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Biomedical subjects

L Enk

Publications and source records attributed to L Enk.

At least 19 recordsLinked to original sources
PubMed1992

A prospective, one-year study on the effects of two long acting injectable contraceptives (depot-medroxyprogesterone acetate and norethisterone oenanthate) on serum and lipoprotein lipids.

Two parenterally administered progestins (depot medroxyprogesterone acetate, DMPA, 150 mg/12 weeks and norethisterone oenanthate, NET, 200 mg/8 weeks respectively) were given to women seeking contraceptive advice. Before treatment and after 1, 6, 7, 12 and 13 months blood samples were taken. In serum and in the ultracentrifugally separated lipoprotein fractions the levels of total and free cholesterol, triglycerides and phospholipids were assayed, as were the apolipoprotein A1 and B levels in serum. At the end of the study NET had induced a decrease in all lipid components of the HDL (high density lipoprotein) fraction of approximately 30% and tended to increase LDL (low density lipoprotein) lipids. DMPA also decreased HDL-lipids, approximately 15%. There was also a transient decrease in apolipoprotein A1 after one month in both patient groups. From epidemiological studies it is inferred that low HDL-levels and high LDL-levels are independent risk factors for the development of atherosclerosis and cardiovascular disease. Thus our findings might indicate an adverse effect in this respect of long term treatment with these progestins, particularly with NET.

Adult↗
PubMed1990

The value of endovaginal sonography and urinary human chorionic gonadotropin tests for differentiation between intrauterine and ectopic pregnancy.

Effectiveness of vaginal sonography combined with urinary human chorionic gonadotropin (hCG) for identification of ectopic pregnancy (EP) was studied in 107 pregnant women. Eighty-nine women had clinical symptoms suspicious of EP. It was suggested that 18 women carried an increased risk for developing EP. In 63 women endovaginal sonography showed no evidence of intrauterine pregnancy. Fifty-eight of these turned out to be pathological pregnancies. In 44 women endovaginal ultrasonography revealed intrauterine pregnancies. Thirty-two of these turned out to be viable, 10 were not viable and resulted in spontaneous abortions, and 2 turned out to be EP. The sensitivity of vaginal sonography to identify a viable intrauterine pregnancy thus was 81% and its specificity was 97%. The sensitivity and the specificity for endovaginal ultrasonography for identifying EP was 96% and 71%, respectively. Endovaginal ultrasonography demonstrated an intrauterine gestational sac in 54% of the women with urinary HCG as low as 40 IU/L to 500 IU/L. These results show that endovaginal ultrasonography is a sensitive instrument for identifying both early normal intrauterine pregnancies as well as pathological pregnancies.

Diagnosis, Differential↗
PubMed1989

Ultrasound-guided puncture of cystic tumors in the lower pelvis of young women.

During the period from 1984 through 1986, 72 ultrasound-guided cyst punctures were performed in 60 young women (less than or equal to 40 years). Thirty-one punctures were performed using the transabdominal route and 41 punctures under the guidance of endovaginal scanning. General or local anesthesia were used in 97% of the transabdominal punctures while the corresponding figure for the endovaginal technique was 49%. Seventy-seven percent (46/60) of the women developed no new cysts within one year of the last puncture. Thirteen percent (8/60) had to be punctured twice and 3% (2/60) three times. No complications occurred in any of the 72 punctures. Of those women with cyst relapses and/or persistent abdominal pain, 7 were subjected to laparotomy and 5 to laparoscopy. Ultrasound-guided puncture of cystic tumors in the lower pelvis of young women seems to be an alternative to laparoscopically guided puncture or laparotomy. As compared to surgery, the ultrasound-guided technique may mean less risk for pelvic adhesions in young women with unproven fertility.

Adolescent↗
PubMed1989

Technical and clinical aspects of ultrasound guided oocyte recovery.

In our experience, as well as that of many other IVF groups, transvaginal, ultrasound-guided follicle aspiration is less invasive and comparable to, or better than laparoscopy with regard to the efficiency of oocyte recovery and safety. For these reasons, we believe that ultrasound-guided follicle aspiration will gradually become the method of choice if the only purpose is to retrieve oocytes.

Female↗
PubMed1988

A comparison of the effects of ethinyl estradiol and estradiol valerate on serum and lipoprotein lipids.

Serum lipids and lipoproteins were assessed after treatment with 2 mg of oestradiol valerate (E2V) and 10 micrograms of ethinyl oestreadiol (EE) in a group of 24 oophorectomised women in a study with an open cross-over design. E2V in this oral dose was quite inert in its effect on lipoprotein lipids. Ten micrograms of EE is a dose which in most women is sufficient to alleviate post-menopausal vasomotor symptoms. However, this low dose of EE increased serum triglycerides as a result of increased levels in the ultracentrifugally isolated lipoprotein fractions. Increased levels of serum and lipoprotein triglycerides are considered cardiovascular risk factors in women.

