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Biomedical subjects

A Herman

Publications and source records attributed to A Herman.

At least 127 records · Page 7Linked to original sources
PubMed1993

Human chorionic gonadotrophin is a better luteal support than progesterone in ultrashort gonadotrophin-releasing hormone agonist/menotrophin in-vitro fertilization cycles.

In an attempt to determine the best luteal support in in-vitro fertilization (IVF) cycles treated with gonadotrophin-releasing hormone agonist (GnRHa) and human menopausal gonadotrophin (HMG) by the ultrashort protocol, 60 patients were prospectively randomized for either i.m. progesterone or human chorionic gonadotrophin (HCG) luteal support. The two groups did not differ in the mean number of oocytes retrieved and embryos replaced, nor in the mean age of the patients and the amount of HMG used. HCG maintained higher levels of oestradiol and progesterone during the luteal phase. Conception rate was significantly higher in the HCG group. We conclude that HCG is superior to i.m. progesterone as luteal support in IVF cycles in which GnRHa is used in the ultrashort protocol.

Adult↗
PubMed1993

A simplified preinduction scoring method for the prediction of successful vaginal delivery based on multivariate analysis of pelvic and other obstetrical factors.

Most of the popular preinduction scoring methods were created three decades ago, applied to selected populations and based on analysis of each factor separately. In order to overcome these limitations and to try and create a simple and reliable scoring method, 401 inductions of labor were analyzed. Failure was defined as delivery by cesarean section, regardless the indication. Results of multivariate analysis demonstrated that only two of the five factors used by Bishop's method were included (cervical dilatation and fetal head station). Gestational age and parity also constituted important factors and thus the new method incorporates these four factors. The variables among each factor were scored according to their relative risk, obtained from the analysis; dilatation 3 cm or more = 2, dilatation 1-2 cm = 1, fetal head station -1 cm or lower = 1, multiparity = 1, term delivery = 1, closed cervix = 0, station -2 cm or higher = 0, primiparity = 0 and non-term delivery = 0. Comparison of the suggested scoring method and Bishop's method demonstrated that in the low score category our method predicted more accurately cesarean section rate (44.7% and 27.6%, respectively). No difference was noted among the middle or high score groups. More studies among other populations may clarify whether our proposed method really overcomes other methods concerning simplicity, universality and predictability.

Birth Weight↗
PubMed1993

Brain lateralization and severity of stuttering in children.

Cerebral lateralization in visual perception was investigated in 9 severe stuttering, 11 mild stuttering and 48 fluent speakers. The subjects were asked to identify words presented in the left or right visual field for 20 ms. Children responded by pointing to the exposed test word on a response card which contained four different words. Errors committed in the left and right visual fields were analyzed. The data showed a left hemisphere superiority in the processing of words in both the mild stutterers and the fluent speakers, but a right hemisphere advantage in the severe stutterers. The results suggest a close relationship between the severity of stuttering and functional brain organization.

Child↗
PubMed1993

Transsexualism and sex-related differences in hemispheric asymmetry.

Sex differences in human brain lateralization are documented by studies on normal subjects, patients with the unilateral brain damage, and individuals with atypical level of hormones. However, there is no agreement as to the specific role of gender in the development of hemispheric asymmetry. This experiment was designed to examine whether gender identity plays an important role in the formation of brain lateralization, as some recent data seem to suggest. A group of subjects showing gender dysphoria (transsexuals) and two groups of control male and female subjects were presented with verbal and visual-spatial tasks. Results show that neither biological sex nor gender identity are sufficient factors to determine the pattern of hemispheric asymmetry.

Adolescent↗
PubMed1992

Mutations defining functional regions of the superantigen staphylococcal enterotoxin B.

