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Biomedical subjects

B Kaplan

Publications and source records attributed to B Kaplan.

At least 253 records · Page 14Linked to original sources
PubMed1996

Polar body diagnosis of common aneuploidies by FISH.

PURPOSE: The purpose of this work was to investigate the reliability and accuracy of polar body analysis for preimplantation diagnosis of common aneuploidies in IVF patients of advanced maternal age. DESIGN: We have previously introduced polar body analysis as an approach for nondestractive evaluation of the genotype of human oocytes. The method has recently been applied in a clinical trial involving 45 infertile patients, demonstrating the feasibility of preconception diagnosis of common aneuploidies by fluorescent in situ hybridization (FISH). The present paper describes the experience of polar body diagnosis in 135 IVF patients (161 cycles) of advanced maternal age. RESULTS: FISH results of the first and/or second polar bodies were available in 648 (72.4%) of 895 biopsied oocytes subjected to FISH analysis. Of 648 oocytes with FISH results, 208 demonstrated chromosomal abnormalities. Of 440 oocytes predicted to be free from monosomy or trisomy of chromosomes X, 18, and/or 13/21, 314 were normally fertilized, cleaved, and transferred in 122 treatment cycles, resulting in 6 healthy deliveries and 12 ongoing pregnancies following confirmation of the polar body diagnosis by CVS or amniocentesis. CONCLUSIONS: The method may be useful for detection of oocytes with common chromosomal trisomies in IVF patients of advanced maternal age.

Abortion, Spontaneous↗
PubMed1996

Differential effect of insulin-like growth factor-1 and growth hormone on hypothalamic regulation of growth hormone secretion in the rat.

Pharmacological administration of either growth hormone (GH) or insulin-like growth factor 1 (IGF-1) were reported to inhibit endogenous GH release in humans and in the laboratory animal. We have evaluated the short-term differential mechanisms whereby the two hormones affect hypothalamic regulation of GH secretion. Wistar male rats (90 days old) were injected i.p. with either GH (recombinant GH NIAMDD, Baltimore, MD, USA), rIGF-1 (Fujisawa Pharmaceutical Co. Ltd., Osaka, Japan) or saline. Animals were sacrificed at 15, 30, 60 and 120 minutes following injection. Hypothalami were dissected and extracted immediately and the levels of growth hormone-releasing hormone (GHRH) and somatostatin were determined using specific antisera. Trunk blood was collected for GH and IGF-1 determination by RIA. Administration of IGF-1 or GH markedly decreased hypothalamic somatostatin stores by 77% and 54% respectively, within 15 minutes. Concomitantly, the wide range of GH levels found in the control group was reduced in the IGF-1 treated group suggesting that the pulsatile pattern of GH secretion was suppressed. Growth hormone administration induced an increase in hypothalamic GHRH stores (60% at 120 minutes). During this period serum IGF-1 levels were not altered. It is suggested that short term modulation of hypothalamic neurohormones by GH and IGF-1 is mediated by rapid stimulation of somatostatin release by both hormones, and inhibition of GHRH release is induced only by GH.

Analysis of Variance↗
PubMed1996

The missing forgotten intrauterine contraceptive device.

Failure to locate the strings of an intrauterine contraceptive device may mean that the device is within the uterine cavity, was expelled or, worst of all, has perforated the uterine wall. We describe a 36-year-old woman complaining of infertility in whom two missing devices were found within the pelvis after having perforated the uterus. This report demonstrates the need to investigate every case of a missing intrauterine contraceptive device. An algorithm for the proper management of such cases is suggested.

Adult↗
PubMed1996

Women's attitudes towards menopause and hormone replacement therapy.

OBJECTIVES: To determine how women aged 50 years or more feel about menopause, and their knowledge, use of and attitude toward hormone replacement therapy (HRT). METHODS: All study participants resided in a single urban community in central Israel and were selected at random from the computerized government registry. Responses were collected by either telephone interview (n = 171) or mailed questionnaire (n = 41) and were analyzed for the group as a whole and by different demographic and attitudinal factors. RESULTS: Most (80%) of the women had a positive or neutral attitude to menopause. More than 80% had heard of HRT, 55% of whom from a physician. Of these, 12% were currently using HRT and 9.5% had done so in the past. Varied reasons were offered for starting or stopping treatment. CONCLUSIONS: Although the great majority of the participants had heard of HRT, and most of these had spoken about it with a doctor, only a small percentage were currently under therapy or had been in the past. We believe gynecologists should devote more effort to public education, in that those women who had discussed HRT with their physician were more likely to use it.

