Search

Sedimentation field-flow fractionation (SdFFF), operated with power-based field programming, was shown to be effective in the characterization of submicrometer fat emulsions. Field programming, in which the decrease of field strength with time gradually increases the average velocity of the sample components, extends the capabilities of sedimentation field-flow fractionation in handling polydisperse samples. Submicrometer fat emulsions were analyzed by three different rates of field decay and two different initial field strengths, using various stop-flow times. Identical size distribution profiles were obtained under all circumstances, using the appropriate stop-flow times. Fractions were collected from the SdFFF eluting bands, and diameters were analyzed by photon correlation spectroscopy, showing good agreement with values given by the FFF instrument. The agreement between the two methods indicated also that polydispersity of size dominated band broadening. Accurate and highly reproducible size distribution profiles were obtained in all the cases studied. Sample loadability was examined by studying overloading effects and detection limits. The linearity of detector response was also established, by injecting increasing loads of sample. The accuracy of the FFF peak shape was examined experimentally, by collecting fractions, dissolving the emulsion in them, and measuring the UV absorption of the solutions. The profile formed by the fractions was relatively close to the FFF band, proving that light scattering does not seriously distort the size distribution profile.

Objective: To evaluate ultrasonically the incidence and duration of tissue damage after testicular sperm aspiration (TESA) procedures., Design: Prospective, nonrandomized study., Setting: Assisted reproductive technology program., Patient(s): Thirty-two men with obstructive azoospermia., Intervention(s): Physical and serial testicular ultrasound examinations 1.5, 3, and 6 months after the surgical procedure., Main Outcome Measure(s): Systematic evaluation of the testicular parenchyma and blood flow., Result(s): In 93.7% of the patients (30 of 32), no evidence of parenchymal or vascular injuries was found 6 weeks after the procedure. In the remaining 2 patients, transient evidence of tissue damage disappeared after 3 months., Conclusion(s): Testicular sperm aspiration is a safe surgical method for sperm retrieval for IVF. Repeated surgical attempts might be considered within 2 months, provided there is no evidence for tissue damage on sonography.

Objective: To characterize clinical and laboratory findings in nonmosaic 47,XXY patients that may help to predict spermatogenetic activity in their testicles., Design: Prospective study., Setting: Assisted reproductive technology program., Patient(s): Twenty patients with nonmosaic Klinefelter syndrome who underwent testicular sperm retrieval for IVF., Main Outcome Measure(s): The correlation between basal FSH, LH and testosterone levels, mean testicular volume, and results of the hCG test and presence or absence of sperm after testicular sperm extraction (TESE)., Result(s): Sperm was found in nine patients (45%). The mean testicular volume was 7.8 +/- 2.5 mL in men with sperm after TESE and 5.6 +/- 1.2 mL in those without sperm after TESE; corresponding testosterone levels were 3.5 +/- 1.2 ng/mL and 1.7 +/- 0.8 ng/mL. Serum levels of FSH and LH did not significantly differ between groups. After the hCG test, the mean serum testosterone level was 16.0 +/- 6.3 ng/mL in men with sperm after TESE and 6.7 +/- 5.6 ng/mL in those without sperm., Conclusion(s): Testicular volume, testosterone levels, and results of the hCG test are important predictive factors of spermatogenesis in patients with nonmosaic Klinefelter syndrome.

Recent developments in infertility treatment, as well as medical and ethical concern to preserve the fertilizing ability of male subjects potentially at risk, led to the inception of a sperm cryobank in our medical center in 1996. Up to the end of the year 2000, 64 young men displaying higher semen values than generally required were accepted as donors, while 305 married (mean age 32.5, range 22-54) and 381 single women (mean age 41.2, range 27-50) were treated by artificial insemination donor (AID), resulting in 251 conceptions. Besides, 437 male subjects aged 15-61 requested sperm cryopreservation. Methodological considerations about sperm cryopreservation, and behavioral implications therefrom, are evaluated.

Objective: The objective of our study was to explore the effect of dexamethasone (DEX), a highly potent, long-acting glucocorticoid, on the treatment outcome of 74 anovulatory women aged 21 to 29 years, with normal gonadotropins, androgen, and prolactin (PRL) serum levels who failed to conceive on antiestrogen therapy., Methods: The patients received human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG) for ovulation induction. Starting on day 4 of the induced menstruation, hMG was administered in combination with DEX, 0.5 mg at night, or without DEX as an adjuvant treatment. The total amount of gonadotropins used, time required for stimulation, percentage of fertilization, serum estradiol levels, pregnancy rate, cumulative pregnancy rate, and abortions were recorded., Results: There were no differences in either the cumulative pregnancy rate (54.1% in the DEX group and 52.7% in the untreated group) or the abortion rates (21.7% in the DEX group compared to 20.8% in the untreated group). The other parameters investigated also did not differ significantly between the groups., Conclusions: The overall results did not support DEX as a clinically useful adjuvant therapy for anovulatory, normoandrogenic patients.

