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Biomedical subjects

A J Peters

Publications and source records attributed to A J Peters.

51 records · Page 3Linked to original sources
PubMed1992

Color Doppler ultrasonography assessment of tubal patency: a comparison study with traditional techniques.

OBJECTIVE: To compare the results of color Doppler ultrasonic hysterosalpingography (color US-HSG) and x-ray-HSG with chromoperturbation at the time of laparoscopy. DESIGN: Open, uncontrolled study of women seeking evaluation for infertility from August 1989 to July 1991. SETTING: Clinical environment. PATIENTS: Two hundred thirty-eight infertile women. INTERVENTION: Saline was administered transcervically during transvaginal color Doppler sonography in 238 women. Traditional x-ray-HSG was performed in 89 women. Laparoscopy with chromoperturbation was done in 121 women. Forty-nine women had all three procedures performed. MAIN OUTCOME MEASURES: The frequency of diagnosis of bilateral tubal patency, bilateral tubal occlusion, and unilateral tubal patency after color US-HSG and x-ray-HSG was compared with chromoperturbation. The diagnostic efficacy of color US-HSG and x-ray-HSG was compared with chromoperturbation. RESULTS: Correlation between color US-HSG and x-ray findings with chromoperturbation occurred in 81% versus 60% (P = 0.0008) of all women studied. In 49 women who had all three procedures performed, color US-HSG results correlated with chromoperturbation more often than x-ray-HSG (82% versus 57%, P = 0.0152). CONCLUSION: Color US-HSG is an alternative technique to x-ray-HSG in diagnosing tubal occlusion as a cause of infertility.

Fallopian Tube Patency Tests↗
PubMed1992

Endometrial receptivity and the luteal phase.

Endometrial receptivity to the implanting blastocyst determines whether pregnancy occurs. Whether fertilization is initiated in vivo or in vitro, the receptivity of the luteal-phase endometrium results from the input of interacting hormonal, growth, and immunologic factors. Endometrial adequacy for implantation has traditionally been assessed by the endometrial biopsy. Newer methods used to study the endometrium, such as ultrasound imaging and measurement of endometrial proteins, have increased our understanding yet have demonstrated the limits of our knowledge. This review is designed to analyze the available literature for concepts and scientific facts to aid in our understanding of the complex events required in preparation of a receptive endometrium. Special attention is focused on the effect of supraphysiologic levels of steroid hormones on the endometrium in ovulation induction. The effect of both embryo quality and luteal-phase support are also reviewed.

Embryo Implantation↗
PubMed1991

Intraabdominal sound levels during vibroacoustic stimulation.

Vibroacoustic stimulation is widely used in the United States as a test for fetal well-being, yet little information is available on the adequacy of the electronic artificial larynx that is commonly used as the stimulator. To determine whether the intraabdominal sound pressure level was dependent on the static force applied to the electronic artificial larynx, we measured the sound pressure level at a position 20 cm from the surface of the anterior abdominal wall in nonpregnant ewes. The electronic artificial larynx was pressed against the surface with three levels of static force: mild, moderate, and strong. Between mild and strong static forces there was a trend toward a reduction in sound pressure level at the fundamental frequency (85 Hz) and the overtones (170 to 1600 Hz) (p less than 0.08). To further examine the relationship between the static force of sound source against the abdomen and the intraabdominal sound pressure level, sine wave oscillations between 20 Hz and 4.0 kHz were produced with an industrial shaker. With a constant dynamic force (0.16 N) applied to the shaker across frequencies, the sound pressure level was greatest at lower frequencies (100 to 110 dB) and less at higher frequencies, above 1.0 kHz (60 to 80 dB). Consistent with the electronic artificial larynx experiments, strong application of the shaker resulted in greater transmission of sound than did mild application (p less than 0.02).

Abdomen↗
PubMed1991

Pregnancy rates after peritoneal ovum-sperm transfer.

