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Biomedical subjects

M Vermesh

Publications and source records attributed to M Vermesh.

At least 37 records · Page 2Linked to original sources
PubMed1988

Rapid measurement of urinary pregnanediol glucuronide to diagnose ectopic pregnancy.

We investigated the ability of a single, random, urinary pregnanediol-3 alpha-glucuronide level to differentiate early intrauterine from ectopic pregnancy. Thirty-four patients with intrauterine gestations were compared with 60 patients with ectopic pregnancies. Urinary pregnanediol-3 alpha-glucuronide was measured by radioimmunoassay and enzyme immunoassay. Compared with intrauterine gestations, results demonstrate that urinary pregnanediol-3 alpha-glucuronide is significantly depressed in ectopic pregnancies: 24.5 +/- 2.2 versus 4.8 +/- 0.7 micrograms/ml (p = 0.0001). Urinary pregnanediol-3 alpha-glucuronide levels obtained by conventional radioimmunoassay correlated closely with values measured in minutes with enzyme immunoassay (r = 0.95, p = 0.0001), and with serum progesterone (r = 0.74, p = 0.0001). Urinary pregnanediol-3 alpha-glucuronide measured by enzyme immunoassay exhibited predictive values for detecting ectopic gestations comparable with random serum progesterone or serum beta-human chorionic gonadotropin values. We conclude that ectopic gestations demonstrate a reduced level of urinary pregnanediol-3 alpha-glucuronide (55/60 cases) detectable with a rapid enzyme immunoassay, which makes this assay a practical screening test in early pregnancy.

Chorionic Gonadotropin↗
PubMed1988

Mouse embryo culture as quality control for human in vitro fertilization: the one-cell versus the two-cell model.

Female mice were superovulated with pregnant mare serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG) and mated with male mice. One-cell (n = 429) and 2-cell (n = 450) embryos were collected 20 and 42 hours after hCG and cultured in Ham's F-10 medium (Gibco, Grand Island, NY) (282 mOsm/l, pH 7.4) and in media of altered osmolality (260, 300, 316 mOsm/l), altered pH (7.0, 7.8, 8.0) or various dilutions of Cidex (Surgikos, Arlington, TX) (1:1000, 1:10,000, 1:100,000). Stages of development were observed for 4 days. The development of embryos in the 1-cell system was significantly impaired under all studied conditions by the 4-cell stage of development. The 2-cell system failed to detect trace amounts of Cidex in the culture media and an increase in osmolality to 300 mOsm/l. Other changes in osmolality (260 mOsm/l) and pH (7.8) were detected by the 2-cell system only at the blastocyst stage. The authors conclude that the 1-cell system is more sensitive than the 2-cell system to mild changes in in vitro fertilization culture media.

Animals↗
PubMed1988

Persistent tubal ectopic gestation: patterns of circulating beta-human chorionic gonadotropin and progesterone, and management options.

To aid in the clinical decision making involved with persistent ectopic gestation, a total of 329 operative procedures for tubal gestation were reviewed. Six of 114 (5.3%) cases treated conservatively had persistent trophoblastic activity. The decline in serum beta-human chorionic gonadotropin (hCG) and progesterone (P) at 3 and 6 days postoperatively was similar in the "persistent ectopic" and the "resolved ectopic" groups. However, beyond day 6 both beta-hCG percentage of baseline and P level were significantly higher in the "persistent ectopic" (greater than 22.6 +/- 6.6%, greater than 3.4 +/- 0.7 ng/ml, respectively) than the "resolved ectopic" group (less than 2.7 +/- 0.8%, less than 0.2 +/- 0.05 ng/ml, respectively). Four patients underwent a second operation, whereas two were managed expectantly. These data suggest that the diagnosis of persistent ectopic gestation is best made by an initial measurement of serum beta-hCG or P at 6 days postoperatively, and at 3 day intervals thereafter. The choice of management may be determined by various factors including serum beta-hCG and patient's symptoms.

Adult↗
PubMed1988

Effect of androgen on adrenal steroidogenesis in normal women.

