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Biomedical subjects

J Lippes

Publications and source records attributed to J Lippes.

At least 19 recordsLinked to original sources
PubMed2005

Sonographic recognition of three cases of septate uteri diminishes failures of quinacrine sterilization.

AIM: Using sonography, the bicornate and septate uterus as causes of failure of quinacrine sterilization (QS) are explored. Whether QS can be effectively performed on women with a bicornate or septate uterus is a question answered by a presentation of three such cases. METHODS: Three cases presented were part of a prospective nonrandomized study of QS in 205 women requesting sterilization at the Family Planning Clinic, School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Brazil. Sonography was performed on all patients before, during and after QS. Quinacrine was packaged as seven pellets in a modified Copper-T IUD inserter (Sipharm, Sisseln, Switzerland). Each woman received the first transcervical insertion of 252 mg of quinacrine during the follicular phase of the menstrual cycle, usually immediately after menses. One month later, a second insertion was similarly performed. Patients were advised to use an alternate method of birth control for 12 weeks to allow time for scarring of the oviducts. A blood pregnancy test was done before the QS procedure. RESULTS: The diagnosis of a septate or bicornuate uterus was made by sonography in three of the 205 patients in the study. It was obvious that quinacrine had to be inserted into the two horns of such an anomalous uterus if the dissolved drug was to enter both fallopian tubes. Quinacrine dissolved into "lakes of quinacrine," and sonographically could be seen at the top of the uterine fundus. For this clinical trial of 205 patients, there were 546 woman-years of follow-up, and the Pearl index was 0.73 per 100 woman-years (95% confidence limits: 0.02, 1.4). CONCLUSIONS: The bicornate or septate uterus can be a cause of failure of QS if undetected. Advantages of sonography prior to, during and after QS are apparent in the three patients with septate uteri. Sonography is advantageous when performing QS by demonstrating an anomaly of the uterus, which required separate insertions of quinacrine into each horn of a septate uterus and helping to direct quinacrine into each horn of these anomalous uteri.

Adult↗
PubMed2003

An FDA phase I clinical trial of quinacrine sterilization (QS).

OBJECTIVE: To review the significance of a United States Food and Drug Administration (FDA) approved Phase I clinical trial of a new use for an old drug, quinacrine. To discover whether ultrasound may have utility in quinacrine sterilization (QS). METHOD: This clinical trial began on 16 September 2000 at the Women's and Children's Hospital of Buffalo (WCHOB) in Buffalo, New York. Ten patients volunteered to have QS. These subjects were carefully followed with regularly scheduled examinations, including extensive laboratory blood tests. In addition, each patient had a trans-abdominal ultrasound examination six weeks or later past the date of the second insertion of quinacrine. The trial was completed on 30 April 2003. RESULTS: Laboratory results fell within normal limits, thus providing additional evidence to affirm the lack of toxic effects of QS. With ultrasound, we were able to see scars in both oviducts on all of our patients. One patient with a small scar as seen on ultrasound became pregnant. CONCLUSION: QS was found to be safe and effective. Ultrasound holds the promise of reducing the failure rate.

Adult↗
PubMed1999

Pelvic actinomycosis: a review and preliminary look at prevalence.

A review of the literature on pelvic actinomycosis reveals that actinomycetes normally reside in the female genital tract. Therefore the identification of actinomycetes in the vagina or cervix by any laboratory technique, including Papanicolaou smears with specific immunofluorescence or culture, is not diagnostic of any disease and is not predictive of any disease. The evidence strongly suggests that removal of the intrauterine contraceptive device of a patient with a positive culture is not necessary and that, in the absence of evidence for pelvic infection, antibiotics are not required. Pelvic actinomycosis is a rare disease whose pathogenesis is poorly understood.

Actinomyces↗
PubMed1999

Hepatocyte growth factor in human milk and reproductive tract fluids.

PROBLEM: Despite evidence indicating a role for hepatocyte growth factor (HGF) in gastrointestinal and reproductive physiology, the concentration and distribution of HGF in human breast milk (BM) and reproductive tract fluids remain unknown. METHOD OF STUDY: Using enzyme-linked immunosorbent assay (ELISA), the HGF concentrations were determined in human oviductal fluid (hOF), follicular fluid (FF), amniotic fluid (AF), seminal plasma (SP), and colostrum/milk samples, and expression of HGF mRNA by milk cells and AF cells were examined by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: HGF is present at nearly 70-fold normal serum (0.85+/-0.15 ng/mL) concentration in FF (n = 3; x = 57+/-16 ng/mL) and AF (n = 17; x = 57+/-26 ng/mL), and is also present in hOF (n = 3; x = 4.8+/-2.3 ng/mL) and CVL (n = 8; x = 0.7+/-1.1 ng/mL) varying throughout the menstrual cycle. HGF is found at 3-times serum concentration in BM (n = 24; x = 2.3+/-1.3 ng/mL) with no significant difference between premature and full term or stage of lactation (colostrum, transitional, mature milk). HGF mRNA was detected in BM cells but not in AF cells. CONCLUSIONS: HGF is present in sufficient amounts to profoundly affect gastrointestinal maturation in the fetus via swallowed AF and neonate via BM, and helps to explain the increased rate of necrotizing enterocolitis (NEC) in infants of premature rupture of membrane (PROM)-complicated pregnancies, and the decreased rate in breast fed neonates. HGF in FF may be necessary for the development and maturation of the oocyte. HGF in hOF, SP, and cervicovaginal lavage (CVL) is likely to enhances epithelial cell integrity and the mucosal barrier. Thus, HGF is widely available in the reproductive tract with functions that remain to be fully elucidated.

