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Biomedical subjects

M R Laufer

Publications and source records attributed to M R Laufer.

34 records · Page 2Linked to original sources
PubMed1998

Vulvar disorders in prepubertal girls. A literature review.

OBJECTIVE: To review and discuss vulvar disorders in prepubertal girls. STUDY DESIGN: Literature review. RESULTS: Bacterial and fungal vulvitis, dermatitis, inflammatory dermatoses, secondary drug reactions, viral infections and a variety of vulvar tumors can all present as primary vulvar problems in prepubertal girls. In addition, systemic diseases can present with vulvar involvement. CONCLUSION: In order to facilitate optimal care of prepubertal girls with vulvar disorders, a comprehensive review of the literature is presented.

Child↗
PubMed1997

Identification of clear vesicular lesions of atypical endometriosis: a new technique.

OBJECTIVE: To describe a new technique for improvement of visualization and identification of clear vesicles of endometriosis. DESIGN: A new descriptive technique. SETTING: Tertiary care center. PATIENT(S): Adolescent and adult women with pelvic pain undergoing laparoscopic evaluation. INTERVENTION(S): The pelvis is filled with irrigation fluid, and then the laparoscope is submerged, with evaluation of the pelvic peritoneum through the liquid medium. MAIN OUTCOME MEASURE(S): Identification of clear lesions of endometriosis. RESULT(S): Laparoscopic visualization of clear lesions of atypical endometriosis can be facilitated with the use of liquid introduced into the pelvis in order to identify and appreciate the three-dimensional configuration of lesions and to exclude light reflection as a possible etiology. CONCLUSION(S): This method is suggested for identification of subtle lesions of endometriosis, which will aid in the establishment of the definitive diagnosis for adolescents and adults with chronic pelvic pain and will decrease the number of cases of unrecognized atypical endometriosis.

Adolescent↗
PubMed1997

Primary hypothyroidism presenting as severe vaginal bleeding in a prepubertal girl.

We describe a case of acquired primary hypothyroidism in a prepubertal girl who presented with profound bradycardia, precocious puberty, and severe vaginal bleeding. A pelvic ultrasound revealed markedly enlarged ovaries with numerous cysts. Cystic aspiration, in concert with L-thyroxine therapy, appeared to halt vaginal bleeding, and led to resolution of cysts. This is the first reported case of percutaneous cyst aspiration to treat ovarian hyperstimulation caused by hypothyroidism in a child.

Bradycardia↗
PubMed1997

Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy.

STUDY OBJECTIVE: To evaluate adolescent girls with chronic pelvic pain not responding to conventional medical therapy, using advances in operative laparoscopy to determine endometriosis prevalence, clinical stage, and type of lesion. DESIGN: A descriptive retrospective study of subjects who (1) were referred for the evaluation of chronic pelvic pain, (2) did not respond to a nonsteroidal anti-inflammatory drug and an oral contraceptive pill, and (3) underwent a laparoscopy to determine the etiology of the pelvic pain. SETTING: Patients referred to a surgical gynecologist in a pediatric/adolescent gynecology and reproductive endocrine academic practice. PARTICIPANTS: All patients younger than 22 years of age with chronic pelvic pain. INTERVENTION: Operative laparoscopy to determine the etiology of the chronic pelvic pain. MAIN OUTCOME MEASURES: Operative laparoscopy results including stage and description of endometriosis. RESULTS: More than two thirds of the study population (69.6%) was found to have endometriosis. All subjects had either stage I or II as determined by the American Fertility Society's classification system. The nature of the pain in the 32 subjects with endometriosis was both acyclic and cyclic in 20 (62.5%), acyclic only in 9 (28.1%), and cyclic only in 3 (9.4%). Other presenting symptoms included gastrointestinal in 11 (34.3%), urinary in 4 (12.5%), and irregular menses in 3 (9.4%). CONCLUSIONS: Adolescents with chronic pelvic pain not responding to medical therapy have a high rate of endometriosis and should be referred to a gynecologist who is experienced with the subtle laparoscopic findings of atypical endometriosis to diagnose the etiology of the pelvic pain and initiate appropriate therapy.