Ovarian hyperandrogenism may induce adrenal enzymatic defects that mimic true inherited disorders of adrenal hormone biosynthesis. To assess the effect of hyperandrogenism on adrenal steroidogenesis, seven normal ovulatory women were studied on 2 days during the early follicular phase of their cycles. Plasma 17-hydroxyprogesterone (17-Prog), 17-hydroxypregnenolone, dehydroepiandrosterone (DHEA), DHEA sulfate, androstenedione (Adione), testosterone (T), 11-deoxycortisol, and cortisol concentrations were measured every 15 min for 3 h after iv injection of 0.25 mg ACTH (day 1) and pretreatment with dexamethasone on each day. On the second study day, T (80 micrograms/h) was infused iv for 5 h, and ACTH was given after 2 h of T infusion. The T infusion raised mean serum T levels from 1.2 +/- 0.3 (+/- SE) to 8.6 +/- 0.6 nmol/L. The maximum incremental (delta max) plasma Adione response to ACTH was significantly higher (2.6 +/- 0.3 to 3.2 +/- 0.4 nmol/L; P less than 0.009) during the T infusion, while the delta max responses of the other steroids did not change. There was an increase in the delta max 17-Prog to cortisol ratio (4.9 +/- 0.7 to 7.0 +/- 1.0; P less than 0.05), but no change in the delta max 17-Prog to Adione or 17-hydroxypregnenolone to DHEA ratios and no changes in the delta max delta 5- to delta 4-steroid ratios. These data suggest that acute T elevations result in subtle inhibition of 21-and/or 11 beta-hydroxylase activities, but not in 17-20-desmolase or 3 beta-ol activities.

17-alpha-Hydroxypregnenolone↗
PubMed1988

Vaginal bromocriptine: pharmacology and effect on serum prolactin in normal women.

Oral bromocriptine treatment of hyperprolactinemia is frequently associated with gastrointestinal side effects. To assess the efficacy and safety of an alternate route of treatment, we randomly administered 2.5, 5.0, and 7.5 mg of bromocriptine vaginally to five normal women at 1-week intervals. Plasma bromocriptine and prolactin (PRL) levels were measured hourly for 12 hours, then every 2 hours for 12 hours after each dose. At the end of each study, the vagina was flushed with saline for measurement of residual drug. For comparison of serum PRL levels, six additional women were given 2.5 mg bromocriptine orally. After administration of 2.5, 5.0, and 7.5 mg vaginally, plasma bromocriptine was initially detectable at 5.4 +/- 0.4, 4.4 +/- 0.7, and 3.5 +/- 0.6 hours, respectively. For the same vaginal doses, the mean (+/- SEM) peak plasma levels were 555 +/- 164 pg/mL at 12 +/- 0.6 hours, 702 +/- 252 pg/mL at 11.2 +/- 0.9 hours, and 1055 +/- 220 pg/mL at 10.7 +/- 1.7 hours, respectively. After each dose, there was a slow decline in plasma bromocriptine levels, remaining above 50% of peak values at 24 hours. Less than 1% of the administered drug was recovered from the vagina at 24 hours. The pattern of PRL inhibition with all three doses was similar. The mean plasma PRL level decreased by 7 hours, the maximum PRL decrease (64 +/- 3, 75 +/- 1, and 66 +/- 4% after 2.5, 5.0, and 7.5 mg, respectively) occurring at 11 hours, and the plasma PRL levels changed little during the remaining 13 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravaginal↗
PubMed1987

Follicle-stimulating hormone is the main determinant of follicular recruitment and development in ovulation induction with human menopausal gonadotropin.

The early hormonal changes that lead to follicular maturation and/or hyperstimulation in women requiring ovulation induction with either human menopausal gonadotropin or gonadotropin-releasing hormone have not been elucidated. This study was undertaken to assess the relative contribution of follicle-stimulating hormone and luteinizing hormone to estradiol secretion and follicular maturation in patients receiving human menopausal gonadotropin or gonadotropin-releasing hormone. The study group consisted of 10 women (26 to 38 years of age) with secondary amenorrhea as a result of hypothalamic dysfunction who had failed to ovulate when given clomiphene citrate. The patients were randomly assigned to either human menopausal gonadotropin (n = 5) or gonadotropin-releasing hormone (n = 5) treatment. On day 5 after the onset of induced menses, all women had baseline blood samples obtained at 10-minute intervals for 4 hours. At this time either 150 U of human menopausal gonadotropin or 75 ng/kg of gonadotropin-releasing hormone administered hourly was given, and blood sampling every 10 minutes was continued for an additional 6 hours. Thereafter, patients were evaluated daily until ovulation. A significant and sustained increase in the mean plasma follicle-stimulating hormone level was first measured during the third hour after human menopausal gonadotropin administration (p less than 0.05. The area under the curve of the mean plasma follicle-stimulating hormone value after this initial increase was significantly greater than its baseline (2119 +/- 240 versus 1425 +/- 188 mlU/ml; p less than 0.01). This rise in mean follicle-stimulating hormone level was followed in less than 2 hours by a significant and uniform rise in mean plasma estradiol concentration (p less than 0.05). In contrast, no immediate change in the mean levels of luteinizing hormone, follicle-stimulating hormone, or estradiol occurred after gonadotropin-releasing hormone administration. The mean daily levels of luteinizing hormone were similar in both groups; however, mean daily follicle-stimulating hormone (20.0 +/- 1.1 versus 9.2 +/- 1.4 mlU/ml) and estradiol (1004 +/- 174 versus 495 +/- 83 pg/ml) levels were significantly higher in patients treated with human menopausal gonadotropin than in those treated with gonadotropin-releasing hormone (p less than 0.001 and p less than 0.05, respectively). In addition, only in patients receiving human menopausal gonadotropin was a positive correlation found between mean daily plasma estradiol and follicle-stimulating hormone (r = 0.685, p less than 0.05) levels and between mean daily plasma estradiol and prolactin (r = 0.94, p less than 0.001) levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1987