Amniotic Fluid↗
PubMed1996

Cytokines of the human reproductive tract.

PROBLEM: How is it possible that the female genital tract immunologically does not reject spermatooa not the preimplantation and nidating embryo? METHODS: Four fluids of the human reproductive tract, i.e., human oviductal fluid (hOF), follicular fluid (FF), amniotic fluid (AF), and seminal plasma (SP) were investigated by specific ELISA for 18 cytokines. The concentrations, presence or absence of these compounds were evaluated for their possible role in the immunology of the reproductive process. RESULTS: Stem cell factor and IL-11 were detected in all reproductive tract fluids examined whereas large amounts of IL-1 beta and IL-1RA was found in AF and hOF. Follicular fluid revealed IL-2. HOF contained IL 2, IL-6, IL-8, TNF-alpha, MIP-1 alpha, IFN-gamma, and high levels of IL-1 beta, IL-10, IL-1RA, and sIL-2R. Amniotic fluid contained sIL-2R, IL-8, IL-1 beta, IL-1RA, IL-6, TNF-alpha, and MIP-1 alpha. No IL-12 or IL-13 was detected in hOF follicular fluid or amniotic fluid. Almost no free TGF-beta 1 or TGF-beta 2 was found in any reproductive tract fluid except seminal plasma. Seminal plasma contained large quantities of free TGF-beta 1 (9,220 +/- 3,635 pg/mL) in addition to large quantities of latent TGF-beta 2 (2,933 +/- 2,169 pg/mL) and TGF-beta 1 (71,000 +/- 3,240 pg/mL). Furthermore, considerable concentrations of IL-8 (1900 +/- 374 pg/mL) and sIL-2R (350 mu/mL) exist in seminal plasma. CONCLUSIONS: HOF contains a high level of IL-10 (588 +/- 304 pg/mL), a powerful immune suppressor which probably plays a role in regulating immune responses in the fallopian tube and possibly in the endometrial cavity. Our observations suggest that seminal plasma with its huge content of TGF beta provides immune protection for sperm. Unfortunately, such high concentrations of TGF beta may also inhibit an immune defense in any organ in which semen is deposited.

Amniotic Fluid↗
PubMed1994

The sequential effects of human cervical mucus, oviductal fluid, and follicular fluid on sperm function.

OBJECTIVE: To compare the sequential effects of human cervical mucus (CM), oviductal fluid, and follicular fluid (FF) on sperm motility, hyperactivation, and the acrosome reaction during 9 hours of incubation in vitro. DESIGN: Spermatozoa from a fertile donor were allowed to penetrate human CM in vitro and then were recovered and incubated in either 30% human oviductal fluid or a simple salt solution for 3 hours before challenge with 20% FF. Thus, the sequential effects of the fluids collected from the female reproductive tract on sperm hyperactivation and acrosome reaction were examined. SETTING: The donor insemination program at the University Clinic within the Jessop Hospital for Women, Sheffield, United Kingdom. PATIENTS: All donors used in this study were involved in the donor insemination program. MAIN OUTCOME MEASURES: Sperm motility, hyperactivation, and percentage of acrosome-reacted spermatozoa were measured. RESULTS: This study used an in vitro technique to mimic sperm transport in vivo. Spermatozoa sequentially incubated with female reproductive tract secretions in vitro showed a maintenance in the level of FF-induced hyperactivated motility and a decreased response to the FF-induced acrosome reaction when compared with sperm challenged with FF in the absence of prior incubation with human oviductal fluid. CONCLUSION: It is suggested that human oviductal fluid may serve to delay the FF-induced acrosome reaction.

Acrosome↗
PubMed1994

Human oviductal fluid prolongs sperm survival.