Background: Women with premature ovarian failure may conceive spontaneously or following different regimens of ovulation induction., Case: A 29-year-old woman with eight years of hypergonadotropic hypogonadism following chemotherapy and radiotherapy for Hodgkin's disease conceived spontaneously and spontaneously aborted after discontinuation of estrogen replacement. Subsequently she underwent pituitary gonadotrope downregulation and attempted controlled ovarian hyperstimulation without an ovarian response or follicular development. Despite this failure, she conceived spontaneously on two occasions, resulting in a live-born infant and an ongoing pregnancy., Conclusion: Cases of hypergonadotropic hypogonadism may not be permanent or irreversible. Interventional regimens may fail to induce ovulation despite the presence of residual oocytes capable of recruitment and fertilization.

Four women with the antiphospholipid syndrome associated with lupus anticoagulant and a poor obstetric history were treated with a combination of glucocorticosteroids, anticoagulants and platelet inhibitor therapy. All patients had at least one previous miscarriage while receiving prednisone and low-dose aspirin. The treatment regimen included: aspirin, dipyridamole, prednisone, and warfarin or heparin. This treatment resulted in a successful pregnancy outcome in all cases, without preeclampsia or recurrence of thrombosis. One patient developed a vertebral compression fracture while receiving heparin and prednisone. Two pregnancies required cesarean delivery for fetal distress at 32 and 34 weeks. All four infant birth weights were appropriate for the gestational age. This regimen may be a therapeutic option for patients with the antiphospholipid antibody syndrome, especially if they have failed other commonly used treatments.

Therapy with steroids and aspirin has been reported to benefit pregnancies in patients with lupus anticoagulant (LA). In this study, habitual first-trimester aborters with LA using steroids and aspirin were compared to a control group of untreated habitual aborters without LA. In habitual aborters with LA, 12 of 24 (50%) pregnancies reached the second trimester as compared to 8 of 22 pregnancies (36%) in the control group. Since the treated group did no better than the control group, LA probably is not a cause of first-trimester abortion. However, once the second trimester is reached, a 50% incidence of growth retardation was found, and 42% of fetuses died in the second or third trimester in treated LA patients. Treatment with steroids and anti-platelet aggregating agents may be necessary despite the attendant risks to prevent those sequelae in the second and third trimesters. There was a 29% live birth rate in treated LA patients; the rate was 36% in control patients. However, this rate was produced only by early intervention, which was unnecessary in the control patients.

Toxic shock syndrome can occur after any surgical procedure. We report the first case of toxic shock syndrome that has occurred after a loop electrosurgical excision procedure. The patient recovered with supportive care and antibiotics.

Tubal factors cause infertility in about a third of cases. With current diagnostic techniques, such as laparoscopy and hysterosalpingography, only a fraction of the causes of tubal infertility can be diagnosed and in many cases misdiagnosis results. Newer methods, such as ampullosalpingoscopy enable examination of the fimbria and ampullar segment of the fallopian tube, but the examination of the proximal tube, in which 10-20% of occlusions occur, is still impossible. We describe a new diagnostic technique, falloposcopy. It involves the transuterine insertion of a fiber optic device into the fallopian tube through a hysteroscope. This technique enables direct visualization of all segments of the fallopian tube, as well as removal of intratubal debris or adhesions. Using falloposcopy, a new grading method for tubal disease has been developed. We describe the results of 129 falloposcopic procedures in 82 women. Following falloposcopy, women with mild to moderate disease, according to the new classification, have conceived without further therapy during a follow-up period of up to 3 years. Falloposcopy may aid in differentiating between patients suitable for tubal surgery and those who should be referred for in vitro fertilization.

The effect of an intraumbilical prostaglandin (PG) F2 alpha injection on the third stage of normal labor was studied in 54 normal, laboring women at term. Either 1 mg of PGF2 alpha diluted to 20 mL in normal saline (27 women) or 20 mL of normal saline alone (27 women) was injected into the umbilical vein immediately after delivery using a randomized, double-blind protocol. The mean (+/- SD) duration of the third stage was 7.31 +/- 6.37 minutes in the PGF2 alpha patients and 8.94 +/- 7.10 in the normal saline patients. Intraumbilical PGF2 alpha did not influence the third stage of normal labor.

Objective: To assess the effect of gonadotropin-releasing hormone agonist (GnRH-a) on pituitary suppression, subsequent ovarian response, and results of in vitro fertilization (IVF) treatments in polycystic ovarian syndrome (PCOS) patients., Design: Randomized prospective study., Setting: In vitro fertilization program and endocrinologic institute., Patients: Thirty patients with PCOS; 16 received GnRH-a, and 14 did not receive GnRH-a., Interventions: Ovum pick-up and embryo transfer., Main Outcome Measures: Response to GnRH-a test, serum and follicular fluid (FF) hormonal measurements, steroid levels, and aromatse activity in granulosa cell (GC) culture, and results of IVF., Results: Pituitary responsiveness was abolished in all patients 14 days after GnRH-a administration, and early luteinization was prevented. Steroid levels in FF did not differ between the two groups. In GC culture, progesterone (P) levels were higher in patients without the GnRH-a (3,704 +/- 1,232 nmol/L versus 2,117 +/- 235 nmol/L; P less than 0.05) as were androstenedione (A) levels (5.3 +/- 1.0 nmol/L versus less than 3.5 nmol/L; P less than 0.05). However, aromatase activity and IVF results were similar in the two groups., Conclusions: Administration of GnRH-a in patients with PCOS decreases P and A production by the GC cells and prevents early luteinization. It does not affect the IVF results.