The endocrinologic evaluation of a 45,X true hermaphrodite.

A 13-year-old 45,X girl presented with spontaneous menses and the acute onset of progressive hirsutism. Complete endocrinologic evaluation of hirsutism was unremarkable. An exploratory laparotomy revealed a gonad containing ovarian and testicular tissue. Chromosome analysis from four different tissues confirmed the karyotype to be 45,X. She was H-Y antigen positive.

Adolescent↗
PubMed1987

Longitudinal evaluation of the luteal phase and its transition into the follicular phase.

The precise patterns of LH, FSH, and PRL secretion and their correlation with estradiol (E2) and progesterone (P) secretion during the entire luteal phase have not been elucidated. To analyze in detail the secretory patterns of these hormones we performed 29 consecutive studies in 5 healthy, regularly menstruating women throughout their luteal phase [days 0 (ovulation), 2, 6, 10, and 14] and subsequent early follicular phase (day 2F). During each study plasma LH, FSH, PRL, E2, and P were measured at 10-min intervals for 6 h. Both plasma LH concentrations and LH pulse frequency declined from days 0 to 10 and increased thereafter, whereas LH pulse amplitude continued to decline throughout the luteal and early follicular phases. Plasma FSH concentrations followed a pattern similar to that of LH; however, there was a larger increase in the FSH level on days 14 and 2F. Plasma PRL levels declined initially on day 2 and again on day 14. Regression analysis indicated a positive correlation between LH concentrations and LH pulse frequency (r = 0.715; P less than 0.001) and between PRL and E2 concentrations (r = 0.528; P less than 0.01). A negative correlation was found between plasma P concentrations and both LH concentrations (r = -0.521; P less than 0.01) and LH pulse frequency (r = -0.633; P less than 0.001) and between plasma E2 and FSH concentrations (r = -0.762; P less than 0.001). Thirty-six (65%) PRL pulses and only 11 (39%) FSH pulses coincided with LH pulses. There was no clear pulsatile pattern of secretion of either E2 or P. We conclude that 1) the plasma LH, FSH, PRL, E2, and P concentrations vary markedly throughout the luteal phase; 2) the plasma LH level is largely dependent on the frequency of LH pulses; 3) plasma P decreases plasma LH by reducing the frequency of LH pulses; 4) the remarkable synchrony between PRL pulses and LH pulses implies that their secretion may be regulated by a common neuroendocrine mechanism; and 5) the preferential increase in FSH during the late luteal phase may play an important role in follicular recruitment for the subsequent cycle.

Adult↗
PubMed1987

Endogenous opioids modulate the inhibitory effects of androgen on the hypothalamic-pituitary axis of normal women.

This study was designed to investigate the effect of dihydrotestosterone (DHT) on LH secretion in normal women and the role of endogenous opioids in modulating this effect. Pulsatile LH release and maximum LH responsiveness to exogenous GnRH were determined on 3 consecutive days: basally (day 1), during DHT infusion (day 2), and during DHT plus naloxone (Nal) infusion (day 3). Steady state plasma DHT levels of 6.5 +/- 1.1 (+/- SEM) ng/mL (22.5 +/- 3.8 nmol/L) were achieved by infusion. DHT infusion significantly decreased the maximum LH response to GnRH from 35.5 +/- 8.2 to 11.6 +/- 2.8 IU/L (P less than 0.05). This inhibitory effect was not altered by Nal. In addition, DHT significantly decreased LH pulse frequency (basal, 4.3 +/- 0.3; DHT, 2.8 +/- 0.3 pulses/6 h; P less than 0.05), but not the amplitude of the LH pulses. However, after the addition of Nal to DHT, the pulse frequency increased significantly from 2.8 +/- 0.3 to 4.7 +/- 0.3 pulses/6 h (P less than 0.05). The mean plasma LH level did not change during the infusion of DHT alone, but it did increase significantly when Nal was added (DHT, 4.8 +/- 1.0; DHT + Nal, 7.9 +/- 1.0 IU/L; P less than 0.01). The results of this acute pharmacological study suggest that androgens may have two separate effects on the hypothalamic-pituitary axis: 1) inhibition of GnRH release, which appears to be mediated via opioid peptides, and 2) inhibition of pituitary LH secretion, which is not dependent on opioids.

