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Biomedical subjects

N Gleicher

Publications and source records attributed to N Gleicher.

At least 19 recordsLinked to original sources
PubMed1992

Hysterosalpingography and selective salpingography in the differential diagnosis of chemical intrauterine versus tubal pregnancy.

OBJECTIVE: To determine the validity of hystersalpingography (HSG) and/or bilateral selective salpingography in the differential diagnosis of early (biochemical) intrauterine versus intratubal abortions. DESIGN: The study design involved the performance of HSG and selective salpingography in sequential patients with low declining beta-human chorionic gonadotropin (beta-hCG) values. SETTING: Medical School-affiliated Infertility Center. PARTICIPANTS: Four sequential pregnant infertility patients who demonstrated declining beta-hCG levels before pregnancy could be confirmed by ultrasound (chemical pregnancies). RESULTS: Three of four patients demonstrated a characteristic tubal opacification pattern in conjunction with a normally appearing endometrial cavity, considered diagnostic of an early tubal pregnancy. In contrast, a missed intrauterine pregnancy (IUP) demonstrated a characteristically abnormal endometrial cavity. CONCLUSIONS: Some early (chemical) pregnancy losses are intratubal rather than intrauterine. The correct differential diagnosis of early missed IUPs versus intratubal pregnancies is important because of its prognostic significance.

Adult↗
PubMed1992

Standardization of hysterosalpingography and selective salpingography: a valuable adjunct to simple opacification studies.

OBJECTIVE: To investigate the correlation between opacification and perfusion pressures during hysterosalpingography (HSG) and selective salpingography under the assumption that the latter may add to the diagnostic capabilities of the procedures. DESIGN: Perfusion pressures were uniformly evaluated by standardizing injection volume per time interval of contrast medium and the delivery system. Pressures were measured in a closed system through a digital manometer and recorded on tracing paper. SETTING: Fully ambulatory gynecoradiology suite at academically affiliated infertility center. PATIENTS: Thirty infertility patients. INTERVENTION: Hysterosalpingography and selective salpingography for diagnostic purposes. MAIN OUTCOME MEASURE: Correlation between opacification patterns and perfusion pressures. RESULTS: The evaluation of perfusion pressures during HSG is unreliable because they may be affected by uterine factors and will only reflect the oviduct of least resistance. In contrast, perfusion pressures during selective salpingography are reflective of only the investigated tube. They appear to lie within a functionally normal range of up to 350 mm Hg. Tubes by opacification judged as normal exhibited a pressure range of 429 +/- 376 mm Hg, which was significantly lower than that of abnormally appearing oviducts (957 +/- 445 mm Hg; P = 0.001). CONCLUSIONS: The concomitant performance of perfusion pressure studies during selective salpingography further enhances the diagnostic capability of selective salpingography over HSG in the diagnostic evaluation of fallopian tubes.

Female↗
PubMed1992

Endometriosis: a new approach is needed.

Endometriosis is generally regarded and treated as an endocrine and/or a surgical disease. Endocrine and surgical approaches to treatment are effective only in treating the symptoms of the disease and not its pathophysiology. Consequently, the success of such therapy is at best short-lived, and probably non-existent in mild disease. This thesis therefore argues for a new therapeutic approach towards endometriosis. In view of increasing evidence in favour of an immunological aetiology for this condition, it is suggested that such an approach may involve immunological rather than endocrine manipulation. It is also proposed that so-called unexplained infertility may in many cases represent a precursor stage of endometriosis, since immunological abnormalities in both of these conditions are so similar. Large-scale, prospective, multicentre clinical trials of immunotherapy in unexplained infertility and endometriosis appear to be indicated at this time if endometriosis is to lose its importance as one of the major contributors to female infertility.

Endometriosis↗
PubMed1992

Sonographic transcervical balloon tuboplasty.

