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Biomedical subjects

R S Sawers

Publications and source records attributed to R S Sawers.

At least 19 recordsLinked to original sources
PubMed1998

Liaison between gynaecologists, microbiologists and genitourinary medicine clinics in the management of patients with genital chlamydia and gonococcal infections.

Inadequate treatment and follow-up of women with genital infection with Chlamydia trachomatis and Neisseria gonorrhoeae can cause long-term morbidity. Inadequate contact tracing can predispose to re-infection. As some women with genital infections present to agencies other than genitourinary medicine (GUM) clinics, improved liaison between these and GUM departments are important in safeguarding proper follow-up and contact tracing.

Adolescent↗
PubMed1989

A new method for studying human oocytes by light and electron microscopy.

Since ovarian follicles appear to be randomly oriented with respect to the plane of the section, the method of sectioning and examining follicles at their maximum diameter described here allows direct comparison between oocyte populations of women and small differences can be detected. Re-sectioning for EM allows selected follicles of interest to be examined at a higher resolution.

Adult↗
PubMed1987

Is changing hypothalamic activity important for control of ovulation?

The activity of the hypothalamic gonadotrophin releasing hormone pulse generator in women with regular ovulatory and anovulatory menstrual cycles was assessed to see whether changes therein are important determinants of normal and impaired ovarian function. Endogenous gonadotrophin releasing hormone secretion was inferred by measurement of the pituitary luteinising hormone response by characterisation of pulsatile luteinising hormone release over eight hours on three occasions during the course of follicular development and once during the luteal stage of the same cycles. In 13 ovulatory cycles (serum progesterone concentration greater than 25 nmol/l) confirmed by ovarian ultrasonography a pronounced variability in luteinising hormone pulse patterns among subjects was compatible with ovulation. In the luteal stage of ovulatory cycles the luteinising hormone interpeak interval (85 min, range 42-125) was significantly longer than that during the early follicular (64 min, 40-103), mid-follicular (62 min, 37-107), and late follicular (59 min, 39-80) stages of the same cycles. Thus in ovulatory cycles no increase in frequency of the gonadotrophin releasing hormone pulse generator was detected during follicular development, though this activity decreased in the luteal stage. In five late follicular stage studies in which part of the preovulatory luteinising hormone surge was captured no change in pulse frequency of luteinising hormone was detected compared with the mid-follicular stage of the same cycles or when compared with the late follicular stage of other cycles when no luteinising hormone surge was captured. Though mean luteinising hormone concentrations in luteinising hormone surge series (36 IU/l) were high, the amplitude of luteinising hormone pulses (165%) was only slightly greater than during non-surge late follicular stage studies (145%). Hence no change in hypothalamic gonadotrophin releasing hormone activity is required to generate the preovulatory discharge of luteinising hormone in man, which occurs as a result of the sensitising action of rising oestradiol concentrations on pituitary responsiveness to the same hypothalamic input signal. Luteinising hormone pulse frequency, peak amplitude, and mean serum luteinising hormone concentrations in seven anovulatory cycles (progesterone concentration less than 10 nmol/l) were not different from those at comparable stages of ovulatory cycles. These data suggest that the primary abnormality in this group of regularly menstruating anovulatory women lies in the ovary rather than in the hypothalamic control of the anterior pituitary.

Adult↗
PubMed1987

Characteristics and incidence of dysfunctional ovulation patterns detected by ultrasound.

The nature and incidence of normal and abnormal spontaneous ovarian cycles, identified with ultrasound and endocrine tracking, were examined in 45 regularly cycling infertile women with no definitive cause and 15 women who were apparently normal and were receiving donor insemination because of clearly infertile partners. In 136 cycles, four apparently distinct abnormal patterns were detected. The total incidence in the infertile group was 58% compared with 23% in the donor insemination group (P less than 0.005). Twelve of 26 subjects who had at least three cycles tracked showed two different abnormalities, and 1 subject had three different abnormalities in five abnormal cycles. These results suggest that abnormal cycles are a significant factor in unexplained infertility and that diagnosis and treatment cannot be based on the study of a single cycle.

Adult↗
PubMed1987

Effect of bromocriptine on LH pulsatility in the polycystic ovary syndrome.