Adult↗
PubMed1987

Acute salpingitis in sterilized women.

Previously sterilized women are generally considered protected against salpingitis. However, when we diagnosed salpingitis by laparoscopy in 48 patients during a 16-month period, we found four (8%) who had been previously sterilized. Therefore, contrary to generally stated belief, salpingitis may occur after interruption of tubal continuity.

Acute Disease↗
PubMed1987

Monitoring techniques to predict and detect ovulation.

This study was designed to evaluate the accuracy of various methods in predicting and detecting ovulation in 14 spontaneous and 17 clomiphene citrate (CC)-induced cycles. From cycle day 11 all subjects (n = 27) were followed with daily transvaginal ultrasound; rapid measurement of serum luteinizing hormone (LH) and estradiol (E2); determination of urinary LH with First Response (Tambrands Inc., Palmer, MA) and Ovustick (Monoclonal Antibodies, Inc., Mountain View, CA) kits; and recording of basal body temperature (BBT). The results demonstrated that transvaginal ultrasound detected ovulation in all cycles. Mean daily serum LH levels were similar in both groups, and peak values of 40 mIU/ml or greater preceded the day of ovulation in all cycles. Serum E2 peak was significantly greater in CC cycles (961 +/- 96 versus 463 +/- 39 pg/ml) (P less than 0.01) and preceded the LH peak in 97% of the cycles. First Response and Ovustick predicted ovulation in 53.3% and 87.5% of the cycles, respectively (P less than 0.01). BBT nadir predicted the day of ovulation in only 10% of cycles. In conclusion, this study revealed that transvaginal ultrasound is an excellent method for detection of ovulation and that Ovustick is a very useful method for prediction of the day of ovulation.

Adult↗
PubMed1986

Non-vascular transplantation of the rabbit uterus.

Transplantation of the uterus may be an optimal solution in young hysterectomized patients, in women with agenesis of the uterus or in severe uterine anomalies. In the human model, attempted tubal and ovarian homografts have usually failed. Eighteen rabbits underwent unilateral non-vascular uterine transplantation. Four rabbits underwent total unilateral uterine autograft. Three uteri showed severe inflammation and necrosis 72 h, 1 week and 1 month postoperatively. Thereafter, the operative technique was modified to avoid contamination from the vagina and four rabbits underwent supravaginal unilateral non-vascular autograft. Three uteri had preserved endometrial and myometrial structure on relaparotomy. The following four rabbits underwent homotransplantation of the uterus and showed acute rejection of the transplant. Under cyclosporine therapy three homotransplanted rabbits developed pelvic abscesses while three other rabbits showed preserved myometrial and endometrial structures.

Animals↗
PubMed1986

Contraceptive practices of female physicians.

To evaluate a potential bias between methods of birth control used and prescribed by physicians, we surveyed sexually active female physicians in regards to their own methods of birth control. When the contraceptive practices of female physicians are compared to those of the general population, no difference in use of various contraceptive methods is found. Among female obstetrician-gynecologists, however, the intrauterine device continues to be a disproportionally popular method of contraception. It is concluded that no gender bias exists in prescribing patterns of contraceptives since contraceptive use in female physicians is identical to that of the general populations.

Adult↗
PubMed1986

Pitfalls in sonographic imaging of the incompetent uterine cervix.

Artifacts interfering with sonographic imaging of the uterine cervix in pregnancy are described. Increasing the amount of fluid in the urinary bladder closes the cervix and alters the configuration of the lower uterine segment, while increased intra-uterine pressure results in reciprocal changes. Angulation of the transducer and manual pressure thereon distort sonographic findings. It is concluded that, contrary to recent reports in the literature, sonography cannot reliably demonstrate changes in cervical compliance during pregnancy. Vaginal examination remains the ultimate diagnostic modality for the diagnosis of the incompetent cervix, while sonography may be used as an adjunct only.

Cervix Uteri↗
PubMed1986

Prenatal sonographic diagnosis of Hirschsprung's disease.

The prenatal sonographic presentation of Hirschsprung's disease is described. This report strongly suggests that bowel distention in Hirschsprung's disease may begin in the late third trimester of intrauterine life. The importance of early diagnosis and treatment cannot be overemphasized. Sonography may greatly contribute to the early diagnosis of Hirschsprung's disease.

Adult↗