The purpose of this study was to evaluate sonographic guidance for transcervical tubal catheterization and transcervical balloon tuboplasty of patients with bilateral proximal tubal occlusion. Cornual catheterization and transcervical balloon tuboplasty were performed under sonographic guidance. Injection of micro-bubble emulsion confirmed tubal recanalization. Tubal patency demonstrated by sonography was confirmed by injection of contrast material under fluoroscopy. Four women with bilateral proximal tubal occlusion confirmed by previous hysterosalpingogram and laparoscopy underwent sonographically guided transcervical balloon tuboplasty. Patients with distal or peritubal damage were excluded from this study. Bilateral tubal patency confirmed by sonography and subsequent fluoroscopy was achieved in all four patients. One patient conceived spontaneously, a month following the procedure, and delivered at term. Sonographically guided transcervical balloon tuboplasty can be performed successfully on patients with proximal tubal occlusion. Identification of the catheter tip and successful cannulation of the internal tubal ostia were easier to perform under fluoroscopy. Further improvements in sonographic equipment and catheter technology will hopefully eliminate radiation and replace fluoroscopy during the performance of transcervical balloon tuboplasty. Sonographic transcervical tubal catheterization may, therefore, become a simple and cost-effective procedure for the diagnosis and treatment of patients with proximal tubal occlusion.

Evaluation Studies as Topic↗
PubMed1992

Regulatory effect of antiphospholipid antibodies on signal transduction: a possible model for autoantibody-induced reproductive failure.

OBJECTIVES: The broad range of reproductive processes apparently affected by antiphospholipid antibodies suggests that antiphospholipid antibodies have to exert their clinical effects at every basic cellular level. Because phospholipids constitute essential components of every cell membrane, and because signal transduction processes are dependent on second messengers with phospholipid epitopes, we investigated the hypothesis that interference with signal transduction processes by antiphospholipid antibodies could represent such a basic cellular process. STUDY DESIGN: To test this hypothesis we established an in vitro placental culture system in which the stimulation of explants by phospholipase A2 and phospholipase C in the presence of normal human serum resulted in a significant increase in human chorionic gonadotropin secretion. RESULTS: When normal human sera were replaced with antiphospholipid antibody-containing sera from two women with established histories of reproductive failure, this increase in human chorionic gonadotropin production was inhibited 42% to 44% under phospholipase A2 stimulation and by 34% to 39% under phospholipase C stimulation. The hypothesis that antiphospholipid antibodies can interfere with signal transduction processes was further strengthened by the observation that antiphospholipid antibody-positive sera contained significantly higher immunoglobulin A antibody reactivity toward the second messenger inositol 1,4,5-triphosphate than control sera (p less than 0.049). CONCLUSIONS: These observations suggest the possibility that if present at excessive levels antiphospholipid antibodies may exert their adverse effect on reproductive processes through the interception of signal transduction processes.

Antibodies↗
PubMed1992

The correlation between lupus anticoagulant and autoantibodies.

The presence of a positive lupus anticoagulant (LA) has recently been associated with reproductive failure. LA positivity and reproductive failure have also been associated with autoantibody abnormalities, especially antiphospholipid autoantibodies. Because the correlation between LA and autoantibody positivity has remained controversial, we retroactively investigated 326 sera of patients with reproductive failure for correlation between lupus anticoagulant and 15 autoantibodies separately for IgG, IgM, and IgA isotypes. LA by TTI and APTT correlated significantly (p less than 0.0001). Among 18 antiphospholipid isotypes, 6 (33%) correlated significantly with TTI, 5 (28%) with APTT, and 3 (17%) both with TTI and APTT. Among 15 isotypes to histone subfractions, 4 (27%) correlated significantly to TTI, 3 (20%) to APTT, and 2 (13%) to both LA assay methods. Of 12 isotypes to antipolynucleotide antibodies, 2 (17%) correlated significantly to TTI, 1 (8%) to APTT, and none to both assay methods. The correlation between LA and autoantibodies was less striking among LA-positive than LA-negative sera. LA by both TTI and APTT was primarily found to correlate with IgG and IgA autoantibodies. This occurs in decreasing frequency to phospholipids, histones, and polynucleotides. At abnormal levels of LA (by either method) the correlation with autoantibody levels is less pronounced and appears closer with IgM autoantibodies to histones and polynucleotides than antibodies to phospholipids. We conclude that the correlation between LA and autoantibodies, especially antiphospholipid antibodies, is less pronounced than often reported in the literature. Patients suspected to suffer from reproductive failure due to abnormal autoimmunity have to be screened not only with LA and/or selected antiphospholipid autoantibodies, but with a more comprehensive autoantibody profile.