Adult↗
PubMed1988

Sonographic techniques in human in-vitro fertilization programmes.

The value of ultrasound in programmes of in-vitro fertilization is discussed. In order to reach the ovaries, the transvesical route was first introduced, and proved less invasive than laparoscopy. The periurethral route has also been used. The transvaginal approach, especially using a vaginal transducer with an attached needle guide, has attracted many IVF groups and is widely used today. Details of this method are presented. Ultrasound has also been used to assist in the replacement of embryos into the uterus, and the various methods are described.

Female↗
PubMed1988

Patients' experience of transvaginal follicle aspiration under local anesthesia.

The development of vaginal ultrasound transducers has facilitated ovum pick-up (OPU) by providing higher precision and less trauma than are found with laparoscopy and other ultrasound-assisted techniques. In order to evaluate the patients' acceptance, 65 patients were asked to answer a questionnaire about their experience with the procedure. The punctures were executed with specially designed needles introduced through a needle guide attached to a vaginal transducer with a frequency of 7 MHz (Brüel & Kjaer, Denmark). The anesthesia consisted of a light premedication and a paracervical block. If needed, a small dose of sedative was given intravenously intraoperatively. The patients classified their pain experience within the day of the puncture on a four-grade scale. Their statements were compared to the physician's opinion of the discomfort caused. Oocytes were retrieved from all patients. Fifty-one patients answered the questionnaire, of whom five found the OPU painful. In two cases the physician underestimated the patients' pain experience. The mean time required for the procedure was 16 min/OPU. We conclude that transvaginal ultrasound-guided OPU is well accepted by most patients under local anesthesia and that it is a rapid and accurate procedure.

Anesthesia, Local↗
PubMed1987

Use of a vaginal transducer for oocyte retrieval in an IVF/ET program.

Sonography has proved to be an important diagnostic and operative instrument in an in-vitro fertilization and embryo transfer (IVF/ET) program. In some IVF/ET programs the technique has even replaced laparoscopy for oocyte retrieval. To date, transvesical follicle aspiration has been the main technique for ultrasound-guided oocyte pick-up. However, this technique has some disadvantages. Therefore, we have developed a transvaginal ultrasound-guided puncturing technique. A new high-frequency vaginal sector transducer was utilized (Brüel & Kjaer). This new transducer, equipped with a needle guide, changed the oocyte retrieval into a simple, safe, and rapid procedure that can be performed under local anesthesia without any discomfort for the patient.

Female↗
PubMed1987

Fertilization and embryo development of oocytes obtained transvaginally under ultrasound guidance.

The widespread use of ultrasound for follicle development assessment and ovum pickup has raised concerns about the theoretical possibility of adverse effects on oocyte function. Studies in other species do not demonstrate any adverse effects when using sonic energies as those presently used in diagnostic ultrasound. However, no data are available concerning the effects of diagnostic ultrasound on human preovulatory oocytes. This study was conducted to determine whether there were any adverse effects on the reproductive function of oocytes using transvaginal ultrasonography. No effect on fertilization and subsequent cleavage of oocytes was demonstrated. This method can, therefore, be recommended for follicle assessment and as a better alternative to laparoscopy for oocyte retrieval.

Adult↗
PubMed1987

Dose and duration effects of oestradiol valerate on serum apolipoproteins A1 and B.

The serum levels of apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) were assessed by electroimmunoassay in 19 bilaterally oophorectomised women before and after treatment with 2 and 4 mg oestradiol valerate (E2V) daily. The first part of the study was conducted in accordance with an open cross-over design. The levels of ApoA1 were found to have increased after the 6-week treatment periods using each of those dosages, the increase being most pronounced after treatment with 4 mg E2V. ApoB concentrations decreased at both dosage levels. The serum levels of total (TC) and free cholesterol (FC) and phospholipids (PL) in the high-density lipoprotein (HDL) fraction correlated positively with the serum levels of ApoA1 before treatment. The correlations between serum ApoA1 and HDL-PL levels persisted after both dosage regimens. Before and after treatment with 2 mg E2V, serum ApoB levels correlated positively with the levels of all lipid components in the low-density lipoprotein (LDL) fraction. After 4 mg E2V, serum ApoB levels correlated positively with LDL-PL and LDL-TC levels. On conclusion of the cross-over, in order to assess the effects of the duration of therapy, the women were followed up for a further period of 3 mth, during which ten were given 2 mg and the other nine 4 mg of E2V daily. The increased levels of ApoA1 and the decreased levels of ApoB seen after the cross-over study were not found to have altered after this treatment-duration evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Effects of cyproterone acetate (CPA) on serum lipoproteins when administered alone and in combination with ethinyl estradiol (EE).

