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Biomedical subjects

P R Garner

Publications and source records attributed to P R Garner.

15 recordsLinked to original sources
PubMed1990

Preeclampsia in diabetic pregnancies.

Diabetic pregnancies complicated by preeclampsia are of concern because of poor perinatal outcome. However, with improved maternal and fetal surveillance the impact of preeclampsia in diabetic pregnancies is declining. This prospective controlled study compared the incidence of preeclampsia and maternal-fetal outcome in 334 diabetic pregnancies and 16,534 nondiabetic pregnancies. The incidence of preeclampsia was 9.9% (33/334) in diabetic pregnancies compared with 4.3% (716/16,534) in nondiabetic controls. The incidence of preeclampsia rose with increasing severity of diabetes by White classification, but was still 8.9% after exclusion of diabetic patients with nephropathy or chronic hypertension. The perinatal mortality rate per 1000 births was 60 for preeclamptic diabetic patients compared with 3.3 for normotensive diabetic patients. Parity, maternal age, and blood glucose control were similar in preeclamptic diabetic patients compared with normotensive diabetic patients. We conclude that preeclampsia is twice as common in diabetic pregnancies compared with normal controls.

Blood Glucose↗
PubMed1989

Insulinoma complicating pregnancy presenting with hypoglycemic coma after delivery: a case report and review of the literature.

The incidence of insulinoma in pregnancy is unknown. All of the eight previously reported cases presented in the first trimester with hypoglycemic episodes. We report a case of a 24-year-old multigravida who presented with hypoglycemic coma after delivery. We discuss the possible protective role of pregnancy counter-regulatory hormones in keeping the patient asymptomatic until delivery, and present the difficulties in both diagnosis and differential diagnosis of insulinoma in the peripartum period. Chronic hypoglycemia in pregnancy has been associated with intrauterine growth retardation and increased perinatal mortality. However, this infant was at the 90th percentile for body weight, suggesting that asymptomatic maternal hypoglycemia had not been present during the gestation. Insulinoma complicating pregnancy, though very rare, should now be included in the differential diagnosis of postpartum hypoglycemia.

Adenoma, Islet Cell↗
PubMed1987

Elevated serum dehydroepiandrosterone sulfate levels in patients with insulin resistance, hirsutism, and acanthosis nigricans.

The association of insulin resistance, hyperandrogenism, and acanthosis nigricans is well established. The ovary is thought to be the site of the excess androgen production. The purpose of this study was to assess the adrenal contribution to the hyperandrogenic state in these women. Twenty-three patients presenting with the combination of hyperinsulinemia, elevated testosterone (T) levels, and acanthosis nigricans were investigated for the source of the increased androgen production. Twelve patients had elevated serum dehydroepiandrosterone sulfate (DS) levels (high DS group) suggestive of increased adrenal androgen production. Eleven patients had normal DS levels (normal DS group). Both normal DS and high DS groups had similar basal serum insulin levels and similar insulin response curves after a 3-hour, 75-gm, oral glucose tolerance test. No correlation was found between serum T or DS levels and either basal serum insulin levels or the area under the insulin response curve. These data suggest that DS levels are frequently elevated in patients with hirsutism, acanthosis, and hyperinsulinemia. Furthermore, the lack of association between serum DS and serum insulin levels suggests that insulin does not directly affect adrenal androgen production, or vice versa.

Acanthosis Nigricans↗
PubMed1987

Primary amenorrhea associated with hyperprolactinemia: four cases with normal sellar architecture and absence of galactorrhea.

Hyperprolactinemia is an uncommon cause of primary amenorrhea. The diagnosis should be sought even in the absence of galactorrhea and sellar abnormality, particularly when thelarche and pubarche have occurred. Reduction of serum PRL levels followed by menarche can be anticipated within a few months of starting bromocriptine therapy in the majority of cases.

Adolescent↗
PubMed1987

Homologous artificial insemination for oligoasthenospermia: a randomized controlled study comparing intracervical and intrauterine techniques.

Homologous artificial insemination (AIH) is used to treat infertility caused by oligoasthenospermia, despite the lack of controlled studies confirming its benefit. This prospective randomized controlled trial was undertaken to determine whether intracervical (IC-AIH) or intrauterine (IU-AIH) homologous artificial insemination improves pregnancy rates in couples with infertility attributable to oligoasthenospermia alone. Twenty couples were randomized to receive IC-AIH or IU-AIH. Sixty-three insemination cycles were completed. During the same study period, 35 cycles with timed vaginal intercourse alone were assessed. Four pregnancies occurred, all following timed vaginal intercourse. No pregnancies resulted from IC-AIH or IU-AIH. This suggests that neither IC-AIH nor IU-AIH is of benefit when oligoasthenospermia is the cause of infertility. Pregnancies previously attributed to AIH may also have been conceived as a result of vaginal intercourse. This confounding effect on the results of AIH should always be considered.