Staphylococcal enterotoxin B (SEB) is both a superantigen and toxin. As a superantigen, SEB can bind to major histocompatibility complex (MHC) class II molecules to form a ligand for alpha/beta T cell receptors bearing particular V beta elements. As a toxin, SEB causes rapid weight loss in mice sometimes leading to death. We show here that both of these functions map to the NH2-terminal portion of the toxin. Three regions were identified: one important in MHC class II binding, one in T cell recognition, and one in both functions. These results support the conclusion that the toxicity of SEB is related to massive T cell stimulation and release of cytokine mediators and show that the residues interacting with MHC and the T cell receptor are intertwined.

Amino Acid Sequence↗
PubMed1992

Methotrexate local injection for unruptured tubal pregnancy: an alternative to laparotomy?

Fifty-nine women with early unruptured tubal pregnancy were treated by a single local injection of methotrexate at laparoscopy. All 59 patients underwent the procedure without any adverse reaction, 47 (80%) of them needing no laparotomy. Twelve patients required a laparotomy for reasons such as rising beta-hCG levels and abdominal pain with or without rising levels of beta-hCG. Only one patient ruptured the tube. None of the women needed a blood transfusion. We found tubal patency in 19 out of 21 patients at follow up hysterosalpingography. Eleven pregnancies were subsequently reported, one of them tubal. The appearance of the injected tube was absolutely normal in three patients, one at cesarean section and two at repeated laparoscopy. No peritubal adhesions were observed. We suggest that this new technique is a safe and effective alternative to laparotomy in a patient with an early unruptured tubal pregnancy.

Adult↗
PubMed1992

Increased fertilization and pregnancy rate in polypronuclear fertilization cycles in in vitro fertilization-embryo transfer.

OBJECTIVE: To compare fertilization and pregnancy rates between cycles with polypronuclear fertilizations and cycles with normal fertilizations. DESIGN: In vitro fertilization-embryo transfer (IVF-ET) cycles in which oocytes were retrieved were divided into two groups according to the nature of fertilization. PATIENTS: All patients were participants of our IVF-ET program. RESULTS: A significantly higher fertilization rate was found in the polypronuclear fertilization cycles (61% versus 36.6%) and also an improved pregnancy rate (47.5% versus 19.6%) and per embryo transfers (53% versus 28.8%). The vast majority of polypronuclear fertilizations occurred in mature oocytes. CONCLUSION: We believe that the increased receptability of the oocytes improves fertilization and conception rates. The polypronuclear fertilization is an extreme expression of such improved receptibility and should be considered as an encouraging sign for conception.

Embryo Transfer↗
PubMed1992

Prediction of in vitro fertilization outcome by sperm penetration assay with TEST-yolk buffer preincubation.

OBJECTIVE: To evaluate sperm penetration assay (SPA) value as a screening tool before in vitro fertilization (IVF). DESIGN: Follow-up study comparing sperm variables and IVF outcome. SETTING: Infertile couples in an academic research environment. PATIENTS, PARTICIPANTS: Two hundred forty-one infertile couples scheduled for IVF. INTERVENTIONS: Sperm penetrating assay with cold Tes-TRIS (TEST) Yolk buffer semen preincubation and IVF. MAIN OUTCOME MEASURES: Percent of egg penetration recoded into poor and good category (0% to 20%, 21% to 100%) and compared with fertilization, embryo transfer, and pregnancy rate (PR) in IVF, as well as sperm count motility and morphology. RESULTS: Sperm penetrating assay predicted fertilization with a high negative (74%) and positive (82%) predictive rate and good specificity value (0.96). One of 31 patients in the poor SPA category (3%) fertilized less than 50% of eggs; no pregnancy occurred. In the good SPA category, 87 of 210 patients (41%) fertilized greater than or equal to 50% of eggs with 34.3% PR. Sperm penetrating assay correlated better with fertilization rate than did sperm count and motility but not morphology. CONCLUSIONS: Sperm penetrating assay is a useful screening assay before IVF together with sperm morphology.

Adult↗
PubMed1992

Ultrashort gonadotropin-releasing hormone agonist (GnRH-a) protocol in comparison with the long-acting GnRH-a protocol and menotropin alone.

