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Biomedical subjects

J J Amy

Publications and source records attributed to J J Amy.

62 records · Page 4Linked to original sources
PubMedDate not supplied

A case of partial sirenomelia and possible vitamin A teratogenesis.

Prenatal echographical findings of a partial sirenomelic fetus are described. An attempt was made to terminate pregnancy by administration of prostaglandin F2 alpha, but uterine rupture occurred. The teratogenic role of vitamin A ingested by the mother in the periconceptional period is discussed.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

Hormones and menopause: pro.

Since the publication of the first controlled randomised trials with disease event outcomes, it has become fashionable to denigrate hormone replacement therapy (HRT). The lack of protection against cardiovascular disease and the moderate increase of the risk of developing breast cancer and other ailments were given wide publicity by the lay press, which caused a considerable anxiety among users. The fact that a similar or even greater increase in the risk of developing a breast carcinoma is associated with a menarche before the age of 11 years, nulliparity, a first pregnancy after the age of 35 years, obesity, and moderate alcohol consumption was not mentioned. As a consequence, the adverse effects were put out of perspective and public opinion--including the medical profession--was blatantly misled. The reporting by medical journals was frequently equally biased. In the light of available evidence one can objectively state that HRT tailored to the needs of the individual woman and started around or shortly after the menopause improves her quality of life at the cost of a negligible risk. Oestrogens are ideally administered parenterally. In women who did not undergo a previous hysterectomy, the progestin should be delivered in the uterine cavity rather than systemically, which might lead to a lesser risk of breast malignancy. Indeed, this latter is not or not significantly increased when unopposed oestrogens are administered. Likewise, the risks of cardiovascular disease and stroke are not increased in treated women, aged 50-59 years. In older women, HRT initiated in the perimenopause can be continued using lower doses.

Aged↗
PubMedDate not supplied

Incidence, recurrence and treatment of the luteinized unruptured follicle syndrome.

The frequency of the luteinized unruptured follicle (LUF) was determined in a population of 220 regularly cycling women, infertile for at least two years. Laparoscopy was performed during the very first days of the luteal phase. In 26 women without other demonstrable cause of infertility, a diagnosis of LUF was made based on the absence of an ovulation stigma and the low concentrations of progesterone (P) and 17 beta-oestradiol (E2) in peritoneal fluid (PF). Twenty of these 26 women underwent a culdocentesis 72-96 hours after the serum LH-rise in a following cycle. In 19 out of 20, low P and E2 concentrations in PF were again found, suggesting the recurrence of LUF. Subsequently, ovulation was induced with human menopausal gonadotrophins (hMG) alone (n = 4), or in combination with human chorionic gonadotrophin (hCG, n = 9). At carefully timed culdocentesis (at LH/hCG + 72-96 hours), P concentration in PF was high in the hMG-hCG treated women but remained low in those given hMG alone. The combination of hMG and hCG may be a valuable treatment of LUF.

Anovulation↗
PubMedDate not supplied

Vaginal hysterectomy.

The authors report on their experience of vaginal hysterectomy in a prospective series of 14 patients with myomatous uteri of the size of 14 to 20 weeks' gestation. The mean uterine volume at the time of surgery was that of 16 1/2 weeks' gestation. The largest myoma had a diameter of 11.6 cm. Five of the patients were also scheduled to undergo bilateral oophorectomy. The paracervical tissues were infiltrated with a dilute solution of lignocaine and adrenaline. Circumferential incision and reflection of the vaginal wall, dissection of the bladder cephalad, opening of the vesico-uterine fold anteriorly and the pouch of Douglas posteriorly were performed initially. This was followed by clamping, division and ligation of the sacro-uterine and cardinal ligaments and of the uterine vessels, as is done during a vaginal hysterectomy. The next step depended on the size and other features of the uterine corpus and included bisection, myomectomy, morcellation and coring. BISECTION: The cervix was grasped on both sides and the uterus was bisected sagittally towards the fundus, using a knife. The bisection, carried out first along the posterior uterine wall, was aided by the repeated repositioning of the vulsella close to the apex of the incision, combined with rotation of the cervical portion of the uterus around the public arch. If necessary, the uterus was rotated back to its original position and the bisection pursued anteriorly. Complete bisection often allowed half the uterus to be delivered through the vagina and the ovarian pedicle to be secured; the same was then done with the other half of the uterus. Myomectomy was frequently combined with bisection or morcellation. Smaller myomas were removed in one piece while larger ones were morcellated and removed in fragments, one of the vulsella always being attached to the residual bulk of the myoma. Morcellation was carried out on the uterus when despite bisection or myomectomy no further descent was possible. Bisection was recommenced as soon as further descent of the uterus could be achieved after myomectomy and morcellation. Coring was performed instead of bisection when dealing with smaller uteri without any distinct large myoma. A circumferential incision was made at the level of the uterine isthmus about 5 mm into the substance of the corpus. A central core of tissue around the uterine cavity was then excised by progressively undercutting the serosal surface of the uterus towards the fundus. Once the uterus was delivered into the vagina, the hysterectomy was completed in the usual fashion. All 14 procedures with or without oophorectomy or salpingo-oophorectomy were completed successfully. The mean weight of the uteri was 639 g (range 380-1100 g), the mean operating time was 84 minutes (range 30-150 minutes) and the mean operative blood loss was estimated at 296 ml (range 100-800 ml). One patient was given a blood transfusion immediately postoperatively. Six women had macroscopic haematuria that cleared up within 24 hours. There were no other important complications. Postoperative hospital stay averaged 3.7 days (range 2-9 days). Only 2 patients remained in hospital for more than 4 days after surgery. All women had recovered fully by the time of their follow up appointment.

Contraindications↗