Adult↗
PubMed1987

Endometrial prostaglandins and menorrhagia: influence of a prostaglandin synthetase inhibitor in vivo.

Prostaglandin levels in the human endometrium were determined on day 2 of the menstrual cycle in eumenorrheic subjects and in patients with menorrhagia, dysmenorrhea, or both. Menorrhagic subjects had significantly higher levels of endometrial prostaglandins of the E and F series when compared with eumenorrheics. Prostaglandin E levels were markedly higher than prostaglandin F. In 10 menorrhagic subjects who completed a double-blind clinical study on the effectiveness of mefenamic acid in lowering menstrual blood loss, 9 exhibited statistically significant reduction in endometrial prostaglandin levels. A decrease in menstrual blood loss was also noted during mefenamic acid treatment in these patients. These findings are consistent with the concept that abnormally high uterine prostaglandin levels may be an important etiologic factor in menorrhagia and support the notion that one of the mechanisms of action of nonsteroidal anti-inflammatory agents in the treatment of this menstrual disorder is inhibition of endometrial prostaglandin production.

Adult↗
PubMed1986

Pregnancies after premature ovarian failure.

Six women who conceived after a diagnosis of premature ovarian failure are discussed. Two pregnancies occurred while the women were receiving conjugated estrogen therapy, two while taking oral contraceptives, and two women conceived spontaneously. The possible role of exogenous estrogens in sensitizing the granulosa cells to the effect of follicle-stimulating hormone and thereby inducing ovulation and conception in some women with premature ovarian failure is examined.

Adolescent↗
PubMed1986

Pregnancy rates after hysterosalpingography with oil- and water-soluble contrast media.

Hysterosalpingography can be accomplished with either oil or water-soluble contrast medium. This randomized prospective study compared pregnancy rates in women who had hysterosalpingography with either water- or oil-soluble contrast material and were followed for six months. Fifteen of 60 (25%) patients who received water-soluble dye conceived compared with 14 of 46 (30%) patients in the oil-soluble group, a statistically insignificant difference. Furthermore, no difference in pregnancy rates within each subgroup of fertility diagnosis was detected. Intravasation was more common in patients administered oil-based contrast materials (six of 46 versus one of 60 patients, P = .02), although no serious consequences occurred. No difference in the amount of pain as assessed by pain scoring was experienced by patients in each group. The authors conclude that pregnancy rates are similar after hysterosalpingography with oil- and water-soluble contrast material, during at least the first six months after the procedure.

Adult↗
PubMed1986

Premature ovarian failure. Current concepts.

Premature ovarian failure is not uncommon. It can occur at any age and has important implications for both patient and clinician. Various therapeutic options are available, including in vitro fertilization with donor oocytes.

Adult↗
PubMed1985

Premature ovarian failure: its relationship to autoimmune disease.

Thirty-three patients with the diagnosis of chromosomally competent premature ovarian failure were reviewed for evidence of autoimmune disease. Thirty-nine percent of subjects had an associated autoimmune disorder, of which thyroid disease was the most common. One patient had vitiligo and one had adrenal insufficiency. A family history of autoimmune disease was elicited from 18% of subjects, all of whom proved to have an autoimmune disease themselves. From these findings, and a review of other studies, the authors conclude that an associated autoimmune disease, or other evidence of autoimmunity, is present in 30 to 50% of patients with premature ovarian failure.

Adolescent↗
PubMed1977

The effect of human chorionic gonadotropin and estradiol-17beta on the maintenance of the human corpus luteum of early pregnancy.

The effect of exogenous human chorionic gonadotropin (HCG) and estradiol valerate (EV) on the maintenance of the corpus luteum of early pregnancy, assessed by serial estimations of serum progesterone and 17alpha-hydroxyprogesterone (17-OHP), was studied in 35 subjects following therapeutic termination of pregnancy by suction curettage before the tenth week of gestation. Continuous intravenous infusion of 50,000 International Units (I.U.) of HCG for 24 hours following termination of pregnancy delayed the decline of serum HCG levels, and 17-OHP levels were maintained at preoperative levels for the 24 hours of the infusion. Single intramuscular injections of 5,000 or 20,000 I.U. of HCG were ineffective. Administration of 25 mg. of EV intramuscularly immediately following therapeutic termination of pregnancy slightly retarded the decline of serum 17-OHP levels. The same treatment when administered in combination with the intravenous infusion of 50,000 I.U. of HCG completely prevented the ability of HCG to maintain serum levels of 17-OHP. These finding susggest an antagonism between estradiol and HCG in maintenance of the human corpus luteum during early pregnancy.

Chorionic Gonadotropin↗