OBJECTIVE: To compare the in vitro fertilization and embryo transfer (IVF-ET) outcome of a 3-day gonadotropin-releasing hormone agonist (GnRH-a) administration: ultrashort protocol with the outcome of long-acting GnRH-a cycles or human menopausal gonadotropin (hMG) alone. DESIGN: Ninety-two cycles of the ultrashort protocol were matched with 92 cycles with long GnRH-a and with 92 hMG cycles. SETTING: The IVF-ET program. MAIN OUTCOME MEASURES: Amount and duration of hMG treatment, hormonal profile on the day of human chorionic gonadotropin administration, cancellation rate, number of oocytes retrieved, and fertilization and pregnancy rates (PRs) were examined and compared among the three groups. RESULTS: The ultrashort group needed a higher number of hMG ampules than the hMG group but significantly less than in the long GnRH-a regimen. The number of oocytes in the ultrashort protocol was the same as in the long GnRH-a, but the number of embryos per retrieval was significantly lower than with the long GnRH-a protocol and similar to that found in the hMG group. The ultrashort protocol yielded 10% PR per cycle and 17% per replacement, significantly lower than with the long GnRH-a protocol, 26% and 36%, respectively, but also lower than in the hMG one, namely 13% and 28%. CONCLUSION: The ultrashort protocol, although being convenient and having some advantages found in the long GnRH-a protocol, is inferior in its outcome compared with the two other protocols.

Chorionic Gonadotropin↗
PubMed1992

Diagnostic hysteroscopy: its value in an in-vitro fertilization/embryo transfer unit.

A total of 324 patients participating in our in-vitro fertilization/embryo transfer (IVF) programme underwent a diagnostic hysteroscopy. Of these, 152 women were referred before their first IVF attempt, because of some hysterosalpingographic suspicion of an intra-uterine abnormality; the other 172 patients had failed to conceive after IVF and transfer of good quality embryos. An intra-uterine pathology (mainly intra-uterine adhesions) was diagnosed in 50% of the patients in each group. Hysterosalpingography, although very sensitive, had low specificity (23%), a false positive rate of 44% and false negative rate of 10%. The main risk factor for intra-uterine pathology was a previous abortion. Conception rates were 22% after surgical treatment and 38% after the diagnostic procedure. We think that hysteroscopy should be performed in every patient failing to conceive after replacement of good quality embryos. It is also recommended whenever a suspicious finding is revealed by hysterosalpingography, before IVF. Routine hysteroscopy before entering an IVF programme should be seriously considered.

Adult↗
PubMed1992

Impaired corpus luteum function and other undesired results of pregnancies associated with inadvertent administration of a long-acting agonist of gonadotrophin-releasing hormone.

Spontaneous pregnancies associated with inadvertent periconceptional administration of long-acting gonadotrophin releasing-hormone agonist (GnRHa), in in-vitro fertilization, occurred in 11 of 161 patients with non-tubal infertility. All these cases exhibited impaired function of the corpus luteum in terms of declining progesterone levels, despite rising levels of human chorionic gonadotrophin. The patients were categorized according to the timing of GnRHa administration: periovulatory (three cases), midluteal (five cases) and late luteal (three cases). Altogether, of the 11 pregnancies, seven ended with a normal livebirth, three with a preclinical gestation and one with a blighted ovum. It appears that spontaneous pregnancies associated with inadvertent administration of GnRHa are not rare. Awareness for early diagnosis and close hormonal monitoring are recommended for the assessment of corpus luteum function and adequate supplementation.

Adult↗
PubMed1992

Prerequisite work-up of the couple before in-vitro fertilization.