Among 114 women with early spontaneous abortions, low beta-human chorionic gonadotropin levels and no ultrasonographically demonstrable residual tissue in the uterine cavity, 68 underwent uterine curettage, and 46 were managed conservatively. No complications, such as bleeding or infection, were observed in either group, and the probability of conception, outcome of subsequent pregnancies and rate of subsequent abortions were similar. Curettage offers no advantage over conservative management in selected patients with early abortions.

Among two hundred and twenty-one patients admitted with the diagnosis of pelvic inflammatory disease (PID), 6 had an underlying malignancy. The rate of underlying malignancy was 1.4% in premenopausal patients and 42.8% in postmenopausal patients. This difference was statistically significant, p less than 0.001. In postmenopausal patients presenting with a pelvic inflammatory process pelvic malignancy should be highly suspected and thorough examination made.

The injection of varying volumes of normal saline solution, alone or with oxytocin, into the umbilical vein immediately after delivery was studied in 125 normal women delivered at term. Thirty seconds after cord clamping, either 20 ml (group 1, n = 25 women), 30 ml (group 2, n = 25) or 40 ml (group 3, n = 25) of normal saline solution alone, or oxytocin 10 units in 20 ml saline solution (group 4, n = 25) or oxytocin 10 units in 40 ml saline solution (group 5, n = 25) were injected into the umbilical vein 1 cm from the introitus just proximal to the umbilical clamp. The mean (+/- SD) duration of placental expulsion was similar in the five study groups. We conclude that neither the volume of the solution nor the oxytocin injected intra-umbilically has any effect on the duration of the third stage of normal labor.

Ovarian cysts are a common complication of GnRH-a administration. We followed 98 patients who were suppressed with GnRH-a before ovarian stimulation with hMG for IVF treatment. Approximately 20% of the patients receiving GnRH-a during the follicular or luteal phase had developed ovarian cysts. However, the number of cysts per patient was significantly higher in the follicular phase compared with luteal phase. Systematic aspiration of those cysts under local anesthesia permitted the start of ovarian stimulation with hMG as scheduled on day 16 after GnRH-a administration. Follicular fluid content of the cysts revealed similar levels of steroids to those in normal follicles. These cysts contained few cells and no egg. In vitro fertilization treatment was more successful in patients whose cysts were aspirated during the luteal phase than in those with cysts during the follicular phase. We concluded that luteal phase cysts are more benign than follicular phase cysts, and it is possible that they represent an enlargement of pre-existing corpora lutea.

Recent observations claimed that growth hormone (GH) administration increased the sensitivity of the ovary to gonadotropin stimulation. These findings prompted us to assess whether ovarian response to human menopausal gonadotropin (hMG) is correlated to GH reserve. Before hMG administration, 25 patients were tested for GH reserve by administration of clonidine. Of the 25 patients, 8 showed a significant increase in GH (9.2 +/- 4.5 ng/mL) and needed a significantly lower dose of hMG/human chorionic gonadotropin to elicit a good ovarian response than the 17 patients who did not respond to clonidine administration may help to estimate the initial dose range of hMG necessary for induction of ovulation.

Our study indicates that the high rate of EP in MAP(+) patients, treated with hMG/hCG, is due to the fact that it is a selected group of infertile patients with probable additional underlying tubal disease. Absence of EP in MAP(-) patients indirectly support the theory that a mechanical factor is at work. It is, therefore, our opinion, that the cause of ectopic pregnancy lies in the patient and not in the drug (hMG/hCG).

A case of salpingitis with pyosalpinx subsequent to tubal ligation is described. The procedure was performed at the time of cesarean section 7 years earlier. The pyosalpinx included the distal portion of the ligated tube, with no evidence of infection in the proximal segment. Although pelvic peritonitis, salpingitis and tubo-ovarian abscess are rare following tubal ligation, they should be suspected in any patient presenting with lower abdominal pain.

A 65-year-old woman with pure primary ovarian squamous cell carcinoma invading the fallopian tube and the terminal ileum is described. The tumor recurred shortly after surgery in spite of complete resection. No response to chemotherapy was observed and the patient expired 6 months after diagnosis. In order to establish the diagnosis of pure primary ovarian squamous cell carcinoma extragenital and genital tumors containing squamous elements as well as endometriosis have to be excluded.