Aged↗
PubMed1996

Abdominal pregnancy following in vitro fertilization in a patient with previous bilateral salpingectomy.

BACKGROUND: We present the first case of abdominal pregnancy after in vitro fertilization and embryo transfer in a patient without oviducts. CASE: A 38-year-old woman, who previously had had two salpingectomies because of two tubal pregnancies, was admitted to our department with intermittent vaginal bleeding and abdominal pain, 21 days after embryo transfer. Exploratory laparotomy revealed a moderate amount of blood in the peritoneal cavity and a mass consisting of blood clots and tissue fragments attached to the posterior aspect of the right broad ligament. Pathologic examination confirmed the diagnosis of abdominal pregnancy. CONCLUSION: Abdominal pregnancy may be the outcome of embryo transfer and should hence be considered a potential complication of the procedure.

Adult↗
PubMed1996

The effect of surgical castration on lipid metabolism in premenopausal and postmenopausal women.

OBJECTIVE: To investigate the effect of endogenous estrogen on lipid and lipoprotein metabolism in premenopausal and postmenopausal women. DESIGN: Prospective randomized study. SETTING: Department of Obstetrics-Gynecology, Beilinson Medical Center and Tel-Aviv University Medical School, Israel. SUBJECTS: Twenty-seven women, 15 premenopausal and 12 postmenopausal, undergoing surgical castration (total abdominal hysterectomy and bilateral salpingo-oophorectomy). METHOD: Blood samples were drawn before the surgical intervention and after a 6-month interval. MAIN OUTCOME MEASURES: Assays were performed for estradiol, luteinising hormone and follicle-stimulating hormone, and triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol and total cholesterol/HDL as well as HDL/LDL ratio. RESULTS: No significant differences were found in both groups, before castration and after 6 months. A modest, but statistically significant, rise in triglycerides was observed in the premenopausal group. CONCLUSIONS: The serum lipid and lipoprotein profile encountered in premenopausal and postmenopausal women were unchanged 6 months after surgical castration. The clinical significance indicates that the effect of endogenous estrogen on lipid metabolism is doubtful and should be further investigated.

Adult↗
PubMed1996

Community screening to reveal iron deficiency in healthy menstruating women in Israelian suburbs.

OBJECTIVE: To determine the incidence of iron deficiency among healthy women of child-bearing age, study the predictive value of blood hemoglobin level for this condition and assess the efficacy of a community screening program. METHOD: All healthy women aged 18-45 years registered with one community outpatient clinic were requested to complete a questionnaire on present and past medical history; one-third also completed a second questionnaire on symptoms related to anemia. All underwent a blood test for hemoglobin, serum-saturated transferrin and ferritin levels. RESULTS: Of the 163 women who complied (83% of the targeted population), 25.8% were diagnosed as having iron deficiency; of these 40.5% had a hemoglobin level of 12 g% or higher. The most sensitive indicator proved to be serum ferritin level. Iron deficiency was more prevalent in women with a personal history of anemia. Only 34.1% of the study group completed follow-up. CONCLUSION: There is a high incidence of iron deficiency among women of childbearing age. However, because of the surprisingly low compliance with follow-up visits, preventive periodic screening of healthy menstruating women using routine blood tests is not recommended at this time, except for those with specific complaints or who are at high risk.

Adolescent↗
PubMed1996

Conservative management of postmenopausal pelvic echo-free findings--preliminary results.

OBJECTIVES: To develop a conservative protocol for the treatment of echo-free findings in the pelvis, diagnosed by sonography in post-menopausal women, in order to avoid unnecessary surgical intervention. METHODS: A prospective study where each post-menopausal-patient underwent sonographic evaluation of the pelvic mass, serum Ca-125 levels, ambulatory aspiration of the cyst, and operative laparoscopy if necessary. RESULTS: One hundred and eighty-two women were included in the 3 years of the study. Only two cases of malignancy were diagnosed. There were no false-negative results. CONCLUSION: Although the results of our protocol of conservative management look promising, we cannot draw final conclusions because of the small sample size. Perhaps as our knowledge increases, physicians will feel more confident in handling adnexal findings conservatively.