Adolescent↗
PubMed1997

Inducing amenorrhea during bone marrow transplantation. A pilot study of leuprolide acetate.

OBJECTIVE: To evaluate, in a pilot study, the use and efficacy of a gonadotropin-releasing hormone (GnRH)-agonist in inducing amenorrhea in women undergoing BMT. STUDY DESIGN: We evaluated the use of the GnRH agonist leuprolide acetate (LA) for the induction of amenorrhea in 10 postmenarcheal women prior to BMT. If there was a contraindication to the use of the intramuscular (i.m.) formulation of LA, the subcutaneous (s.c.) formulation was given as a daily intravenous (i.v.) bolus. Once the subject's platelet count was > 50,000/microL, the LA was discontinued. Menstrual bleeding, time from initiation of therapy to amenorrhea, and liver function test results were monitored. RESULTS: All subjects had induction of amenorrhea with the use of LA except for one subject with a large, myomatous uterus, who experienced light spotting. One subject who was thrombocytopenic at the prescribed time of the second dosage of i.m. LA received i.v. LA with documentation of continued pituitary/gonadal suppression. No adverse effects were determined to be directly related to either the i.m. or i.v. LA. CONCLUSION: LA is an option for the induction of amenorrhea in postmenarcheal women undergoing BMT. In thrombocytopenic subjects, administration of the s.c. formulation of LA by an i.v. route served as an alternative to i.m. injection and was documented to maintain gonadotropin suppression.

Adolescent↗
PubMed1995

Evaluation of hormonal testing in the screening for in vitro fertilization (IVF) of women with tubal factor infertility.

PURPOSE: To evaluate the frequency of abnormal prolactin and thyroid stimulating hormone (TSH) test results in ovulatory women with tubal factor infertility who were screened for in vitro fertilization (IVF). METHODS: Charts were identified from 112 ovulatory women with follicle stimulating hormone (FSH) < 20 mIU/ml who were diagnosed with tubal factor infertility and were screened for IVF with thyroid stimulating hormone (TSH) and prolactin levels. Women previously diagnosed with thyroid disease were subsequently excluded and 98 subjects remained. All subjects were determined to be ovulatory by biphasic basal body temperature (BBT) charts, luteal phase progesterone > 4 ng/ml, or endometrial biopsy revealing secretory endometrium. Results of cycle day 3 serum TSH and prolactin concentrations were recorded. The normal range for each test reflects the geometric mean +/- 2 standard deviations (i.e., 95% interval), as obtained from the reference laboratory. Under this construct, hypothesis tests were performed to determine whether or not our study population was consistent with the reference range of normal hormone levels. Under the null hypothesis (normal levels), we expected 5% of the TSH tests to be abnormal (i.e., high or low levels), and 2.5% of the prolactin tests to be abnormal (i.e., high levels). Exact bionomial confidence intervals and P-values were calculated. We also tested for age trend in the proportion of abnormal results. RESULTS: Study subjects had an age range of 25-43. In the study group, 4 (0.041) out of the 98 women screened had abnormal TSH levels. Of these four abnormal TSH results, three were elevated (i.e., TSH > 4.6 microIU/ml) and one was low (i.e., TSH < 0.6 microIU/ml). The frequency of an abnormal TSH value was not significantly different from that expected from the reference laboratory normal values (95% CI 0.011, 0.101). Of the 98 subjects, 7 (0.071) had abnormal prolactin levels, which was significantly different from that expected from the reference laboratory normal values (95% CI 0.029, 0.142; P = 0.023). When stratified by age, there was no observed trend of abnormalities for TSH or prolactin levels with increasing age. CONCLUSIONS: In ovulatory women presenting for IVF with tubal factor infertility, our results show that routine screening with a TSH test does not yield a significantly higher proportion of abnormal results than that expected from the reference laboratory normal values. However, prolactin level screening was found to yield a higher incidence of abnormal tests than expected from the reference laboratory normal values.

Adult↗
PubMed1995

Hormone testing in women with adult-onset amenorrhea.