We present the technique of peritoneal ovum-sperm transfer as an option for treatment in couples with unexplained infertility factors. In 1989 we reported the first successful pregnancy, in the United States, after transferring sperm and oocyte into the peritoneal cavity. We now report the results of a prospective study of this procedure. Twelve women with unexplained infertility underwent 23 cycles of peritoneal ovum-sperm transfer. Ovulation stimulation was achieved with human menopausal gonadotropin. Ultrasonographically directed oocyte recovery was performed by the transvaginal route with the patient under local anesthesia and sedation. After oocyte recovery, 4.5 +/- 0.4 (mean +/- SE) oocytes and 13.3 +/- 1.0 (mean +/- SE) x 10(6) motile spermatozoa were transferred into the pouch of Douglas. Six clinical pregnancies occurred in 23 stimulated cycles for a pregnancy rate of 26% per cycle. This value compares with the overall pregnancy rates of 16% for in vitro fertilization and 27% for gamete intrafallopian transfer reported by the In Vitro Fertilization Registry. Thus these preliminary data suggest that peritoneal ovum-sperm transfer is at least as successful as in vitro fertilization and gamete intrafallopian transfer. Advantages of peritoneal ovum-sperm transfer over gamete intrafallopian transfer include its being an office nonsurgical procedure not necessitating a general anesthetic and decreased cost. Therefore peritoneal ovum-sperm transfer is a reasonable first approach in couples with unexplained infertility.

Adult↗
PubMed1991

Hysterosalpingography with color Doppler ultrasonography.

To assess the accuracy of the diagnosis of tubal occlusion with the use of color Doppler flow ultrasonography and hysterosalpingography, 129 infertile women were studied. All 129 women had the procedure performed with an ATL Ultramark 9 (Advanced Technology Laboratories, Bothel, Wash.) color Doppler ultrasonography machine. Eighty-five of the 129 women also had an additional study including x-ray hysterosalpingography and/or chromopertubation. Of these 85 women, 58 had pelviscopic examination with chromopertubation. The frequency of diagnosis of tubal occlusion was compared among the three methods. When results of ultrasonography-hysterosalpingography were compared with those of x-ray hysterosalpingography and/or chromopertubation, 69 of 85 (81%) studies showed agreement, and 50 of 58 (86%) ultrasonography-hysterosalpingography findings agreed with observations at chromopertubation. The frequency of comparable findings between x-ray hysterosalpingography and chromopertubation is 75%. These data suggest that ultrasonography-hysterosalpingography is at least as accurate as x-ray hysterosalpingography in diagnosing tubal occlusion. In addition, ultrasonography-hysterosalpingography is safer and more cost-effective than x-ray hysterosalpingography and chromopertubation.

Evaluation Studies as Topic↗
PubMed1989

Endometrial adenocarcinoma histologic subtypes: clinical and pathologic profile.

All cases of endometrial adenocarcinoma treated at the Geisinger Medical Center from January 1970 to June 1980 were retrospectively reviewed in an attempt to elucidate the clinical and pathologic profiles of the various histologic subtypes. Complete clinical and pathologic data was available in 418 cases of stage I endometrial adenocarcinoma. The frequency of the histologic subtypes were adenocarcinoma 66%, adenoacanthoma 16%, adenosquamous 5%, papillary 8%, clear cell 3%, and secretory 2%. Absolute 5-year survival was adenocarcinoma 88%, adenoacanthoma 91%, adenosquamous 62%, papillary 63% (P less than 0.01), clear cell 43% (P less than 0.001), and secretory 89%. When comparing the clinical and pathologic profile of the various histologic subtypes, adenosquamous (52%, P less than 0.001) and clear cell (43%, P less than 0.05) were associated with the highest percentage of grade 3 differentiation. Adenosquamous (38%, P less than 0.05) and clear cell (36%) also had the highest percentage of deep myometrial invasion. Papillary subtype (46%, P less than 0.05) was associated with the highest percentage of nulliparity. There was no difference among the subtypes when comparing menopausal status, exogenous estrogen, obesity, hypertension, diabetes, or uterine size. In summary, (1) adenocarcinoma and adenoacanthoma are the most frequent subtypes; (2) adenosquamous, papillary, and clear cell have decreased 5-year survival; (3) the decreased 5-year survival in adenosquamous and clear cell subtypes appears to be associated with increased grade 3 differentiation and deep myometrial invasion while the poor prognosis associated with papillary subtype was not related to grade or myometrial invasion.

Adenocarcinoma↗
PubMed1989

Analysis of failure patterns in stage III endometrial carcinoma and therapeutic implications.

