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Biomedical subjects

M Elstein

Publications and source records attributed to M Elstein.

At least 91 records · Page 5Linked to original sources
PubMed1984

Effects of the anti-oestrogens, clomiphene and tamoxifen, on the cervical factor in female infertility.

The anti-oestrogens clomiphene and tamoxifen are successful therapeutic agents in the induction of ovulation but the associated pregnancy rates are low. One cause for this may be a direct anti-oestrogenic effect on cervical mucus, reducing its sperm penetrability. This potentially adverse effect has been shown to occur with clomiphene. In this study the effects of clomiphene and tamoxifen on the cervical factor are compared in women who were anovulatory or had defective ovulation. Forty fully investigated infertile women were randomly allocated to different treatment sequences after being observed for three control cycles. A double-blind placebo technique was used with four different treatment regimes. Serial serum progesterone and oestradiol were assayed. Cervical mucus from the periovulatory phase was assessed by means of the cervical score and in vitro sperm penetration tests. Both these anti-oestrogens can affect cervical mucus but their effect seems to be related more to the end-organ sensitivity of the individual than to a specific action of the drug per se.

Cervix Mucus↗
PubMed1984

Degradation of the copper-releasing intrauterine contraceptive device and its significance.

Measurements were made of the copper remaining on used Gravigard intrauterine contraceptive devices (IUCDs) that had been in utero for up to 40 months. The topography and composition of the surface deposits were analysed by scanning electron microscopy and energy-dispersive X-ray analysis. The rate of copper loss decreased exponentially from 0.42 mumol d-1 (26.7 micrograms d-1) upon insertion to 0.056 mumol d-1 (3.6 micrograms d-1) after 26 months of use; between 27 and 40 months of use a linear release of 0.32 mumol d-1 (20.3 micrograms d-1) was observed. There was no correlation between this changing rate of copper loss and the pregnancy rate with the device in situ. The changes in the rate of copper loss were probably due to the growth of a surface corrosion product which, due to internal stresses, fractured after about 2 years and exposed fresh copper; this results in a progressive increase in breakage of the copper wire after 3 years. It is recommended that a copper IUCD of this type be replaced after 3 years.

Copper↗
PubMed1982

The effect of ethinyl estradiol 20 mcg and levonorgestrel 250 mcg on the pituitary-ovarian function during normal tablet-taking and when tablets are missed.

A new combined pill containing 20 micrograms of ethinyl estradiol and 250 micrograms of levonorgestrel has been developed. The safety margin of this type of low-dose preparation needed to be assessed and this was done by evaluating daily levels of LH, FSH, estradiol, progesterone, 1-NG and EE2 as well as cervical mucus characteristics in six patients when one and then two consecutive pills were deliberately omitted mid-way through the cycle. Results demonstrated that there was no evidence of breakthrough ovulation, although there was some continued ovarian steroidogenesis, a feature consistent with previous studies using combined preparations. Existing instructions to patients regarding missed pills should continue in order to ensure maximal contraceptive safety.

Adolescent↗
PubMed1982

IUCD liability.

In the UK the marketing and quality control of all intrauterine devices (IUCDs) is controlled by the Medicines Act (1968). Training is supervised by the Joint Committee of Contraception (JCC), and Trainers have to ensure that the trainee has acquired safe standards before the JCC certificate is granted. Patients must be adequately counselled and consent obtained. There is no unequivocal evidence of its mode of action in humans, which might limit its acceptability to certain individuals. There are a number of problem areas. How long should a copper-containing IUCD be retained when there is clinical evidence of continued effectiveness for more than the statutory 2 years? Perforation of the uterus and the resulting abnormal situation of an IUCD can be potentially dangerous. Sound technique minimizes its occurrence but if perforation occurs there must be defined and documented action. Because the IUCDs' primary intrauterine action is to prevent implantation, should pregnancy occur, there is an increased likelihood of ectopic gestation. Awareness of this, and appropriate early action, should prevent a disastrous outcome. There is clear evidence that ascent of organisms relates to the cervical thread. Perhaps tailless devices should be made available for women who are at risk of developing pelvic inflammatory disease? Other potential problem areas, where there might be legal liability involving practitioners, include the management of abnormal bleeding and difficult removals.

Female↗
PubMed1981

Bacteriological colonisation of uterine cavity: role of tailed intrauterine contraceptive device.

Intrauterine contraceptive devices (IUCDs) are thought to cause pelvic inflammatory disease by allowing vaginal bacteria to pass into the uterus along the tail of the device. In this study the uterine cavities of 22 women using an IUCD were examined by a multiple biopsy technique. All five uteruses with a tailless IUCD were sterile but 15 out of 17 with a tailed device contained bacteria. The bacteria had not reached the fundus and most were commensals. The bacteria were not introduced by insertion of the IUCD as bacteria were present in several cases long after insertion. No differences in bacterial count were found between monofilamentous and multifilamentous devices. Bacteria were cultured from only four devices, which suggested that the bacteria adhere to the endometrium and not to the device. The bacteria in the cavity represent interference by the tail with the protective mechanisms of the uterus, which explains the increase in pelvic inflammatory disease in IUCD users.

Adult↗
PubMed1981

Cefuroxime: potential use in pregnant women at term.

The placental transfer of cefuroxime was studied in 20 women after one or more 1.5 g intravenous injections. Ten women had labour induced at term and ten were delivered by elective Caesarean section. High concentrations of cefuroxime were found in the cord blood and amniotic fluid and therapeutically active antibiotic levels were found in the infants for up to six hours after delivery.

Amniotic Fluid↗
PubMed1979

Some estrogenic effects of two oral contraceptives consisting of norgestrel and two different doses of ethynylestradiol.

Some biological and biochemical effects (i.e. KPI, cervical mucus, SHBG and ceruloplasmin) as well as serum ethynylestradiol and serum norgestrel, following the use of two oral contraceptives containing the same amount of norgestrel (dl-norgestrel 0.5 mg) and either 30 microgram or 50 microgram of ethynylestradiol were compared. There was no difference in the clinical features in either group of patients. There was a statistically significant difference in the levels of unconjugated ethynylestradiol but not in the other biochemical parameters studied. It is concluded that the absence of any such difference might be attributable to the strong antiestrogenic effects of dl-norgestrel.

Adolescent↗