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Biomedical subjects

B Hedon

Publications and source records attributed to B Hedon.

At least 91 records · Page 5Linked to original sources

Correlations between free plasma estradiol and estrogens determined by bioluminescence in saliva, plasma, and urine during spontaneous and FSH stimulated cycles in women.

Estrone and estradiol (E1 + E2) concentrations in saliva were compared with four other parameters of estrogen status in five normal ovulatory women and ten FSH stimulated women selected for an in vitro fertilization program. E1 + E2 in saliva, plasma, and urine were assessed by a rapid, specific and sensitive enzymatic assay using bioluminescence. The free fraction of plasma estradiol was determined by equilibrium dialysis and total plasma estradiol by conventional radioimmunoassay. The pattern of E1 + E2 variation in saliva was similar to that of free plasma estradiol and the two parameters were correlated in both spontaneous and stimulated cycles. However, the lower correlation coefficient (r = 0.52, P less than 0.001) in spontaneous cycles compared with the high (r = 0.96, P less than 0.001) in the stimulated cycles shows that salivary E1 + E2 could be representative of plasma free estradiol in stimulated cycles but not in normal cycles. The free fraction of plasma estradiol reproduced the variation of total plasma estradiol in spontaneous as well as in FSH stimulated cycles and both parameters were strongly correlated (r = 0.91, P less than 0.001 and r = 0.90, P less than 0.001), respectively. The data show that salivary E1 + E2 concentrations are highly representative of the free fraction of E2 in plasma and at a lesser extend (r = 0.72, P less than 0.001) of total plasma E2 in FSH stimulated cycles.

Adult↗

[Benign liver tumor during pregnancy. Review of the literature and management (apropos of a case)].

The authors report a case of a tumour of the liver in a pregnant woman who had taken oral contraception for six years. Since oral contraceptives have become far more widely used the two benign tumours of the liver, namely a hepatocellular adenoma of the liver and focal nodular hyperplasia, have become far more common. The increased blood supply to the liver can make such a tumour symptomatic and increase the risk of it rupturing intraperitoneally, especially at the onset of labour. A course of management has been suggested according to the size of the tumour and the duration of the pregnancy.

Adult↗

[The place of immunology in recurring spontaneous abortion].

Spontaneous repeated miscarriages are often explained by an immunological mechanism. Whereas in normal pregnancy the mother develops a tolerance immune response induced by paternal antigens of fetus, she is unable to react in this variety of miscarriage. The immunological theory is supported by some solid experimental arguments, which are detailed. Antigens generating the tolerance response are probably TLX antigens, expressed on syncitiotrophoblast and cross reacting with class I HLA antigens. Diagnosis of immunological miscarriage is based on elimination of other causes and on absence in woman of antibodies directed against husband class I antigens. Tolerance immune response can be induced by injections to wife of great quantity of conjunct lymphocytes. An anti HLA, and later on anti TLX, immunization is often obtained. Several teams have applied this treatment, with frequent good results: about 80% of fecundated patients conduct a normal pregnancy until its time.

Abortion, Habitual↗

[RU 486 and induction of labor in 3d trimester pregnancy interruptions. Preliminary clinical studies].

The authors report 12 cases of induction of labour which was carried out with the help of RU 486 in the 3rd trimester of pregnancy (mean duration of the pregnancy 34.2 weeks). Nine cases had malformed fetuses and 3 cases had normal infants. In 6 cases out of the 12 delivery took place within 48 hours after RU had been administered by itself and in 3 cases induction with Syntocinon was helped when RU was given beforehand. In 3 cases the live-born children showed no secondary ill effects.

Abortifacient Agents↗

Recurrent abnormal follicular maturation and ovarian stimulation for in-vitro fertilization.

A total of 1078 cycles were stimulated for in-vitro fertilization between 1 January 1986 and 31 July 1987. One-hundred-and-ninety-six cycles had to be cancelled because of an abnormal ovarian response (18.2%). The majority of these cancellations were due to the phenomenon of follicular atresia (45%) or the absence of follicular growth (30%). Bad responder patients who had undergone cancellation during at least two successive cycles, when compared with normal responder patients, were somewhat older and had more frequent periovarian adhesions and ovulatory defects. The use of a GnRH agonist allowed correction of a certain number of ovarian response inadequacies, but follicular atresia and absence of folliculogenesis remained frequent phenomena.

Adult↗

Ovarian stimulation by a combination of a gonadotropin-releasing hormone agonist and gonadotropins for in vitro fertilization.