The effects of serum lipids and lipoproteins of 2 mg cyproterone acetate (CPA) given alone and in combination with 35 or 50 micrograms ethinyl estradiol (EE) were studied in 21 oophorectomized women in a study with a cross-over design. CPA in this low oral dose was rather inert in its effects on lipoprotein lipids. It induced only a small decrease in the free cholesterol and phospholipid content of the high density lipoprotein (HDL) fraction. As regards the CPA-EE combinations, they induced a slight increase in the HDL fraction, a small decrease in the low density lipoprotein (LDL) fraction and a substantial increase in triglycerides both in the serum and in the very low density lipoprotein (VLDL) fraction. This lipoprotein pattern is invariably induced after the administration of an alkylated estrogen or an "estrogen dominated" oral contraceptive. An increase in triglycerides is a "biochemical" adverse effect which may have clinical implications for some patients.

Adult↗
PubMed1987

High- and low-density lipoproteins stimulate progesterone production in cultured human granulosa cells.

Cultured human granulosa cells are dependent upon gonadotrophins and exogenous cholesterol for maximal progesterone production. In previous studies low-density lipoproteins (LDLs) have been considered the preferred source of cholesterol, while high-density lipoproteins (HDLs) seemed rather to reduce progesterone synthesis in these cells. In this study, granulosa cells were harvested from 12 women and cultured in medium containing lipoprotein-deficient serum for 3 days. This was followed by 2 days of culture in medium supplied with LDL or HDL fractions, prepared by sequential ultracentrifugation and affinity chromatography. In the presence of LH, both lipoprotein fractions enhanced progesterone secretion in a concentration-dependent fashion while basal progesterone secretion was enhanced to a lesser extent. Progesterone secretion in response to lipoproteins did not differ between cells from pre-ovulatory follicles stimulated with gonadotrophins in vivo and less mature follicles obtained earlier in the menstrual cycle. We conclude that human granulosa cells in vitro can utilize cholesterol carried by HDL as well as LDL for progesterone synthesis.

Adult↗
PubMed1987

Oocyte retrieval under the guidance of a vaginal transducer: evaluation of patient acceptance.

Follicle puncture under the guidance of ultrasound has now been used for some years. The most important advantage of the ultrasound-guided technique compared with the laparoscopic technique is that the former can be performed under local anaesthesia. However, both the trans-vesical and the perurethral ultrasound-guided puncturing routes may be quite painful for the patient. For that reason we have developed a trans-vaginal follicle puncture technique using a vaginal transducer. The aim of this study was to evaluate the patients' experience of pain with this new technique. Scanning of follicles was performed using a specially designed vaginal transducer that makes the patients having a full bladder unnecessary. Local anaesthesia was applied as a paracervical block. Follicles were then punctured through the vagina with a needle inserted through a needle guide attached to the transducer. Fifty-one patients answered a questionnaire about their experience of the puncture procedure. Only 10% of the patients found the puncture painful. Ninety-eight per cent of the patients felt no anxiety about going through the procedure again. We therefore conclude that trans-vaginal oocyte pick-up using a vaginal transducer is very well accepted by most women.

Anesthesia, Local↗
PubMed1987

Effect on fertilization of intra-peritoneal exposure of oocytes to carbon dioxide.

Follicular aspiration is generally performed via laparoscopy after creating a pneumoperitoneum with carbon dioxide (CO2). Adverse effects on embryo development may occur following exposure to CO2, which is known to cause a decrease in follicular fluid pH. Such a reduction in pH may affect fertilization and early embryonic development and this study was carried out to study these effects. Oocytes obtained by laparoscopy were compared with those obtained under ultrasonic guidance to determine whether CO2 exposure had any adverse effect. The results suggest that CO2 may affect fertilization, but once this has occurred, there is no effect of CO2 on the rate of cleavage of the embryos.

Carbon Dioxide↗
PubMed1987

Role of ultrasound in infertility.

The use of ultrasound technology and its further prospects in an infertility clinic are described. First, the ultrasonic ovarian scanning during the follicular phase of stimulated cycles is discussed. With this technique the number and size of the follicles, and the thickness of the endometrium can be estimated. Second, three different routes for ultrasound guided follicle puncture are described, namely the transvesical, the transvaginal and the perurethral puncture. Finally, the ultrasound guided embryo transfer procedure is explained.

Embryo Transfer↗