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Biomedical subjects

A Milwidsky

Publications and source records attributed to A Milwidsky.

60 records · Page 4Linked to original sources

Prevention of premature delivery in a unicornuate uterus by cervical cerclage.

A 26-year-old woman had two premature deliveries when 6 months pregnant. Neither produced a living child. A hysterosalpingogram was done, confirming a diagnosis of unicornuate uterus. When the patient became pregnant again, a third and fourth time, cervical cerclage was done in both cases. Pregnancies were terminated by cesarean section because of breech presentation and malformation of the uterus and in each case a healthy living child was delivered. In our view, in order to prevent premature deliveries, when a diagnosis of uterus malformations has been confirmed, a cerclage should be performed.

Adult↗

Interleukin-1-mediated regulation of plasminogen activation in pregnant mare serum gonadotropin-primed rat granulosa cells is independent of prostaglandin production.

OBJECTIVES: This study examines the effects of interleukin-1 (IL-1) on plasminogen activator (PA) activity and prostaglandin (PG) E production in pregnant mare serum gonadotropin (PMSG)-primed granulosa cells and the potential involvement of PGE in the regulation of ovarian plasminogen activation. METHODS: Granulosa cells were obtained from PMSG-primed rat (27-day-old) ovaries and cultured in serum-free conditions for 48 hours in the absence or presence of IL-1 beta (10 ng/mL) with and without transforming growth factor-beta 1 (10 ng/mL). Cellular PA activity was measured through the conversion of plasminogen to plasmin and assay of the plasmin-mediated cleavage of [14C]-labeled globin to acid-soluble products. RESULTS: Exposure of PMSG-primed granulosa cells to IL-1 resulted in a 30% reduction (P < .05) in PA activity. Addition of hCG (1 IU/mL) to the granulosa cell cultures resulted in a 2.3-fold increase in PA activity, an effect significantly attenuated by co-administration of IL-1. The IL-1-mediated inhibition occurred concurrent with a 6.6-fold increase in the ability of the corresponding conditioned media to inhibit exogenous urokinase activity. This latter inhibitory capacity was the result of a significant increase in plasminogen activator inhibitor type 1 (PAI-1), given its abolition by a polyclonal anti-rat PAI-1 immunoglobulin G. The IL-1-mediated effects on PA/PAI-1 were accompanied by a sevenfold increase in PGE content of the spent culture medium. This response was dose dependent. The IL-1 effects on plasminogen activation and PG production were abolished by the IL-1 receptor antagonist, suggesting specific IL-1 receptor-mediated responses. Indomethacin, an inhibitor of PG biosynthesis, prevented the IL-1-induced increase in PGE accumulation but failed to affect the response of the PA system. Transforming growth factor-beta 1, a known regulator of IL-1 action, significantly attenuated the IL-1-stimulated PGE production but did not interfere with the ability of IL-1 to affect the PA system. CONCLUSIONS: The present observations suggest a pleiotropic response of PMSG-primed granulosa cells to IL-1, characterized by the induction of PAI-1 concurrent with but independent of PG production. These findings corroborate and extend earlier observations suggesting that IL-1 affects PA activity and PGE production in immature rat ovaries. Moreover, these observations support our contention that IL-1 may play a major regulatory role in the cellular events leading to ovulation and early corpus luteum formation.

Animals↗

Long-term results of valve replacement in children suffering from rheumatic heart disease.

Severe pathological changes in the cardiac valves are often observed at an early age in children in the developing countries. Mitral stenosis is best managed by closed commissurotomy. However, mitral insufficiency, aortic insufficiency and tricuspid lesions may lead to life-threatening hemodynamic effects which necessitate valve replacement. This differs from experience in the developed countries where surgery for rheumatic valvular disease is limited to the adult. Our experience includes 33 children aged 5 to 16 years. Twenty-four children underwent single valve replacement, eight had two valves replaced and one had triple valve replacement. All were classified Grade IV or late Grade III (New York Heart Association). Four children had to be operated on despite known rheumatic activity. Two children in shock and pulmonary edema underwent emergency operation. There were two hospital deaths and eight late deaths. Patients have been followed for up to eight years. Twenty children are now classified as Grade I and lead completely normal lives and the remaining three are classified as Grade II. Postoperative catheterization studies have documented improvement from severe preoperative hemodynamic changes to near normal values at rest after operation. The cardiothoracic ratio has decreased impressively. We conclude that the natural history of rheumatic heart disease in children with severely damaged heart valves is favorably modified by valve replacement.

Adolescent↗

Declining beta-HCG levels: an indicator for expectant approach in ectopic pregnancy.

Early surgical intervention in ectopic pregnancy is desirable. However, occasionally some patients do not benefit from this approach, as the natural history of ectopic pregnancy is not always tubal rupture or any other catastrophic event. A retrospective as well as a prospective analysis of 144 cases of suspected ectopic pregnancies was performed. The results of this study support expectant management in cases where serum beta-HCG levels are declining, provided the patient is stable and has no acute abdominal symptoms.

Chorionic Gonadotropin↗

The role of ultrasound in ovulation induction by gonadotropins.

Fifty anovulatory women were selected for treatment with gonadotropins. Sixty-five were monitored by serum 17-beta estradiol (E2) levels and human chorionic gonadotropin was administered accordingly. Retrospective evaluation of cycles indicates that the overstimulation syndrome and the number of undesired multiple pregnancies can be reduced after both ovaries have been visualized by ultrasound if, regardless of E2 serum levels, human chorionic gonadotropin is administered when one or two mature follicles are seen and withheld when three or more mature follicles are seen.

Anovulation↗