Search PubMed⌕ Search

Biomedical subjects

A DeCherney

Publications and source records attributed to A DeCherney.

32 records · Page 2Linked to original sources
PubMed1984

Improved techniques for separating motile spermatozoa from human semen. II. An atraumatic centrifugation method.

A simple and atraumatic method for concentrating washed, motile spermatozoa from normal and subnormal semen specimens is described. It incorporates a modified technique of centrifugation in which sperm are spun onto a soft, fluid cushion, thereby minimizing mechanical damage. Following initial semen dilution to 5-10 ml in an artificial medium, the mixture is transferred to a test tube and layered onto 1 ml of oily contrast medium (Lipiodol). After centrifugation at 300 g for 10 min all but 0.5 ml of the supernatant is discarded, and the unshaken test tube is incubated at 37 degrees C for 15-20 min, during which time the motile sperm migrate into the upper 0.5 ml. After this incubation, 0.3 ml of the upper layer is removed which is sufficient for most IVF and AIH purposes. It contains concentrated, washed, motile spermatozoa that are free of debris and most abnormal forms. No change in pH or osmolarity and no diffusion of any iodine from the oil base into the top layer were detected.

Cell Separation↗
PubMed1984

The role of the social worker in the in-vitro fertilization program.

The role of the clinical social worker in the In-Vitro fertilization Program is to help provide patients with an environment that includes realistic expectation and emphasizes the emotional spectrum of euphoria, anxiety and dysphoria that can accompany the demanding protocol. The literature supports the need for counseling and supportive psychotherapy in the infertility clinic but has not dealt specifically with the psychological demands of In-Vitro fertilization. This paper addresses the emotional stress of in-vitro fertilization and emphasizes the role of social worker as counselor, educator and guide.

Adaptation, Psychological↗
PubMed1984

Rapid microcomputer-based analysis of semen characteristics from photographs taken by the MEP method.

Use of a microcomputer with the multiple exposure photography (MEP) method for rapid analysis of semen characteristics is described. The computer is programmed to calculate information fed from a digitizing tablet while scanning projected images of photographed sperm. In this way sperm concentration, percentage of motility, average velocity and frequency distribution of sperm velocity, as well as percentage of abnormal forms are immediately obtained. The method was found to be as accurate, less prone to error, and significantly less time consuming than the previous manual measuring method. It can greatly facilitate routine semen analysis in laboratories using the MEP method.

Computers↗
PubMed1983

Hysteroscopic management of intrauterine lesions and intractable uterine bleeding.

Müllerian fusion defects, submucous myomas, and intractable uterine bleeding have been managed traditionally by major surgical intervention. However, the cystoscope-resectoscope provides the operative versatility allowing transvaginal surgical management of these situations. Forty women underwent hysteroscopy and treatment with the cystoscope-resectoscope at the Yale-New Haven Hospital. Those patients treated for septate müllerian defects also underwent concomitant laparoscopy. Therapeutic surgical use of the cystoscope-resectoscope resulted in no immediate or long-term complications. Of 11 patients with uterine anomalies treated in this fashion, 9 carried to term without difficulty. Fourteen women with space-occupying intrauterine lesions were treated and resumed normal cyclical menses for a minimum of 1 year. In all 11 patients with intractable uterine bleeding hemorrhage was controlled immediately and 6 women remained amenorrheic for a sustained period. The use of the cystoscope-resectoscope for the management of these entities provides several advantages: 1) A transcervical approach obviates the necessity for abdominal surgery, and 2) the instrument is rapidly and easily accessible to the practicing gynecologist.

Colposcopy↗
PubMed1980

Homotransplantation of the human fallopian tube: report of a successful case and description of a technique.

The rising emphasis on conservative surgical treatment of the fallopian tube has generated a greater demand for methods of reparative surgery. Thus far, the use of surrogate tubes and allotransplantation of the fallopian tube hae not fulfilled the requirements for success. A case of homotransplantation of the human fallopian tube is presented. At surgery, a midsegment anastomosis was performed by grafting the good portion of the left tube to a viable segment of the right tube. The arteries and veins were then anastomosed with 9-0 silk and a single-layer closure; an operating microscope was used. Patency was documented with chromotubation, and bleeding was controlled with microcautery. Decadron and Phenergan were placed in the patient's abdomen along with 150 ml of saline. She was given systemic Decadron, Phenergan, and antibiotics pre- and postoperatively. Three months after surgery hysterography revealed a viable-appearing fallopian tube. The patient subsequently aborted an 8-week intrauterine gestation. Fallopian tube homotransplantation has a role in the treatment of infertility, but the patient population for which this procedure is applicable is limited.