To assess the clinical utility of routine endocrine testing in women with adult-onset amenorrhea, charts were identified from 127 women diagnosed with adult-onset amenorrhea who had a thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), and prolactin (PRL) level performed. Women who were pregnant or previously diagnosed with thyroid disease were subsequently excluded and 120 subjects remained. Of the 120 women screened, 12 (0.100) had abnormal FSH levels, 9 (0.075) had abnormal PRL levels, and 5 (0.042) had abnormal TSH levels. The incidence of an abnormal FSH level (95% CI 0.053, 0.168; p < 0.001) and PRL level (95% CI 0.035, 0.138; P = 0.007) was significantly elevated as compared to the reference laboratory normal values. However, the incidence of an abnormal TSH level in the study population was not statistically different from that of the reference laboratory normal values (95% CI 0.014, 0.095, p = 0.88). The evaluation of 120 women with adult-onset amenorrhea demonstrated abnormal concentrations of FSH, PRL and TSH in 10, 7.5 and 4.2% of patients, respectively. A rank ordering of these endocrine tests may be useful when evaluating women with adult-onset amenorrhea.

Adolescent↗
PubMed1994

Developmental abnormalities of the female reproductive tract.

Development abnormalities of the female reproductive tract have a vast array of presentations and etiologies. This review outlines the etiologies, treatments and long-term follow-up of significant developmental anomalies of the female reproductive tract.

Androgens↗
PubMed1993

Measurement of embryotoxic factors is predictive of pregnancy outcome in women with a history of recurrent abortion.

OBJECTIVE: To determine whether the production of embryotoxic factors in early pregnancy is predictive of pregnancy outcome in women with a history of two or more unexplained recurrent abortions. METHODS: Between July 1987 and June 1991, 450 nonpregnant women were evaluated for recurrent abortion. Embryotoxic factors were found in 328 of 346 women with an otherwise unexplained etiology. These women were given progesterone immunosuppressive therapy in a subsequent conception cycle, and embryotoxic factors were measured at 5 weeks' gestation. RESULTS: Data on embryotoxic factors and pregnancy outcome were available for 141 of 208 reported subsequent pregnancies. Of women still positive for embryotoxic factors, 40 had a repeat first-trimester spontaneous abortion whereas 16 delivered a viable infant; of women who no longer produced embryotoxic factors, only 11 had a repeat first-trimester abortion and 74 delivered a viable infant. CONCLUSIONS: The embryotoxic factor assay may be useful in predicting pregnancy outcome in women with a history of unexplained recurrent abortion. Further work is needed to evaluate the effectiveness of immunosuppression for this condition.

Abortion, Habitual↗
PubMed1984

Serological and biochemical identification of a plasma membrane antigen specific to Leydig cells.

Purified mouse Leydig cells have been prepared from interstitial cell suspensions using a Percoll gradient procedure. The isolated cells are 88-95% pure as determined by light microscopy. Staining for 3-beta-hydroxysteroid dehydrogenase indicates that over 85% of the Leydig cells recognized by differential interference microscopy are also positive for this enzyme. After separation, the Leydig cells are viable by dye exclusion assays and exhibit normal in situ morphology when examined at the ultrastructural level. Leydig cell suspensions have been used to raise a polyclonal antiserum in rabbits. This antiserum, prior to absorption, reacts in indirect immunofluorescent studies with the surfaces of isolated Leydig cells, with testicular germ cells, with spermatozoa and with somatic cells such as splenocytes. Following absorption with lymphocytes and spermatogenic cells, the antiserum binds only to Leydig cell plasma membranes. Quantitative measurements with 125I-protein A confirm the specific labeling of Leydig cells by the absorbed antiserum. Biochemical identification of the Leydig cell plasma membrane antigen has been accomplished by immunoblotting polyacrylamide gel nitrocellulose transfers. A single major band of Mr approximately 40,000 is detected on one-dimensional transfers; two weakly reactive spots of Mr 43,000 and 45,000 are detected using two-dimensional immunoblots. Blotting experiments conducted using concanavalin A have identified the major Leydig cell constituents reactive with this lectin. The Leydig cell plasma membrane antigen(s) does not bind concanavalin A.