The effects were studied of bromocriptine, 10 mg daily for 1 year, on luteinizing hormone (LH) pulse characteristics in patients with classical polycystic ovarian syndrome (PCOS). All patients were hirsute, had been oligomenorrhoeic since menarche, had LH: FSH ratios of greater than 3:1, and either elevated serum testosterone (T) or dehydroepiandrosterone sulphate (DHAS) concentrations. In 10 subjects who completed the study menstrual frequency increased from an average of 3.6 to 8 per year but few of the cycles were ovulatory. Mean (SE) serum testosterone fell from 4.4 (0.5) nmol/l pretreatment to 2.8 (0.3) nmol/l (P less than 0.01) and DHAS from 7.9 (1.1) mumol/l to 5.4 (1.1) mumol/l (P less than 0.05). Serum delta 4 androstenedione and oestradiol did not change with bromocriptine treatment. Mean serum LH fell from 17.4 (2.4) IU/l to 11.2 (1.8) IU/l (P less than 0.03) after 12 months of bromocriptine. No pattern of LH pulsatility specific to PCOS was detected during 10 min sampling for an 8 h period prior to dopamine agonist treatment. LH interpeak interval (58 (5.2) min) and peak amplitude (156 (7.2%) of mean nadir) in untreated PCOS were similar to that of the mid-follicular stage of ovulatory cycles, and bromocriptine for 1 year did not alter these variables. We conclude that while bromocriptine reduces serum androgen levels and increases menstrual frequency it has no effect centrally to modify hypothalamic GnRH secretion. The reduction in LH levels by bromocriptine may be the result of diminished gonadotroph sensitivity to GnRH or reduced pituitary stores of LH available for release. Despite the return towards normal of various hormonal characteristics of PCOS, bromocriptine has little place in the management of this condition.

Adolescent↗
PubMed1986

Follicular growth and endocrine profiles in spontaneous and induced conception cycles.

Twenty conception cycles were tracked with ultrasound ovarian scanning from the midfollicular to midluteal phase, and simultaneous hormone profiles were obtained in 18 of the cycles. Twelve cycles were spontaneous and 8 were induced with a variety of regimens. Two of the spontaneous cycles did not have endocrine data, and in one other no follicular growth was observed, despite repeated scanning. The induced cycles did not differ significantly from the spontaneous ones in any respect except the number of follicles and the consequent estradiol (E2) levels. E2 levels per unit total follicular surface area, however, were similar in both groups and remained relatively constant throughout the late follicular phase.

Adult↗
PubMed1986

Control of hidradenitis suppurativa in women using combined antiandrogen (cyproterone acetate) and oestrogen therapy.

The effects of combined treatment with the antiandrogen, cyproterone acetate, and ethinyl oestradiol on four women with long-standing hidradenitis suppurativa have been investigated. The condition was controlled successfully in all patients with 100 mg/day cyproterone acetate using the reversed sequential regimen; lowering the antiandrogen to 50 mg/day caused deterioration. Before treatment, plasma testosterone levels were within the normal range, but plasma androstenedione values were raised and sex hormone binding globulin levels were low. On treatment, the androstenedione concentration fell and sex hormone-binding globulin values were raised. However, since these levels were unaltered by reducing the antiandrogen dosage, the main action of the therapy is probably that of the antiandrogen within the target cells.

Adult↗
PubMed1986

Relationship between human sperm motility characteristics and sperm penetration into human cervical mucus in vitro.

A series of 100 modified Kremer tests of human sperm penetration into human cervical mucus was carried out as part of the routine investigation of couples presenting with infertility. The outcome of these tests was significantly correlated with the concentration and progressive motility of the spermatozoa in the semen sample used for the test. Other semen characteristics significantly correlated with the test result were the mean velocity of progression (VP) and the amplitude of lateral head displacement about the axis of progression (AH) of the progressive spermatozoa. Normal sperm morphology was also correlated with the outcome. Using these semen characteristics as the independent variables to predict the test outcome in a discriminant analysis (normal vs abnormal tests), 34.2% of the variance was accounted for. From the discriminant function equation 75.0% of the test results could be predicted correctly. In the 30 cases in which the semen samples used for the tests showed greater than or equal to 25 X 10(6) progressively motile spermatozoa per ml, mean VP of greater than or equal to 25 microns/sec and mean AH of greater than or equal to 7.5 microns, 83.3% had normal test results. Conversely, all 13 cases for which the semen characteristics were below these limits had abnormal test results. Therefore, both the concentration of progressively motile spermatozoa and their movement characteristics are significant factors determining the outcome of homologous tests of human sperm-cervical mucus interaction.

Cervix Mucus↗
PubMed1986

A standardized approach for evaluating the penetration of human spermatozoa into cervical mucus in vitro.