The poor outcome of certain patients with Stage III endometrial carcinoma has led some investigators to direct adjuvant therapy to the abdominal cavity. To better define failure patterns, a review of 126 patients with Stage III endometrial carcinoma treated at four institutions was performed. Seventy-four patients were diagnosed at surgery with pathologic Stage III disease, whereas 52 patients presented with clinical Stage III disease. Most patients received external beam irradiation to the pelvis with a variety of boost techniques. Site of disease, grade, depth of invasion, and pathology were examined for prognostic significance. Actuarial techniques were used to analyze survival and recurrences. For the 52 clinical Stage III patients, 5-year survival was 36%. The median survival of 20 patients who were treated with radiation therapy (RT) following biopsy was 9 months. Pelvic control was poor in these patients, with 16/18 evaluable patients failing locally. Thirty-two patients who underwent resection with adjunctive RT had a 5-year survival of 48%. Local failure occurred in 40% of patients, whereas 38% of patients had abdominal failure. Isolated abdominal failure was infrequent with 6% failing as isolated recurrence, and 16% failing as the only site of distant disease. For 74 pathologic Stage III patients, 5-year survival was 54%. Local failure resulted in 20% of patients, and isolated abdominal failure occurred in 7% of patients. The subset of patients with ovarian or tubal involvement included 42 patients, with a 5-year survival of 60%. Further analysis of this subset by grade and depth of myometrial penetration was found to be prognostically significant. Twenty-four patients who were Stage III because of parametrial or pelvic peritoneal involvement had a 5-year survival of 44%. Local control and survival is improved in Stage III patients treated with surgical resection. The high rate of distant metastases in both abdominal and extra-abdominal sites has significant therapeutic implications.

Adult↗
PubMed1988

Vaginal recurrences of endometrial carcinoma: the prognostic value of staging by a primary vaginal carcinoma system.

Fifty-five of 1716 women with endometrial carcinoma seen consecutively at three institutions prior to 1986 were found to have an isolated post-hysterectomy vaginal recurrence. Their therapy included external radiation therapy (RT) and brachytherapy for 26 women, external RT alone for 17, brachytherapy only for 4, and no RT for 8. Combined external RT/brachytherapy doses ranged from 2000 to 10,000 cGy with a median of 6000 cGy. The 3- and 5-year actuarial survival rates are 48% and 31% for the entire group, and the 3- and 5-year pelvic control rates are 52% and 42%. The 5-year survival and pelvic control rates for those who received greater than or equal to 6000 cGy in total RT dose are 47% and 68%, compared with 12% and 10% for those receiving less than 6000 cGy (p = 0.002 and p = 0.004). For patients receiving their second RT course, the 5-year survival rate is 16%, compared with 48% for those not previously irradiated. The Perez modification of the International Federation of Gynecology and Obstetrics (FIGO) staging system for primary vaginal carcinoma was applied to each recurrence. There were 15 Stage I cases (vaginal mucosa), 32 Stage II cases divided between 15 Stage IIA (subvaginal infiltration) and 17 in Stage IIB (parametrial infiltration), and 8 Stage III cases (pelvic wall involvement). The 3-year actuarial survival and pelvic control rates using this staging system are: Stage I: 85%/100%; Stage II: 41%/43%, Stage IIA: 59%/53%, Stage IIB: 26%/35%; Stage III: 13%/0%. These outcome endpoints are significantly better for Stage I than Stage II patients (p = 0.01 & 0.0004) and for Stages I and IIA compared to Stages IIB and III (p = 0.0005 & 0.002). The pre-treatment variables of age, interval since hysterectomy, initial stage, and location did not predict for survival, but a higher rate of pelvic control was observed for apical than for suburethral recurrences (56% vs. 20%). Grade III histology was highly correlated with poor survival (p = 0.0006). This vaginal carcinoma staging system appears to have value in predicting treatment outcome for patients with post-hysterectomy vaginal recurrences.

Adenocarcinoma↗
PubMed1987

Adjuvant radiotherapy for stage I, grade 2 endometrial adenocarcinoma and adenoacanthoma with limited myometrial invasion.

All cases of endometrial adenocarcinoma from January 1970 to December 1980 treated at the Geisinger Medical Center were reviewed retrospectively. One hundred eighty-eight cases of stage I grade 2 adenocarcinoma of favorable histologic subtype (adenocarcinoma, adenoacanthoma) and limited myometrial invasion (less than one-third of the myometrium) were identified. Surgery and adjuvant radiotherapy was used in 136 cases, and 52 cases were treated with surgery alone. There was no statistically significant difference between the two groups in menopausal status, parity, exogenous estrogen, obesity, hypertension, diabetes, or uterine size. Five-year survival for the surgery and radiotherapy group was 94% (128 of 136), and the recurrence rate was 2.2% (three of 136). The five-year survival for the surgery-alone group was 98% (51 of 52), and the recurrence rate was 1.9% (one of 52). There was no statistically significant difference in five-year survival or recurrence between the two groups. This study suggests that surgery alone is adequate treatment for stage I grade 2 adenocarcinoma of favorable histologic subtype and limited myometrial invasion. This study also shows a possible benefit in the combined use of histologic subtype, grade, and myometrial invasion as prognostic indicators and as guides for adjuvant radiotherapy.