OBJECTIVE: To compare the effect of human oviductal fluid on sperm motility and hyperactivation during 9 hours' incubation in vitro with follicular fluid (FF) and medium controls. DESIGN: Fertile donor spermatozoa were allowed to penetrate human cervical mucus in vitro and then recovered and incubated in either 30% human oviductal fluid, 20% FF, or medium for up to 9 hours. Sperm motion characteristics were measured using a sperm motility analyzer. SETTING: The donor insemination program at the University Clinic within the Jessop Hospital for Women, Sheffield, United Kingdom. PATIENTS: All donors used in this study were involved in the donor insemination program. MAIN OUTCOME MEASURES: Sperm motility, hyperactivation, curvilinear velocity, progressive, lateral head displacement, and linearity were measured using a sperm motility analyzer. RESULTS: After 9 hours' incubation, spermatozoa in human oviductal fluid had a significantly higher percentage motility than sperm incubated in FF or the control medium. A more linear sperm motion was consistently observed in the spermatozoa incubated in human oviductal fluid: significantly different from FF and media at 3 hours and 6 hours. The effect of human oviductal fluid on maintaining sperm motility was not affected by the addition of P. CONCLUSION: Human oviductal fluid can maintain sperm motility in a mechanism that is not mediated by the low concentration of P. We suggest that human oviductal fluid is a favorable environment for sperm survival.

Body Fluids↗
PubMed1993

Human oviductal fluid proteins. V. Identification of human oviductin-I as alpha-fetoprotein.

OBJECTIVE: To investigate whether human oviductin-I (hOV-I) from human oviductal fluid (hOF) and human alpha-fetoprotein (hAFP) are identical molecules. DESIGN: Comparison of amino acid and carbohydrate composition of hOV-I with that of hAFP. Isolation of hAFP from oviductal fluid of a patient and evaluation of its immunochemical properties in relation to hOV-I and authentic hAFP standard. SETTING: Procedures were performed in an academic research environment. PATIENTS: Human oviductin-I was isolated from a pooled sample of hOF obtained from four patients in a third world country. AFP was purified from a sample of oviductal fluid obtained from a single patient during her periovulatory period. INTERVENTIONS: Human oviductal fluid was collected coincident to elective tubal ligations. MAIN OUTCOME MEASURES: The amino acid and carbohydrate composition of hOV-I was determined. AFP was purified from hOF using ion-exchange chromatography and gel filtration. The identity between hOV-I and hAFP from hOF was assessed using enzyme-linked immunosorbent assay (ELISA) and Western immunoblot analysis. RESULTS: The amino acid and carbohydrate composition of hOV-I indicated similarities between hOV-I and hAFP. Both hOV-I and hAFP reacted with mouse anti-hAFP monoclonal antibody and purified polyclonal rabbit anti-hOV-I immunoglobulin G in an identical manner as observed by noncompetitive ELISA. Purified AFP from hOF of a single patient had a molecular mass of 66 kd and was found to be identical with hOV-I by Western immunoblot analysis. CONCLUSIONS: Human oviductin-I and hAFP are chemically similar and immunologically identical molecules. We believe that this finding is the first documentation for the existence of AFP in hOF.

Animals↗
PubMed1993

Human oviductal fluid proteins. VI. Correlation between alpha-fetoprotein and serum levels of ovarian hormones.

OBJECTIVE: To determine the relationship, if any, between the ovarian hormonal status of women and levels of alpha-fetoprotein (AFP) in their oviductal fluid. The threshold questions were the following: (1) does the presence of AFP in human oviductal fluid (hOF) represent a generalized phenomenon and (2) if so, is there any relationship between AFP in hOF and the ovarian hormones, estradiol (E2) and progesterone (P)? DESIGN: Eleven women who elected minilaparotomy tubal ligations volunteered to donate hOF and serum samples for this study. AFP, E2, and P were determined be radioimmunoassay. SETTING: Procedures were performed in an academic research environment. PATIENTS: This study encompasses only those patients who elected minilaparotomy tubal ligation and volunteered to donate hOF and sera. Clinical features of these patients are described. INTERVENTIONS: Patients undergoing tubal ligations had Foley catheters inserted into the fimbriated ends of each oviduct, and hOF was collected for 24 hours. Concomitantly, blood was drawn for analyses of serum. The Investigational Review Board of the Erie County Medical Center approved this study requiring the collection of oviductal fluid from human subjects. RESULTS: Levels of AFP in hOF did not correlate with the serum concentrations of E2 and P per se. However, there was a highly significant correlation between levels of AFP in hOF and serum E2:P ratio. The concentration of AFP in hOF progressively increased with respect to the ratio of serum E2:P. Although AFP was present in all samples of hOF, it was undetectable in corresponding sera. CONCLUSIONS: Based on these data, it is concluded that AFP is generally present in hOF. Furthermore, it is suggested that AFP in hOF may be under the control of ovarian steroids.

Adult↗
PubMed1989

Human oviductal fluid proteins. III. Identification and partial purification.

