Biomedical subjects

P R Manasse

Publications and source records attributed to P R Manasse.

8 recordsLinked to original sources

PubMed1994

Evaluation of different sperm function tests as screening methods for male fertilization potential--the value of the sperm migration test.

OBJECTIVE: To assess the value of different sperm function screening tests in predicting fertilization. DESIGN: Prospective study. SETTING: Academic tertiary referral center for fertility treatment. PATIENTS: Ninety-five couples attending for initial screening and IVF-ET. Only cycles where three or more grade I oocytes were collected were included, and patients with endometriosis were excluded. INTERVENTIONS: Each patient had a standard semen analysis, cervical mucus (CM) penetration test, hypo-osmotic swelling test, and sperm migration test performed between 4 and 8 weeks before IVF-ET. MAIN OUTCOME MEASURES: The correlation between sperm function test results and the percentage of fertilized oocytes and the power of the tests to predict fertilization. RESULTS: The sperm migration test correlated highly with fertilization rate (r = 0.62) and was most useful in identifying the group of patients likely to achieve fertilization (Odds ratio [OR] 0.07, confidence interval [CI] 0.02 to 0.2). The CM penetration test showed a moderate correlation with fertilization rate (r = 0.45) and some predictive power (OR 0.37, CI 0.13 to 1.00). Sperm concentration, but not motility or normal morphology, showed slight correlation with fertilization rate (r = 0.28) but the combination of normal semen parameters did not distinguish patients likely to achieve fertilization (OR 1.51, CI 0.62 to 3.65). The hypo-osmotic swelling test did not correlate with fertilization rate (r = 0.21). CONCLUSIONS: This study evaluated the predictive power of several simple tests available for use in most laboratories as screening tests of sperm fertilization potential. Apart from sperm concentration, normal traditional semen characteristics were of little clinical benefit. The hypo-osmotic swelling test had no predictive power. The CM penetration test correlated with fertilization rate but might be difficult to perform routinely as a continuous supply of suitable CM would be required. The sperm migration test proved to be the best discriminator of sperm fertilization potential and should be considered as a first level screening test in the assessment of male fertility.

Cervix Mucus↗

PubMed1993

Effect of aspirating needle calibre on outcome of in-vitro fertilization.

Thirty patients with intact ovaries undergoing ultrasound-guided transvaginal oocyte retrieval for in-vitro fertilization treatment had their ovaries randomized for follicular aspiration with small and large aspiration needles while under mild sedation. Collections using smaller diameter needles had no significant effect upon the number of oocytes collected per follicle aspirated, or on the subsequent fertilizing capacity of those oocytes. There was significant reduction in pain perceived by the patient when the smaller needle was used during the collection.

Adult↗

PubMed1993

Longitudinal assessment of amniotic fluid index.

OBJECTIVE: To derive a longitudinal gestational reference range for amniotic fluid index and to compare it with the established cross-sectional reference range. DESIGN: Longitudinal prospective study. SETTING: Liverpool Maternity Hospital and Mill Road Maternity Hospital, both teaching hospitals in central Liverpool. SUBJECTS: One hundred and fifteen pregnant women, in whom the expected date by the last menstrual period and ultrasound scan at 18 to 19 weeks were in agreement by seven days, were recruited. They were divided into two groups and scanned at four weekly intervals as follows: Group A: scanned at 20, 24, 28, 32, 36, 40; and Group B: scanned at 22, 26, 30, 34, 38, 42. RESULTS: Amniotic fluid index varies with gestation, rising from early gestation to peak at 30 weeks and then falling from 36 to 42 weeks. Comparison of our reference range with that of Moore and Cayle (1990) shows obvious differences at the lower limit. CONCLUSION: We have established a normal longitudinal reference range for the amniotic fluid index. Our ranges, derived from longitudinal data, would seem a more appropriate reference than the established reference ranges derived from cross-sectional data. In particular, the differences at the lower limits may have considerable clinical implication in the use of amniotic fluid index in the prediction of fetal compromise.

Amniotic Fluid↗

PubMed1993

Undiagnosed breech.

OBJECTIVES: To assess the proportion of breech presentations diagnosed in labour and to compare their outcomes with those diagnosed prior to the onset of labour. DESIGN: Retrospective casenote review. SETTING: Mill Road Maternity Hospital, a teaching hospital in central Liverpool. SUBJECTS: Three hundred and five singleton breech presentations delivered in the hospital between January 1988 and July 1991; 226 cases prior to the onset of labour and 79 cases diagnosed for the first time in labour. MAIN OUTCOME MEASURES: Rates of vaginal delivery and caesarean section, birthweight, short term morbidity as assessed by trauma, signs of cerebral irritation and admission to the newborn intensive care unit (NBICU), and Apgar scores. RESULTS: Breech presentations diagnosed for the first time in labour were more likely to deliver vaginally than those assessed and allowed to go into labour (odds ratio 1:68 95% CI 1.0-3.0). This difference was not due to demographic variables or differences in birthweight. There was no short term morbidity attributable to vaginal breech delivery. CONCLUSION: A significant number of breech presentations are not detected until labour despite rigorous antenatal surveillance. Our results show that undiagnosed breeches may not be important as they are more likely to deliver vaginally, with no excess morbidity or mortality, compared to diagnosed breeches in labour, carefully assessed for vaginal delivery. There are, therefore, no grounds for delivering all undiagnosed breeches by caesarean section.

