PubMed Health⌕ Search

Biomedical subjects

N Gleicher

Publications and source records attributed to N Gleicher.

At least 73 records · Page 4Linked to original sources
PubMed1993

Antithyroid antibodies and the association with non-organ-specific antibodies in recurrent pregnancy loss.

OBJECTIVES: The purpose of our study was to evaluate the incidence of antithyroid antibodies and non-organ-specific antibodies in women who have had three or more recurrent spontaneous abortions. STUDY DESIGN: Sera from 45 women for the presence of antithyroid antibodies to thyroglobulin and thyroid peroxide and for the non-organ-specific autoantibodies to 6 phospholipids, 5 histones, and 4 polynucleotides were analyzed. Sera from 100 apparently health blood donors served as controls. RESULTS: The test results of 14 (31%) of 45 study subjects were positive for one or both antithyroid antibodies compared with 19 (19%) of controls. Five (11%) of 45 patients had positive test results for one or more non-organ-specific antibodies, and 4 (8%) of 45 had positive test results for the lupus anticoagulant by either activated partial thromboplastin, tissue thromboplastin time, or both. Only 3 (21%) of 14 subjects whose test results were positive for thyroid antibodies also demonstrated non-organ-specific autoantibodies. COMMENTS: The incidence of antithyroid antibodies in women who have had recurrent abortions appears not to be significantly increased compared with a normal random control population. Antithyroid antibodies do occur, however, with significantly greater frequencies in women with recurrent spontaneous abortions than non-organ-specific autoantibodies (p = 0.02). Organ-specific and non-organ-specific autoantibodies may serve as independent markers of risk for repeated pregnancy loss in patient populations where pregnancy loss is associated with abnormal autoimmune function.

Abortion, Habitual↗
PubMed1993

The association of antithyroid antibodies in euthyroid nonpregnant women with recurrent first trimester abortions in the next pregnancy.

OBJECTIVE: To evaluate the prognostic value of antithyroid antibodies in euthyroid women with a history of recurrent first trimester abortions on future pregnancy loss. DESIGN: The sera of 42 euthyroid women with a history of three or more consecutive first trimester abortions were evaluated for the presence of antibodies to thyroglobulin and thyroid peroxidase before pregnancy and again as soon as the diagnosis of pregnancy was made. SETTING: Medical school-affiliated private infertility center. PATIENTS: Forty-two women with a history of three or more consecutive first trimester abortions who were planning to conceive again. MAIN OUTCOME MEASURE: The presence of antithyroid antibodies in the nonpregnant state and their association with pregnancy loss in the next gestation. RESULTS: Thirteen of 42 women (31%) were positive for the presence of antithyroid antibodies at the initial screening before pregnancy. All 13 maintained positivity by the time their next pregnancy was diagnosed. Only 12 of those 42 women (29%) experienced a first trimester abortion. Eight of these 12 women (67%) were positive for one or more antithyroid antibody. In contrast, among 30 nonaborting women, only 5 of 30 (17%) exhibited thyroid antibody positivity. The detection of thyroid antibodies before conception carried an increased risk of pregnancy loss in the next pregnancy (8 of 13, 62% versus 4 of 29, 14%). CONCLUSION: The presence of antithyroid antibodies in nonpregnant women with a history of recurrent abortion identifies a subgroup of women at significantly increased risk for yet another pregnancy loss in their next gestation. Because organ-specific autoantibodies thus demonstrate similar prognostic significance to nonorgan-specific autoantibodies, it is tempting to conclude that peripheral autoantibody abnormalities seen in habitual aborters only reflect an underlying T-lymphocyte defect, which may be the actual cause of pregnancy loss.

Abortion, Habitual↗
PubMed1993

The multicentre transcervical balloon tuboplasty study: conclusions and comparison to alternative technologies.

Transvaginal tubal catheterization procedures have been suggested as an alternative to microsurgery and in-vitro fertilization (IVF) in the treatment of women with proximal tubal occlusion. A transcervical balloon tuboplasty (TBT) catheter was specifically developed and tested in a prospective multicentre trial. A total of 151 women with confirmed bilateral or unilateral tubal occlusion were studied. The primary study population included 106 women who, after exclusion of patients for protocol violations, represented those females who were treated for complete tubal occlusion with TBT. TBT is an ambulatory, minimally invasive catheter procedure, performed under paracervical block or mild sedation, which utilizes a co-axial balloon catheter under fluoroscopic guidance. Re-canalization, pregnancy and reocclusion rates following the procedure were documented. A total of 28 patients demonstrating uni- or bilateral tubal patency after either hysterosalpingography and/or selective salpingography represented the control population. TBT established tubal patency of at least one Fallopian tube in 95/106 patients (90%) and in 167/205 obstructed oviducts (82%). Clinical pregnancies occurred in 37/106 females (35%), with a life table adjusted rate of 37%. Patients without distal disease had significantly higher pregnancy rates than those with bipolar tubal disease (49% versus 12%, life table adjusted rate; P = 0.0002) but pregnancy rates were independent of underlying aetiology for tubal disease. Pregnancy rates in control patients who did not reach TBT because of tubal patency after hysterosalpingography and/or selective salpingography were significantly lower than in those successful treated with TBT (P = 0.027), and occurred only for four cycles after hysterosalpingography and with approximately a 1 year delay after selective salpingography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

What do we really know about autoantibody abnormalities and reproductive failure: a critical review.

CONDENSATION: The diagnosis and treatment of autoantibody-associated forms of reproductive failure is critically reviewed. OBJECTIVE: To critically evaluate the published literature in reference to autoantibody-associated forms of reproductive failure. LOCATION: Medical School-affiliated private Infertility Center. MATERIALS: A review of over 200 published papers reflecting on the topic. RESULTS: Autoantibody associated reproductive failure, characterized by a decrease in fecundity and an increase in the risk of pregnancy loss, appears established. Autoantibody abnormalities, as routinely detected by standard laboratory assays, are, however, neither immunologically nor biologically specific since cross reactivities between autoantibodies are frequent and a specific autoantibody may cause a biological effect in one but not in another affected individual. CONCLUSIONS: The evaluation of autoantibody abnormalities in all cases of suspected autoimmune-associated reproductive failure is valuable and will improve clinical care of affected patients. Clinicians need, however, to recognize the limitations of autoantibody testing and have to adjust their clinical management to the degree and quality of autoantibody evaluation available to them in their community.

Abortion, Habitual↗
PubMed1993

Abnormal (auto)immunity and endometriosis.

Immunologic abnormalities may precede endometriosis and be involved in its pathophysiology especially as it relates to the occurrence of infertility and pregnancy loss. Many cases of unexplained infertility may represent undiagnosed endometriosis. This is supported by the observation that immunologic profiles in endometriosis and unexplained infertility are very similar. It is argued that endometriosis is a systemic rather than local disease, thus requiring systemic therapy. Currently available medical and surgical techniques are effective in relieving symptomatology associated with endometriosis, although this is often temporary. A new clinical approach is needed that considers systemic presentation and likely immunologic pathophysiology.

Abortion, Spontaneous↗
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↗