Prerequisite examinations, including immune status for rubella and hepatitis B antigens, cultures for Chlamydia trachomatis and mycoplasmas, Pap smear and hystersalpingogram were performed in 227 couples before their enrollment into an in-vitro fertilization (IVF) programme. The examinations were completed in 187 couples. Immune status for rubella had already been documented in 45% of the women: of the remainder, 11 patients were not immune (6%). A screening test for hepatitis B antigens had already been documented in only 10% of the patients; eight of the remaining women (5%) were carriers of hepatitis B antigen. C. trachomatis and Mycoplasma hominis were each isolated from 14% of the patients and Ureaplasma urealiticum from 16%. Pap smears had been previously performed in only 35% of the enrolled women. Six (5%) of the 122 newly referred cases had cervical intra-epithelial dysplasia. In 21 (11%) cases some pathology in the uterine cavity was demonstrated. One patient conceived after diagnostic hysteroscopy; another two patients conceived following lysis of adhesions and before IVF treatment. The results of this study show the importance of the preparatory examinations before the IVF and embryo transfer procedure, and raise the medical and medico-legal aspects of this prerequisite work-up.

Adult↗
PubMed1991

Identification of the staphylococcal enterotoxin A superantigen binding site in the beta 1 domain of the human histocompatibility antigen HLA-DR.

The staphylococcal enterotoxin A (SEA) is a superantigen that must bind to class II molecules of the major histocompatibility complex to be recognized by T cells. In humans, most HLA-DR class II allelic and isotypic forms, such as DR1, bind SEA well. DRw53 is an exception, binding SEA very poorly. We have localized this difference to a single residue (amino acid 81) in the beta 1 domain. A highly conserved histidine at residue 81 allows SEA binding, but a tyrosine does not. Residue 81 is predicted to lie in an alpha-helix on the surface of the molecule, with its side chain pointing up out of the pocket associated with binding of conventional peptide antigens. This finding supports the hypothesis that superantigens and conventional antigens bind to different sites on the class II molecule.

Amino Acid Sequence↗
PubMed1991

Clear ovarian cyst aspiration guided by vaginal ultrasonography.

Thirty patients with clear ovarian cysts underwent aspiration guided by vaginal ultrasound. In 23 cases a complete aspiration was accomplished. In 4 only partial aspiration was possible, and in the remaining 3 failed aspiration led to surgery. Histological findings correspond to retroperitoneal lipoma and mucinous cystadenoma (2 cases). Malignant cells were not detected in the fluid of any of the 27 aspirates. Eight of the ten patients presenting with abdominal pain experienced a relief following aspiration. Recurrence of the cyst occurred in 12 cases (40%) with significantly smaller dimensions (P less than 0.01). Vaginal ultrasound aspiration of clear cyst is easy and safe and can be considered as an outpatient procedure.

Adult↗
PubMed1991

Fluorescein angiography in hypertensive pregnancies.

A retrospective study in two university hospitals investigating retinal changes in pregnancies complicated by hypertension, seldom revealed retinal vascular changes in pre-eclamptic toxemia. Fluorescein angiography was performed on 16 severe pre-eclamptic toxemias and 14 chronic hypertension pregnancies. Normal caliber retinal vessels and normal filling time, with no subretinal or subepithelium leakage, was found in all pre-eclamptic toxemic patients. Four out of the 14 chronic hypertensive patients showed signs of mild hypertensive retinopathy. A review of the literature on fluorescein angiography in pregnancy showed that vascular changes in pre-eclamptic toxemia are choroidal rather than retinal.

Adult↗
PubMed1991

Extremely large number of twists of the umbilical cord causing torsion and intrauterine fetal death.

Extremely large number of twists of the umbilical cord causing torsion of the entire length of the umbilical cord was found in two cases of intrauterine fetal death. It was twisted in one case 35 times and in the other 20 times. No additional pathology, such as stricture or abnormality of the Wharton's jelly, was found. The two mothers complained of decreased fetal movements and both newborns were found later to be growth retarded. A long cord of 120 cm was present in one case and normal length of 70 cm in the other. Close antenatal care in cases with growth retarded fetuses or decreased fetal movements may help in avoiding fetal demise in such rare cases.

Adult↗