophages from 23 women released significant MDGF activity in vitro; the release was linear for up to 72 h. Among the 55 women, macrophages from 10 of 36 (28%) women with normal pelvic anatomy or tubal occlusion/pelvic adhesions released significant MDGF activity. In contrast, macrophages from 13 of 19 (68%) women with endometriosis, a significantly higher proportion (P less than 0.02), released MDGF. The finding that endometriosis is associated with in vivo primed peritoneal macrophages that produce MDGF in vitro may help to explain the proliferation or maintenance of endometrial tissue in the peritoneal cavity.

Animals↗
PubMed1988

Production of fibronectin by peritoneal macrophages and concentration of fibronectin in peritoneal fluid from patients with or without endometriosis.

Fibronectin, a known growth factor for fibroblasts, is produced by alveolar macrophages from patients with interstitial pulmonary fibrosis. Because peritoneal macrophages have been implicated in the disease process of endometriosis, we measured the production of fibronectin by peritoneal macrophages in vitro and the concentration of fibronectin in peritoneal fluid samples. Twenty-nine patients had a normal pelvis, 22 had endometriosis, and 14 had tubal occlusion and/or adhesions. Human peritoneal macrophages demonstrated de novo synthesis of fibronectin. The peritoneal macrophage fibronectin was detected by an enzyme-linked immunosorbent assay for serum fibronectin. Peritoneal macrophages from patients with endometriosis produced approximately three times the amount of fibronectin as normal patients or patients with tubal occlusion and/or adhesions (P less than or equal to .01 and P less than or equal to .02, respectively). The mean peritoneal fluid concentration of fibronectin, however, was about 30% lower in patients with endometriosis than in normal patients (P less than or equal to .02). We suggest that increased peritoneal macrophage fibronectin production in patients with endometriosis may contribute to the adhesion formation and associated reactive fibrosis seen in this disease, and may also influence the implantation of endometrial cells and their subsequent growth in the pelvis.

Ascitic Fluid↗
PubMed1987

Altered maturation and function of peritoneal macrophages: possible role in pathogenesis of endometriosis.

Human peritoneal macrophages from healthy women and patients with endometriosis were analyzed with flow cytometry for size distribution, cell membrane antigen expression, and membrane function. Endometriosis was associated with a significantly increased number of peritoneal macrophages and a higher proportion of large macrophages with increased expression of three antigen markers. Peritoneal macrophages from normal patients exhibited diminished cell membrane capping function as compared with that of endometriosis-related macrophages or blood monocytes. On the basis of these findings, a hypothesis is formulated suggesting that endometriosis is associated with an increased influx of macrophages that are allowed to undergo further maturation-activation. The resultant population of large macrophages may contribute to the maintenance of the disease or associated infertility.

Ascitic Fluid↗
PubMed1987

Peritoneal fluid environment and infertility.

The PF environment is one that hosts the processes of ovulation, gamete transportation, fertilization, and early embryonic development. The cellular and acellular constituents of this dynamic fluid are in a constant interactive state, being influenced by the physiologic events of the menstrual cycle and pelvic disease processes; these constituents probably influence disease manifestation and reproduction. The importance of understanding this zone of early reproductive life has been now recognized. We hope that future investigations will define the exact role(s) of known components and some yet-to-be defined substances of PF in disease processes that affect reproductive function. With better understanding of normal and abnormal events in this pelvic microenvironment, we can develop rationales for novel treatment modalities.

Ascitic Fluid↗
PubMed1987

Semen parameters and fertilization of human oocytes in vitro: a multivariable analysis.

Semen parameters in 195 couples undergoing in vitro fertilization and embryo transfer were studied using multivariable analysis. Semen parameters that correlated most closely with reduced ability to fertilize apparently mature oocytes were a slow rate of foreward progression of sperm and the presence of excess numbers of white cells in semen. In men with semen parameters within the normal range, the hamster egg penetration assay (HEPA) test did not add additional predictive power. In men with suspected semen abnormalities, however, a low attachment rating added some, but minimal, predictive value. None of the predictive methods reported thus far in this or other studies offers sufficient accuracy to reliably identify the men who will prove infertile for in vitro fertilization treatment.

Analysis of Variance↗
PubMed1987

Cyclic changes of peritoneal fluid parameters in normal and infertile patients.

This study compared peritoneal fluid volume, macrophage count, and macrophage concentration by diagnosis and cycle week of 426 patients undergoing laparoscopy. Patient diagnosis and cycle week had no significant interaction. Peritoneal fluid volume was dependent upon cycle week and diagnostic group, but macrophage count depended only upon diagnostic group. Endometriosis was associated with a significantly elevated total number of macrophages. Postovulatory peritoneal fluid volumes were significantly higher than preovulatory values. Cyclic and postovulatory differences in peritoneal fluid volume support proposed pathophysiologic roles.