Adult↗
PubMed1980

Presacral neurectomy for pelvic pain in infertility.

Twenty patients have undergone presacral neurectomy at Yale-New Haven hospital over the past 7 years. The patients were separated into three subdivisions according to abnormal findings at the time of surgery: group I, endometriosis; group II, pelvic inflammatory disease (PID); and group III, those patients with neither endometriosis nor pelvic inflammatory disease but with pelvic pain and infertility. At the time of surgery, an attempt was made to correct and repair coexistent pelvic abnormalities. The groups were evaluated for relief of pain and subsequent viable intrauterine pregnancy. A control group of infertility patients complaining of pain who underwent infertility laparotomy without presacral neurectomy was used for comparison. Presacral neurectomy has traditionally been performed for pain associated with endometriosis and has resulted in subsequent pain relief and pregnancy rates of 30% to 60%. Pregnancy rates of 46% to 47% were found in the PID group, the endometriosis group, and the control group. In addition, 75% of the patients with either PID or endometriosis had significant relief of pain following presacral neurectomy as compared with only 26% of the control group undergoing only infertility laparotomy. It is concluded from these findings that presacral neurectomy plus reconstructive pelvic surgery is more effective than infertility laparotomy alone for the treatment of pelvic pain but that presacral neurectomy does not increase the subsequent incidence of pregnancy.

Endometriosis↗
PubMed1979

The conservative surgical management of unruptured ectopic pregnancy.

With the earlier and more accurate diagnosis of ectopic pregnancy based on rapid beta-subunit pregnancy tests and the use of ultrasound and laparoscopy, the percentage of diagnosed unruptured ectopic pregnancies is rapidly increasing. This, coupled with the earlier treatment of pelvic inflammatory disease, the use of IUDs, and increasing numbers of tubal plastic surgery, caused the authors to evaluate the problem of conservative management of ectopic pregnancy. In this study 98 patients at the Yale-New Haven Hospital who had ectopic pregnancies between 1972 and 1977 are evaluated. Fifty of these patients underwent a salpingectomy or salpingo-oophorectomy. Forty-eight patients underwent salpingostomy. This represents an increase in the conservative surgery rate from 8 to 35.5%. The overall term viable pregnancy rate was 40%, along with a 10% repeat ectopic rate. There was no advantage as far as term viable pregnancy when comparing salpingostomy and salpingectomy. Conservative surgery did not increase the repeat ectopic rate. Salpingostomy is therefore recommended in unruptured ampullar ectopic pregnancies in order to preserve reproductive function. If current trends continue, this will be an increasingly important problem. The statistics are based on a 73% follow-up, with all patients actively trying to conceive.

Castration↗
PubMedDate not supplied

The effect of medroxyprogesterone acetate on blood pressure.

Twenty-four women (21 normotensive and 3 hypertensive) aged 16-35 years received 150-mg injections of medroxyprogesterone acetate (MPA) for contraception. Their blood pressure (BP) was measured under basal conditions by the same nurse before treatment and at 1-, 2- and 3-month intervals. Their mean BP fell from 124.1/79.4 to 119.8/74.6 mm Hg at one month (p less than 0.05 for diastolic pressure) to 117.0/74.9 mm Hg at two months and to 115.6/73.2 mm Hg at three months. When the normotensive patients were analyzed separately, their BP fell, but not significantly. Only one patient had a rise of 20 mm Hg systolic, but she remained normotensive. We conclude that medroxyprogesterone acetate does not raise BP.

Adolescent↗
PubMedDate not supplied

Transcervical balloon tuboplasty. A multicenter study.

Transcervical balloon tuboplasty represents a noninvasive technique to treat proximal tubal occlusion. In a multicenter study, 77 women with confirmed bilateral proximal tubal occlusion underwent the procedure. In 71 patients (92%), at least one proximally obstructed fallopian tube was recanalized. Concomitant distal bilateral tubal occlusions were diagnosed after successful proximal tubal balloon recanalizations in 13 patients (17%). In the remaining 64 patients, 22 clinical pregnancies (34%) have been confirmed during a median follow-up period of 12 months. Among those, 17 (77%) resulted in normal deliveries and five (23%) resulted in a first-trimester miscarriage. One patient was diagnosed with an ectopic pregnancy. Among 25 patients who had not conceived within 6 months of the procedure, 17 (68%) demonstrated continuing tubal patency on repeated hysterosalpingogram. We conclude that transcervical balloon tuboplasty is a safe outpatient technique that may represent an alternative to in vitro fertilization or microsurgical reanastomosis of fallopian tubes.

Adult↗