3-Hydroxysteroid Dehydrogenases↗
PubMedDate not supplied

Pregnancy outcome following ultrasound-detected fetal cardiac activity in women with a history of multiple spontaneous abortions.

OBJECTIVE: To determine whether women with two or more previous spontaneous abortions of unknown etiology, by conventional testing criteria, have a different rate of subsequent fetal loss than controls after ultrasonic documentation of fetal cardiac activity. METHODS: Medical records were reviewed from 185 women with spontaneous abortion of unknown etiology. Of these women, 91.9% were found to have evidence of cellular immunity to trophoblast and were treated with progesterone for immunosuppression. Ultrasound evaluation was obtained at 5-6 weeks' gestation to document fetal cardiac activity. A control group of 63 women was also studied. All women were followed for pregnancy outcome. RESULTS: A total of 248 pregnancies were identified from the 185 study patients with multiple spontaneous abortions. Fetal cardiac activity was visualized by ultrasound in 209 pregnancies from 171 study subjects; of these, the outcomes of 208 pregnancies were known. The rate of spontaneous abortion after ultrasound documentation of fetal cardiac activity was 22.7%. Neither maternal age nor number of previous losses was associated with an increased incidence of spontaneous abortion following documentation of fetal cardiac activity. The rate of spontaneous abortion in the control group after documentation of fetal cardiac activity was 3.3%. CONCLUSION: These data may help clinicians give couples who have experienced recurrent pregnancy loss a more realistic prognosis for pregnancy success once fetal cardiac activity has been confirmed.

Abortion, Habitual↗
PubMedDate not supplied

A clinical pathway for pelvic inflammatory disease for use on an inpatient service.

OBJECTIVE: (1) To create a guideline to improve care of adolescent patients diagnosed with pelvic inflammatory disease (PID); (2) to promote cost-effective, consistent care while minimizing delays and ensuring timely and appropriate use of laboratory tests and other interventions; and (3) to describe the process of the development and the implementation of a clinical pathway for PID. METHODS: The study involved the creation and piloting of a multidisciplinary, collaborative clinical pathway for uncomplicated PID on an inpatient service, and the development of a standardized form for analysis of demographics and variances from the pathway. The setting was an inpatient adolescent service at a children's hospital in an urban setting. All patients admitted with a clinical diagnosis of PID from April 1, 1993, to November 30, 1993, were followed up by means of the clinical pathway. All patients discharged with a diagnosis of uncomplicated PID in fiscal year 1992 (FY92: October 1, 1991, to September 30, 1992) were used as a comparison population. The main outcome measures included length of stay, charges per patient, timing of antibiotic administration, use of laboratory tests at admission and at 48 to 72 hours, and documentation of pathway variances. RESULTS: A clinical pathway was created by consensus during a period of several months. During implementation, 28 of 34 (82%) patients admitted by use of the pathway had a final diagnosis of PID; 23 of the 28 (82%) had uncomplicated PID. Variances from the pathway included missed rapid plasma reagins (RPRs) and laboratory tests that were not indicated. For uncomplicated PID, length of stay was reduced (p=.08) from a median of 4 days in FY92 (mean, 5.0 1 3.1 days; range, 2-15 days) to a median of 3 days in the study group (mean, 3.5 + 1.0 days; range, 2-4 days), with differences not reaching the level of significance. There were significantly more patients staying 5 days or longer in FY92 than in the study group (p<.03). Average charges per patient also decreased by 10% (median, $5,275 in FY92 to $4,919), although these results were not statistically significant. CONCLUSION: A clinical pathway for uncomplicated PID can be developed and implemented through a multidisciplinary, collaborative process, with ongoing use as a means of quality improvement and continuing education. Variances from the pathway highlight the need for ongoing education for health care providers. Downward trends in charges per patient and length of stay, although not significant, are encouraging; but they require longitudinal follow up with larger numbers of patients and analysis of outcomes.

Adolescent↗