Ascitic Fluid↗
PubMed1986

Interleukin-1 production and antigen presentation by normal human peritoneal macrophages.

Human peritoneal macrophages from healthy females have been investigated for their capability to produce interleukin-1 (IL-1), their expression of HLA-DR and -DQ, and for their antigen-presenting capacity in concanavalin A, tetanus toxoid (TT), and autologous T-cell proliferative responses. Fifteen out of thirty macrophage populations produced IL-1 but the activity was 1/5 to 1/10 that of peripheral blood mononuclear cells stimulated under similar conditions. High levels of HLA-DR were expressed on all macrophages while lower and more variable levels of DQ were found. All macrophages induced mitogen-dependent T-cell proliferation while the ability to induce a proliferative response to TT was variable, 12/23 tests were positive. In five samples stimulatory capacity of macrophages in the absence of TT was as strong as in the presence of the stimulus, suggesting that in vivo processed immunogen could be responsible for the proliferative response. The surface density of HLA-D-region-determined antigens was not indicative of the macrophages' ability to induce antigen-specific proliferation. IL-1 production, however, correlated with this function. Antigen presentation was not confined exclusively to peritoneal populations consisting of recently immigrant monocyte-like cells, nor were all young macrophages able to present antigen. This may reflect on the diversion of macrophage function by the local environment.

Antigen-Presenting Cells↗
PubMed1986

Positive correlation between body weight, length of human menopausal gonadotropin stimulation, and oocyte fertilization rate.

One hundred four normally cycling women were treated with fixed low-dose human menopausal gonadotropin (hMG) (2 ampules/day) in preparation for oocyte aspiration for in vitro fertilization. The response rate was related to age, weight, and the ratios weight/height2 and weight/height. The required dose of hMG was related to total body weight, but not to age or either of the weight/height ratios. In patients who required fewer than 5 days of hMG (rapid responders), a significantly higher number (P less than 0.02) of oocytes were harvested, compared with slow responders. However, a smaller percentage of the oocytes from rapid responders fertilized (P less than 0.003) and resulted in a reduced rate of embryo transfer. The difference in pregnancy rates was not statistically significant. The results of the study suggest that patients undergoing in vitro fertilization who weigh less than 55 kg may benefit from treatment with a lower dose of hMG to prolong the stimulation cycle.

Adult↗
PubMed1986

Analysis of deoxyribonucleic acid distribution in noncleaving oocytes from patients undergoing in vitro fertilization.

The purpose of this study was to describe the quantity and distribution of deoxyribonucleic acid (DNA) in oocytes that did not fertilize or did fertilize and failed to cleave, from patients who underwent in vitro fertilization. Patients were selected with at least one cleaving egg, so that the sperm population was known to be fertile, and failure of fertilization or cleavage in the remaining oocytes could be attributed to nonspermatozoan factors. The noncleaving oocytes were classified into five categories, the majority of which (71%) lacked a polar body and any morphologically identifiable nucleus or germinal vesicle. Three general defects were found: failure to replicate the DNA properly; failure to package the DNA properly; and failure to organize the nuclear material properly after sperm penetration. It is concluded that either altered stimulation protocols or altered in vitro maturation conditions are needed to increase the average number of normal embryos available for transfer.

Cleavage Stage, Ovum↗
PubMed1986

A comparison of peritoneal fluid parameters of infertile patients and the subsequent occurrence of pregnancy.

The effects of peritoneal fluid or its cellular components on human oocyte fertilization and cleavage cannot be studied directly. This report explores the association of laparoscopically obtained peritoneal fluid volume, macrophage count, and concentration of 124 infertility patients and their first occurrence of pregnancy during a 2-year follow-up period. Endometriosis patients who achieved pregnancy had a significantly lower mean fluid volume than those remaining nonpregnant. In patients with endometriosis, a fluid volume significantly less than the mean for all endometriosis patients carries a significantly greater chance of pregnancy. The time required for the occurrence of pregnancy in patients with endometriosis appears influenced by peritoneal fluid volume. Peritoneal fluid of patients with endometriosis, via an as yet unknown mechanism or substance, appears to be associated with reduced fertility.

Ascitic Fluid↗
PubMed1986

Increased collagenase activity in human rheumatoid meniscus.

Collagenase activity of the knee joint menisci of patients suffering from rheumatoid arthritis was approximately 3-fold higher than that found in menisci of control patients. The mean collagenase activity in the macroscopically more diseased parts of the rheumatoid menisci was significantly higher than that in the less damaged areas. The specific degradation products resulting from the cleavage of human meniscoid type II collagen by rheumatoid meniscoid collagenase were demonstrated by SDS-polyacrylamide gel electrophoresis. Addition of N-ethylmaleimide, which activates latent mammalian collagenases, did not further increase collagenase activity in rheumatoid menisci. Thus in rheumatoid meniscus, collagenase may be synthesized and then activated, probably by proteolytic enzymes involved in the inflammatory reaction.