In the first of two studies, 20 patients were selected on the basis of tubal infertility and were randomly assigned to two groups receiving different ovarian stimulation protocols. In group A, 10 patients were given follicle-stimulating hormone (FSH), FSH was continued until the criteria for human chorionic gonadotropin (hCG) administration were satisfied. In group B, 10 patients received Buserelin (0.3 ml twice a day subcutaneously) for 14 days to induce pituitary desensitization. Stimulation with FSH was then started, and Buserelin treatment was continued until hCG administration. In the second study, patients were included if they had had at least two previous attempts at ovarian stimulation that failed to reach the stage of follicular aspiration. Ovarian stimulation was conducted with a combination of Buserelin and human menopausal gonadotropin. Use of the gonadotropin-releasing hormone (GnRH) agonist in in vitro fertilization increased the number of oocytes collected, the fertilization rate, the length of the luteal phase and the pregnancy rate. The GnRH agonist also contributed to a generally better ovarian response in patients whose estradiol production had previously responded poorly to conventional ovarian stimulation protocols.

Adult↗

[Tubal sterility. Attempt at cost-benefit comparison between in vitro fertilization and surgery].

The choice that exists when confronted with a case of tubal sterility that can be operated on between in vitro fertilisation straight off or surgery is an example where an analysis of the cost effectiveness may help to make the medical decision. This should, however, depend on several parameters that can not be calculated, such as the other factors in the infertility, the ability for other techniques to be applied, and what the couple want. When the expected success rate for surgery is less than 25 to 35% at present, given the results that are obtainable by in vitro fertilisation surgery is contra-indicated. On the other hand, when the tubal surgery results are expected to be good, and given the introduction of new surgical techniques above 50% success rate, for the next few years at least there are excellent indications to operate. In the distant future it is probable that reversal of sterilisation which gives good operative results will stay as an operation, while tubal blocks that are due to infection will have to resort to in vitro fertilisation, although if laparoscopic surgery can be carried out that might be preferable.

Cost-Benefit Analysis↗

[Action of Parlodel on the preovulatory peak of estrogens and the ovulatory response of patients with abnormal ovulation and normal blood prolactin].

Bromocriptine, a dopamine agonist, is well known for its inhibitory action on prolactin secretion. Its action on other hypophyseal secretions, particularly on the gonadotrophins FSH and LH can indicate use of Parlodel as a stimulatory agent for induction of ovulation even in cases of normal prolactinemia. 129 normoprolactinemic patients with a defect of the preovulatory estrogen rise have been treated over a period of 3 months. 63% of the patients exhibited a positive response to bromocriptine, either because a pregnancy started or because preovulatory E1+E2 became normal. The rate of "responders" is increased among those patients who had conservation of spontaneous menses at the start of therapy. Conclusions of the study are that Parlodel has a place among treatments of ovulation defects. Its genuine efficacity must be confirmed by a controlled study against placebo and other confirmed treatments like antiestrogens.

Adolescent↗

Follicular steroids in relation to oocyte development and human ovarian stimulation protocols.

Oocytes of pre-ovulatory follicles were collected by laparoscopy for in-vitro fertilization in 118 women. Patients were treated either during the natural cycle, or after induction of ovulation with clomiphene citrate, or with human menopausal gonadotrophin (HMG), or clomiphene citrate combined with HMG. The oestrogens (oestrone + oestradiol) and total aromatizable androgens (androstenedione, testosterone and dehydroepiandrosterone and its sulphate) were assayed in follicular fluids using an enzymatic method. The levels of progesterone, 17 alpha OH-progesterone, thromboxane, and prostaglandins (PGE2 and PGF2 alpha) were determined by radioimmunoassay. The best follicular fluid indicator of oocyte fertilization in vitro was the A/E ratio, which was less than 1 when the oocyte was fertilized in vitro and led to a pregnancy. The lowest value for the A/E ratio was obtained with spontaneous ovulation protocols. Regardless of oocyte development, the progesterone level was always greater than 2000 ng/ml, and the PGE2/PGF2 alpha ratio was greater than 1 in all stimulated cycles. Our investigations show that a combination of clomiphene citrate and HMG provides the best stimulation, on the basis of follicular fluid analysis and the outcome of fertilized oocytes.

Androgens↗

[Stimulation of ovulation by pure FSH for in vitro fertilization. Study of the route of administration].

Pulsatile injection of FSH to stimulate ovulation for in vitro fertilization was undertaken in order to compare the intramuscular route with the pulsatile subcutaneous route in two groups of 6 patients each selected at random. The patients were selected in such a way as to reduce as far as possible the parameters that would make it difficult to interpret the results. Both from the point of view of the numbers of patients who responded to stimulation of ovulation as well as the numbers of pregnancies that were obtained, the intramuscular route seems to be preferable.