Autoantibodies↗
PubMed1991

Expansion of health care to the uninsured and underinsured has to be cost-neutral.

Any attempt to address the problem of more than 30 million uninsured and 25 million seriously underinsured citizens in the United States has to be able to offer medical services to this 20% of the population in a cost-neutral way for the US economy, since present economic conditions do not permit further expansion in health care costs. A medical system compartmentalized by medical specialty should be able to save approximately 20% of present-day health care expenditures within each specialty, which then can be used to provide the necessary coverage. Some suggestions are made as to how such cost savings can be achieved. Only an effort spearheaded by physicians can achieve the outlined targets, since, otherwise, physician efforts will easily subvert such attempts. A physician initiative that could solve the crisis would reestablish physicians as leaders in determining national health care policy and should consequently improve the recently disappointing societal image of the profession.

Cost Control↗
PubMed1991

The relationship between autoantibodies and intrauterine growth retardation in hypertensive disorders of pregnancy.

Abnormal levels of autoantibodies have recently been demonstrated in patients with hypertensive disorders of pregnancy and patients whose fetuses have intrauterine growth retardation. We determined total immunoglobulin levels (immunoglobulin G, immunoglobulin M, and immunoglobulin A) and a broad panel of autoantibodies (six antiphospholipid, four antihistone, and four antipolynucleotide antibodies) in 50 normotensive pregnant females, 19 patients with preeclampsia, and 18 patients with chronic hypertension to examine the relationship to intrauterine growth retardation. Mothers who were delivered of infants with intrauterine growth retardation demonstrated significantly more autoantibody abnormalities in the two hypertensive groups and in the normotensive control group as compared with patients delivered of appropriately grown infants. The most frequently observed autoantibody abnormalities were antiphospholipid antibodies and the most frequently observed among those were immunoglobulin G isotypes. Total immunoglobulin levels in both hypertensive and normotensive groups were identical. These results suggest a close association between the degree of B-cell activation and both severity of hypertensive diseases and development of intrauterine growth retardation in their offspring.

Adult↗
PubMed1991

A successful program to reduce cesarean section rates: friendly persuasion.

In 1986, the Division of Maternal/Fetal Medicine, Mount Sinai Hospital Medical Center, Chicago, implemented a cesarean section (C-section) program that used clinical guidelines to educate physicians and a computerized data collection system to provide reliable data for physician peer review; C-section rates fell from 17.5% to 11.5% in 1987, where they have remained. This program has been so successful that it is the model for a comparable program for the hospital's gynecology services.

Cesarean Section↗
PubMed1990

Peritoneal fluid and serum autoantibody levels in patients with endometriosis.

Patients with endometriosis demonstrate autoantibody abnormalities in their peripheral blood. Whether such abnormalities can also be detected in the peritoneal cavity, has not been established. We therefore investigated autoantibodies to 6 phospholipid antigens, 5 histones and histone subfractions and 4 polynucleotides in 14 laparoscopically diagnosed endometriosis and 9 control patients, undergoing laparoscopic tubal occlusion, in both serum and peritoneal fluid. Endometriosis patients demonstrated significantly lower total immunoglobulin G (IgG) levels in peritoneal fluid than controls. In contrast, specific IgG autoantibody levels were higher in peritoneal fluids of endometriosis patients. Mean antiphospholipids and antihistones autoantibodies reached significance when serum/peritoneal fluid ratios were compared with controls. Significant differences between endometriosis and control patients were restricted to IgG isotypes and were not observed for either IgM or IgA isotypes. These data suggest an abnormal concentration of IgG antiphospholipids and antihistones antibodies within the peritoneal cavity of endometriosis patients, which may play a contributing role in the peritoneal pathology of this condition.

Autoantibodies↗