Arthritis, Rheumatoid↗
PubMed1985

Phagocytosis by receptors for C3b (CR1), iC3b (CR3), and IgG (Fc) on human peritoneal macrophages.

Human peritoneal macrophages (HPM) obtained via laparoscopy were examined for the presence and functional capacity of complement and Fc receptors. Between 5 and 20 ml of peritoneal fluid containing 1-2 X 10(6) macrophages/ml was available for each study. Macrophages made up 80-95% of the cells in the fluid. Fc and C3 receptors on HPM were characterized by rosette formation with, and phagocytosis of, IgG- and C3-coated sheep erythrocytes (E). ElgG were bound by 82% and ingested by 63% of HPM, with 4-15 E ingested/HPM. The HPM formed rosettes with EC3b (56%) and EC3bi (71%) but not EC3d,g or EC3d. Antibodies to complement receptors type 1 (CR1) and type 3 (CR3) inhibited rosette formation with EC3b and EC3bi, respectively, indicating that HPM possessed separate and distinct receptors for the C3b and iC3b ligands. In 60% of the samples studied, HPM demonstrated the ability to ingest both EC3b and EC3bi, as well as ElgG. Because of the heterogeneous nature of the cells obtained in peritoneal fluid, due to their progressive change from monocytelike cells into mature macrophages, HPM were separated by 1 g velocity sedimentation into fractions of increasing maturity. They were then examined for phagocytosis via Fc and complement receptors. Fc receptor mediated phagocytosis occurred throughout the monocyte-to-macrophage maturation sequence, while the ability of HPM to ingest via CR1 and CR3 was maturation dependent, with ingestion via CR3 occurring before CR1, in a manner analogous to in vitro differentiation of monocyte-derived macrophages.

Erythrocytes↗
PubMed1985

Peritoneal macrophages modulate human granulosa-luteal cell progesterone production.

Macrophages have been identified in the developing corpus luteum in several species, including man, and also constitute approximately 90% of cells in the peritoneal cavity. We studied the effect of peritoneal macrophages or blood monocytes on progesterone (P) synthesis by human granulosa cells from preovulatory follicles obtained at laparoscopy of 14 women undergoing in vitro fertilization. Pooled granulosa cells from follicles with mature ova were isolated by Ficoll-Hypaque gradient centrifugation. Washed granulosa cells (0.75 X 10(5)/ml) were incubated in Dulbecco's Minimum Essential Medium containing 20% calf serum with varying concentrations of pelvic macrophages (0.8-29 X 10(5)/ml) or fresh and mature blood monocytes (0.25-2.5 X 10(5)/ml). P production was determined by RIA of medium at 24-h intervals for 24-48 h. In situ concentrations of pelvic macrophages from 8 patients with tubal infertility increased cumulative P production to 140 +/- 17.8% (mean +/- SEM) of the control values. A similar increase (182 +/- 62.7%) was found with macrophages from 6 patients with endometriosis or unexplained infertility. Both fresh and mature monocytes stimulated P production to 225% and 261% of control values, respectively. Indomethacin (10(-4) M) or monoclonal antibody to somatomedin-C did not prevent stimulation of P production. These results suggest that peritoneal macrophages may exert luteotropic effects on cumulus cells while the ovulated oocyte resides in the tube, and incoming monocytes may be important in stimulating luteal cells in the developing corpus luteum.

Adult↗
PubMed1985

Endometriosis with massive ascites.

One case of extensive endometriosis with ascites in a young nulliparous woman is reported. The patient had been maintained on suppressive therapy with danazol for over two years, demonstrating the feasibility of conservative management in this extremely rare form of endometriosis. However, long-term efficacy and potential for fertility remain to be determined.

Adult↗
PubMed1984

Accentuated cyclic activation of peritoneal macrophages in patients with endometriosis.

Peritoneal fluid was collected from 107 women undergoing laparoscopic sterilization or diagnostic laparoscopy for evaluation of infertility. Cells consisting mainly of macrophages were separated and subjected to sophisticated flow fluorocytometric analysis. In this way more detailed information was obtained about activational characteristics of the pelvic macrophage population during the menstrual cycle. In normal women the macrophages, as compared to peripheral monocytes, showed evidence of elevated baseline activation, and a gradual increase in several markers occurred during the menstrual cycle. Cells increased in size, lost their ability to stain for myeloperoxidase, and increased in activity of both endoenzymes and ectoenzymes. These results suggest that female peritoneal macrophages are continuously responding to stimuli. The macrophage irritation was much more pronounced in women with mild endometriosis. This accentuated cyclic activation may represent an inflammatory response to bleeding from ectopic implants or retrograde menstruation or may be a consequence of some defect in the cell-mediated immune response in endometriosis.

Ascitic Fluid↗