The role of the macromolecular constituents of human oviductal fluid (hOF) in reproductive physiology is poorly understood. Oviductal fluid contains proteins derived by transudation from serum and those synthesized and secreted by the tubal mucosa. In this communication, we describe purification of hOF-specific proteins. As a first step, serum proteins were removed with an immunoaffinity gel. Fractionation of the proteins unique to hOF was accomplished with DEAE-cellulose chromatography. One of these proteins was obtained in a highly purified state after gel filtration on G-75 Sephadex. This protein of 54 kDa molecular weight had a pI of 4.5 and contained carbohydrate. We propose that this hOF glycoprotein be designated "human oviductin I" (hOV I).

Body Fluids↗
PubMed1989

Human oviductal fluid (hOF) proteins. IV. Evidence for hOF proteins binding to human sperm.

In the management of infertile patients, it is well recognized that gamete intrafallopian transfer (GIFT) has a higher success rate than in vitro fertilization and embryo transfer. Oviducts produce unique proteins that may be responsible for the success of GIFT. Unique proteins from human oviductal fluid (hOF) have been purified in the authors' laboratory. One of these proteins of 54 kDa molecular weight, and containing carbohydrate, was obtained in a highly purified state. In this study, human sperm were incubated with: (1) a mixture of hOF-specific proteins, and (2) the highly purified hOF glycoprotein, designated human oviductin I (hOV-I). Using indirect immunofluorescence, the authors studied the ability of hOF proteins to bind to human sperm. The mixture of hOF proteins appeared to bind to the surface of the entire sperm. Conversely, hOV-I binding was restricted to the head region only. Studies are in progress to discern the function of the sperm-binding interaction(s) with hOF proteins.

Fallopian Tubes↗
PubMed1986

Severe pain at interval IUD insertion: a case-control analysis of patient risk factors.

This investigation, using a case-control analysis approach on an IUD data set from a less-developed country center, delineated four risk factors in patient characteristics that are associated with severe pain at interval IUD insertion. They are: higher education (greater than or equal to seven years), low-parity (1-2 live births), longer open interval (greater than or equal to 13 months) between the end of the last pregnancy and insertion, and non-breastfeeding at the time of insertion. Adjusted relative risks estimated by odds ratios are 2.1, 2.7, 2.7 and 5.0, respectively. For women with a combination of the above risk factors, they have a further increased (additive in nature) risk of suffering severe insertion pain. Similar analysis was also performed on a developed country center data set for which only the effect of education and parity could be studied; an odds ratio of 5.0 for nulliparity was obtained. The plausibility of these findings as well as their clinical and programmatic implications are discussed.

Breast Feeding↗
PubMed1986

Syncope and other vasovagal reactions at interval insertion of Lippes Loop D--who is most vulnerable?

Syncope and other vasovagal reactions occasionally occur at or immediately after IUD insertion. This analysis, using an international data set comprised of interval insertions of Lippes Loop D, found that women who are primiparous (as compared to those who are multiparous), and/or those who want more children are at higher risk for vasovagal reactions and deserve more careful counseling and gentler cervical manipulation. Moderate to severe pelvic pain at insertion is closely associated with the development of vasovagal reaction. Measures to alleviate or prevent pain at insertion could reduce the incidence of vasovagal reactions.

Adult↗
PubMed1983

Laparoscopic findings in patients with pelvic pain.

We have reviewed 1,194 charts of consecutive patients who had a diagnostic laparoscopy for pelvic pain from January 1, 1972, to December 31, 1980, at the Deaconess Division of the Buffalo General Hospital. A total of 749 of these patients had normal pelvic examinations prior to the diagnostic laparoscopy; 479 (63%) had abnormal findings on diagnostic laparoscopy. Of the 445 patients with abnormal pelvic examinations, 78 (17.5%) had normal findings on diagnostic laparoscopy. The laparoscopic findings and ovarian pathology are reviewed. These results are substantiated by other reports in the literature and certainly justify the increasing use of the laparoscope as a diagnostic tool in the gynecologist's armamentarium.

Adolescent↗
PubMed1983

Human oviductal fluid proteins. II. Preparation of an antiserum to a human oviductal fluid protein: existence of autoantibodies against it in some sera.

Rabbit antisera elicited by injection of human oviductal fluid (HOF) and rendered specific by absorption with human kidney and human serum revealed the presence of two possibly HOF-specific antigen(s). One antigen was detected by immunodiffusion in 14 of the 14 fluids tested with one of these antisera. HOF-specific antigen was shown to be a beta-globulin by immunoelectrophoresis. A second antigen was seen in two samples. That autoantibodies might exist directed against HOF-specific antigen in the donor's serum was suggested by immunodiffusion experiments in which 4 of the 13 sera tested gave lines of precipitation when reacted against the corresponding oviductal fluid. In one instance, this line was the same as one of the two lines seen in tests using rabbit antiserum.

Animals↗