Adenocarcinoma↗
PubMed1986

Zinc-vitamin A interaction in pregnant and fetal rats: supplemental vitamin A does not prevent zinc-deficiency-induced teratogenesis.

The influence of a higher-than-normal intake of vitamin A on the detrimental effects of zinc deficiency on vitamin A metabolism was investigated in pregnant Sprague-Dawley rats. At mating, rats were fed diets containing 100 (control), 4.5, or 0.5 micrograms/g zinc combined with 4 (control) or 8 micrograms retinyl acetate/g. Low intake of zinc, but not of vitamin A, caused food intake, total body weight change, fetal weight and placental weight to be low. Incidence of teratogenic effects was more pronounced in low zinc groups than in controls. Concentrations of vitamin A in maternal plasma and liver were affected by the amount of zinc in the diet. Dietary vitamin A, however, did not affect either of these parameters. Maternal plasma zinc concentration was affected only by low dietary zinc, whereas plasma copper and iron were unaffected by the dietary treatments. Maternal liver iron was higher in zinc-deficient rats than in controls; however, maternal liver zinc and copper concentrations were not altered by dietary treatments. No significant differences in vitamin A concentration of fetal liver, fetal plasma, or placenta were seen among the groups. Fetuses from zinc-deficient dams had significantly lower levels of liver vitamin A and liver zinc than did controls. Fetal liver iron was higher in zinc-deficient fetuses than in controls, whereas fetal liver copper was not affected by dietary treatment. These data suggest that supplemental dietary vitamin A does not ameliorate the effect of zinc deficiency on vitamin A metabolism during pregnancy.

Animals↗
PubMedDate not supplied

Cochlear microphonics recorded from fetal and newborn sheep.

PURPOSE: Sounds present within the uterus stimulate the fetal inner ear and central auditory pathway. This study was undertaken to determine the efficiency of transmission of exogenous airborne stimuli to the fetal inner ear. In this way, we may quantify the extent to which the fetal auditory system is isolated from sounds produced outside the mother. MATERIALS AND METHODS: Cochlear microphonics were recorded from fetal and newborn sheep to evaluate the extent to which the fetus is isolated from sounds exogenous to the ewe. Electrodes were surgically placed in contact with the round window membrane in nine near-term fetal sheep. Cochlear microphonics were recorded in response to 1/3 octave-band noises (0.125 to 2.0 kHz) delivered through a loudspeaker 1.8 m from one side of the pregnant ewe. Sound pressure levels generated by the noises were simultaneously recorded ex utero with a microphone and in utero with a hydrophone previously sutured to the fetal neck. After cochlear microphonic amplitudes were recorded, the fetus was delivered through an abdominal incision. Recordings were repeated from the newborn lamb. Fetal sound isolation was calculated as the difference between the sound pressure levels that were necessary to evoke equal cochlear microphonic amplitudes from the fetus and from the newborn lamb. RESULTS: The sound attenuation observed was variable for all frequencies. The fetus was isolated from external sounds by 11.1 dB for 0.125 kHz, 19.8 dB for 0.25 kHz, 35.3 dB for 0.5 kHz, 38.2 dB for 1.0 kHz, and 45.0 dB for 2.0 kHz. CONCLUSIONS: Other investigators have demonstrated that the immature auditory system is more susceptible to damage produced by noise exposure than is the mature auditory system. Low-frequency noise produces damaged cells that later in life code higher frequencies. A possibility of fetal hearing loss produced by intense noise exposure needs more careful evaluation.

Animals↗
PubMedDate not supplied

Seizures in a fetal lamb after cocaine exposure: a case report.

We report the chance observation of two generalized seizures in a fetal lamb that received cocaine. Cocaine was infused intravenously into a 138-day-old fetus while electrocortical (ECoG), electroocular (EOG), and neck electromyographic (EMG) activity were recorded. Fetal rapid eye movement (REM) and nonrapid eye movement (NREM) sleep were disrupted during the cocaine exposure and returned to a normal pattern after infusions were stopped. Seventy-two hours later, however, we recorded generalized seizures with ECoG spike and spike wave activity.

Animals↗
PubMedDate not supplied

Sperm antibodies.

Anti-sperm antibodies (ASA) occur in 1% to 30% of infertile couples. Mechanisms by which ASA impair fertility include prevention of fertilization by decreasing acrosome reaction and/or zona pellucida binding, and postfertilization effects. Treatment for ASA involves assisted reproductive technologies.

Animals↗