Adolescent↗

PubMed1992

Transport in vitro fertilization--a novel scheme for community-based treatment.

OBJECTIVE: To provide an inexpensive and extensive in vitro fertilization (IVF) service for the Mersey Region, United Kingdom. DESIGN: Twenty-four transport IVF patients treated in two district general hospitals using the central university laboratory as co-ordination point for treatment schedule and embryology. Outcomes were compared with 26 control patients treated in the central unit. SETTING: Royal Liverpool University Hospital, a central IVF unit, and two district general hospitals in the Mersey Region. PATIENTS: Fifty patients under 35 years of age with irreversible tubal damage selected and treated by IVF, half in the central unit and the other half in two district general hospitals. MAIN OUTCOME MEASURES: Pregnancy rate (PR) in the different centers. RESULTS: A PR of 42.3% per cycle in the peripheral hospitals compared with 30.7% per cycle in the central unit. CONCLUSION: Transport IVF is an inexpensive and feasible alternative to standard IVF in a central unit for patients without access to central units.

Adult↗

PubMed1992

Nurses' attitudes and satisfaction in two psychogeriatric wards: their structure and correlates.

This study investigated the structure and correlates of previously published job satisfaction and attitude measures for nurses through an analysis of responses from staff working in two psychogeriatric wards. A number of inter-correlations were found between the attitude and satisfaction scales. Factor analysis revealed that one of the attitude scales was multi-dimensional and it is suggested that future research should not assume the uni-dimensionality of attitude and satisfaction constructs. It is concluded that psychometric research has important limitations, that a multiplicity of research strategies (both quantitative and qualitative) should be employed in future investigations and that more importance should be accorded to the organizational context of job satisfaction.

Attitude of Health Personnel↗

PubMed1992

Detrusor mast cells in refractory idiopathic instability.

The diagnosis of interstitial cystitis (IC) is not usually considered in patients with idiopathic instability. Because histamine provokes detrusor contractions in vitro, we assessed detrusor mast cell counts in 29 females with refractory instability. Raised mast cell counts (greater than 28/mm2 of detrusor muscle, consistent with a histological diagnosis of IC) were found in 29% of such cases. Thus cystoscopy and bladder biopsy should be considered in patients with idiopathic instability which fails to respond to anticholinergic drugs, as alternative therapy may be useful. Patients with refractory instability and normal detrusor mast cell counts often gave a history of prolonged childhood nocturnal enuresis (55% of cases); in contrast, patients with intractable instability and abnormally high mast cell counts seldom gave such a history (12%). These trends may give some insight into the aetiology of idiopathic instability--"congenital" or acquired?

Adult↗

PubMedDate not supplied

Multicentre randomised double bind crossover trial on contamination of conventional ties and bow ties in routine obstetric and gynaecological practice.

OBJECTIVE: To assess level of contamination of neckwear worn by gynaecologists and obstetricians during routine working week. DESIGN: Multicentre randomised double blind crossover trial. Participants wore the same conventional ties for three days in one week and bow ties for the same period in second week. SETTING: Two teaching and three district general hospitals in the midlands, Wales, and north England. SUBJECTS: 15 registrars and senior registrars. INTERVENTIONS: A swab soaked in sterile saline was taken from specific area on ties at end of first and third working days and sent in transport medium for culture on chocolatised blood and MacConkey agar for 48 hours. MAIN OUTCOME MEASURES: Level of bacteriological growth assessed semiquantitatively (0 for no contamination; for heavy contamination) after swabs had been cultured. At end of study the participants completed a questionnaire to assess their attitude toward wearing different types of necktie. RESULTS: 12 doctors (80%) completed the study. Although bow ties were significantly less contaminated at end of first working day (z = -2.354, p = 0.019), this difference was not maintained; there was no difference in level of contamination on third day. Level of contamination did not increase between first and third day of wearing the same garment. One of the 10 doctors who returned the questionnaire found the bow tie very uncomfortable. All participants would consider wearing a bow tie if it proved to be less contaminated than a conventional tie. CONCLUSIONS: Although a significant difference in contamination was established between conventional and bow ties on first day of study, this difference was not confirmed on third day and there is unlikely to be any real association between tie type and bacterial contamination. Because of its negative image and difficulty to tie, the bow tie will probably remain a minority fashion.

Attitude of Health Personnel↗