Carefully timed and quantitated Kremer-type tests were performed for assessment of sperm-mucus interaction in 100 couples who underwent an infertility workup. A novel scoring system for these in vitro tests was elaborated and validated. The success of penetration of seminal spermatozoa into the mucus, and their migration within the mucus column, was related to both the sperm concentration and their motility, especially their progressivity. A calculated index of sperm motility quality gave a 70% accuracy rate in predicting the test result (normal versus abnormal), but this success rate was not significantly improved by incorporation of the sperm concentration into the index. No clear biologic relationship was found between this method for assessing Kremer-type tests (which correlated closely with accepted clinical reporting practices) and Katz's "percentage of successful collisions." This apparent discrepancy is considered to reflect basic differences in the approaches of the two scoring systems.

Cervix Mucus↗
PubMed1985

Ultrasound follicle diameter measurement: an assessement of interobserver and intraobserver variation.

The intraobserver and interobserver variation of ultrasound measurement of Graafian follicles was assessed. Fourteen follicles from 10 to 30 mm in diameter were each measured three times in three orthogonal planes by three observers. The intraobserver standard deviation (SD) was 0.6 mm and interobserver SD, 1.2 mm, irrespective of follicle diameter. The pooled SD for both variables was 1.2 mm, giving 95% confidence limits of +/- 2.4 mm for any measurement.

Female↗
PubMed1983

Serum free thyroxine concentrations in normal euthyroid subjects and ones with high serum thyroxine binding globulin concentration.

Serum free thyroxine (fT4) was assayed by a commercial fT4 method in 30 normal euthyroid subjects, 19 pregnant females, 13 euthyroid subjects with high thyroxine binding globulin (TBG) and three with low or undetectable serum TBG concentration. In a number of these fT4 was also calculated on the basis of the application of the law of mass action to the binding situation. In states in which TBG was altered for congenital reasons both the experimentally determined and calculated fT4 were not significantly different from their respective means in the normal euthyroid population. Pregnant females had both lower experimental and theoretical free T4 concentrations. It is inferred from these data that TBG concentration per se is without effect on serum fT4 concentration.

Blood Proteins↗
PubMed1983

Binding of testosterone and oestradiol to sex hormone binding globulin, human serum albumin and other plasma proteins: evidence for non-specific binding of oestradiol to sex hormone binding globulin.

1. The percentage binding of testosterone (T) and oestradiol (E2) to sex hormone binding globulin (SHBG) and human serum albumin (HSA) was determined over a range of SHBG concentrations of 16-250 nmol of dihydrotestosterone (DHT) bound/l. It was found that the binding of both T and E2 to HSA was a function of their binding to SHBG and bore an inverse relationship to it. After removal of both SHBG and HSA from plasma by affinity chromatography a 'residual' binding of about 11% for T and 12% for E2 was still apparent. In addition to the specific high-affinity, low capacity binding of E2 to SHBG, non-specific low-affinity binding of 7-12% was demonstrated after selective denaturation of the specific binding site of the latter. 2. Competition studies indicated that although at the relatively higher levels of SHBG found in the normal female the physiological concentrations of E2, T and DHT need not be taken into account in estimating the unbound fractions of steroids, at the relatively lower levels of SHBG found in normal men and hirsute women, the physiological concentrations of T and DHT are effective in causing statistically significant displacement of E2 from the common, specific binding site on SHBG. 3. A simple computerized technique is described for the determination of fractions of E2 and T respectively, that are unbound to SHBG, unbound to SHBG and HSA, and unbound to all plasma proteins, when the total plasma levels of E2, T, DHT and SHBG are known.

Binding, Competitive↗
PubMed1982

Long-term effects of cyproterone acetate on the pituitary adrenal axis in adult women.

Function of the pituitary-adrenal axis was assessed in 16 adult female patients who had been taking cyproterone acetate for greater than 1 year. Some evidence of reduced basal cortisol output was seen in 25% of the patients, but plasma cortisol levels could be stimulated both by hypoglycaemia and by direct corticotrophin (ACTH) stimulation. The latter effect was confirmed by analysis of steroid excretion in urine although basal excreation rates indicated extensive adrenal suppression. These results suggest that cyproterone acetate does have some glucocorticoid activity which is able partially to suppress the pituitary--adrenal axis, but leaves it still responsive to stress.

Adult↗
PubMed1982

The value of antenatal cardiotocography in the management of high-risk pregnancy: a randomized controlled trial.

The value of routine regular antenatal cardiotocography (CTG) in the management of high-risk pregnancy was assessed in a prospective randomized controlled study of 353 patients. All patients had a weekly CTG trace during the last 6 weeks of pregnancy and according to the random allocation the tracings were concealed from, or available to, the clinicians. Other methods of assessing fetal welfare were available to both groups. There was no significant difference between the concealed and revealed groups in the timing and mode of delivery, birthweights, Apgar score and neonatal morbidity. No apparent effect from the routine use of antenatal CTG in high-risk pregnancy was shown.

Adolescent↗