Adult↗

Influence of the frequency of gonadotropin-releasing hormone (GnRH) administration on ovulatory responses in women with anovulation.

In attempt to optimize gonadotropin-releasing hormone (GnRH) treatment of anovulation, we compared the effect of intravenous GnRH administration at three pulse intervals (PI) during 63 cycles in 30 anovulatory patients who had: (1) amenorrhea secondary to anorexia nervosa (group I: 10 patients, 21 cycles); (2) unexplained anovulation with normal to high luteinizing hormone plasma levels (group II: 12 patients, 24 cycles); and (3) polycystic ovarian disease (PCOD) (group III: 8 patients, 18 cycles). Ovulation was achieved more frequently in group I (85%) than in group II (41%) or in group III (50%). In both groups I and II, the frequency of ovulatory responses was not different with the PI used, and 6 of the 17 women treated for infertility conceived; 3 with 90-minute PIs, 2 with 64-minute PIs, and 1 with 128-minute PIs. In women with PCOD, seven of the nine ovulatory responses and three pregnancies were obtained with 128-minute PIs. The overweight women with PCOD did not respond reliably to GnRH at the doses used, i.e., 4 to 15 micrograms per pulse. In all groups, the urinary estrone and estradiol preovulatory peak, duration of luteal phase, progesterone levels, and preovulatory follicle diameter were unrelated to the frequency of GnRH administration.

Anovulation↗

[Enzymatic determination of urinary estrogens. A 5-year experience in a hospital milieu].

The enzymatic method for urinary estrogens determination from Nicolas et al. has become a useful tool for the management of infertility problems. It can be used for: investigation of ovarian by establishing the urinary estrogens profile during menstrual cycle, useful to: understand anomalies of the spontaneous cycle, explain some therapeutic failures during IVF attempts or artificial inseminations (AID or AIC); prediction of failures during IVF attempts during spontaneous cycles, and monitoring ovarian response during stimulated cycles in order to determine the trigger with hCG; monitoring ovulation during induction of ovulation in anovulatory patients stimulated with various drugs (clomiphene citrate, pure FSH combination of FSH and LH, GnRH ou analogs...) under various conditions of prescription and administration (oral, IM, intermittent pulsatile administration with portable pump with or without hypophyseal down regulation). This technique allows also exploration of androgens after changing main androgens (delta 4 A, T, DHEA, DHEA S) into estrogens through the action of placental aromatase, as well as appreciation of aromatase activity of some tissues in the presence of androgenic substrates. This paper gives the conclusions after 5 years of practice with this method and summaries different works published by the biologists who developed the method and by the clinicians who used its results.

Adolescent↗

[Pregnancies by fertilization in vitro. Biochemistry of the follicular fluid].

Fifty four follicular fluids containing 41 oocytes were sampled from 6 patients in which at least one pregnancy was obtained after IVF. Their biochemical composition has been correlated with the follicle maturity and oocyte quality. Three components have been assayed: steroids, prostanoids, proteolytic enzymes. Determinations of estrogens and total aromatisable androgens were carried out by the enzymatic technic of Nicolas and al.; progesterone and 17 OH progesterone by RIA. Development of in vitro cultured and fertilized oocytes appears to be improved when progesterone and estrogens concentrations in the follicular fluid are above 2 000 and 600 ng/ml respectively, with an A/E ratio under 1. On the other hand, prostanoids (T X B2, PGE2, PGF2 alpha determined by RIA) and proteolytic enzymes : (collagenolytic and kallikrein type activities) seemed related to ovulatory activity rather than to oocyte quality.

Androgens↗

[Evaluation of the clinical and biologic means of assessing fetal prognosis in pregnancy toxemias. Apropos of 223 cases].

Two hundred and twenty-three cases notes of patients with toxaemia of pregnancy were analysed in order to try to establish the ability to predict through clinical and biological assessments of the mother the prognosis for the fetus. Statistical analysis methods were chosen to work out the classification of the parameters and to lead to an index of severity that could be established by a multifactorial discriminating analysis. This study confirms that there is an inversion in the circadian rhythm of arterial blood pressure, with an increase in the evening and at night. It shows how bad prognostically blood pressure instability is. On the other hand oedema of the legs is of no significance. Contrary to the view that has been held for a long time, an increase in weight is directly proportional to fetal parameters. As far as parameters are concerned as a whole (both clinical and biological) a rise in blood urea is more discriminating at every stage of the illness and precedes an increase in the platelet count, the changes in creatinine clearance and night blood pressure. Maternal changes are better correlated with fetal variability before the 35th week of the pregnancy whereas after that date the prognostic value of these readings is of little importance.

Blood Coagulation Disorders↗