Adnexa Uteri↗
PubMed1996

Microalbuminuria as an early predictor of hypertensive complications in pregnant women at high risk.

The value of microalbuminuria in predicting hypertensive complications in pregnant patients at high risk was tested in a prospective trial. A secondary aim was to compare the urinary albumin excretion rate between high risk hypertensive pregnant patients (study group) and pregnant patients at high risk of other complications, normal pregnant subjects, and nonpregnant subjects. Over the last 5 years, 276 patients were studied (142 in the study group v 134 controls). Albumin was measured in an 8-hour overnight urine collection throughout pregnancy using a radioimmunoassay technique. The pregnant women in both the study and control groups demonstrated a statistically significant increase in albumin excretion rate in the second and third trimesters compared with the first. Mean albumin excretion rate values were significantly higher in the study group (P = 0.0001). Using logistic and linear regression models, the presence of microalbuminuria in the early third trimester was proven to be predictive of hypertensive complications (odds ratio, 2.1; confidence intervals, 1.26 to 3.53) and birth weight (R2 = 0.7, P < 0.05) in the study group. Intrauterine growth retardation and neonatal outcome were less predictable. With the introduction of radioimmunoassays and in light of these significant clinical results, we believe that high-risk patients in whom abnormal proteinuria develops usually have a microalbuminuric phase weeks earlier, and this test has some predictive value for severe disease. In addition, the accepted definition of gestational proteinuria should be reconsidered.

Adult↗
PubMed1996

Penetration of the bladder by a perforating intrauterine contraceptive device: a sonographic diagnosis.

We describe a case of penetration of the urinary bladder by an intrauterine contraceptive device with perforation of the uterine wall. This finding was discovered incidentally during an ultrasound examination for an earlier nonspecific mild abdominal pain of short duration. No abnormality had been noted on pelvic examination, during which the device's strings were found to protrude through the patient's cervix; a short laboratory workup including urinalysis, urine culture, blood count and blood sedimentation rate was also negative. The sonographic diagnosis was confirmed by cystoscopy. The device was retrieved transcervically. No complications were observed on follow-up. Bladder perforation by an intrauterine contraceptive device is very rare, and only a handful of such cases have been described. In all previous cases, the diagnosis followed a rather prominent clinical presentation, whereas, in this case, the patient complained of intermittent low abdominal pain of short duration. We therefore suggest that pelvic ultrasound examination be performed in every patient with unexplained low abdominal pain who is known to carry an intrauterine contraceptive device.

Adult↗
PubMed1996

Future fertility following conservative management of complete abortion.

Dilatation and curettage is the usual procedure implemented in cases of incomplete or missed abortion in the first trimester of pregnancy. The management of complete abortion depends on pregnancy age. We examined the possibility that conservative management of complete abortion can be effective and does not affect future fertility. A total of 172 women who presented with complete abortion to our Ambulatory Gynecological Clinics of the Dan Region, Israel, were managed conservatively. Of 161 who desired to become pregnant, 118 (73%) conceived within 18 months. We conclude that it is possible to avoid curettage in the management of complete abortion of<8 weeks' gestational age with little or no effect on future fertility.

Abortion, Incomplete↗
PubMed1996

A 'sweet' indication for ovulation induction.

In diabetic patients, euglycaemia at the time of conception is crucial for the success of the pregnancy. In consideration of the difficulty in achieving and maintaining tight glycaemic control for long periods, we administered clomiphene citrate, which is usually indicated in cases of absent or infrequent ovulation, to enhance fecundability in 10 pregestational diabetic patients. All conceived within one to three cycles of the drug, and nine delivered healthy term babies after uneventful pregnancies; one aborted spontaneously in the eighth gestational week. No effect of the drug on the diabetes was noted as based on measurements of glycosylated haemoglobin and fructosamine concentrations and the absence of changes in the patients' insulin requirements. In the light of these successful results, and in view of the importance of euglycaemia at the beginning of diabetic pregnancies, we suggest a new 'sweet' indication for the use of clomiphene citrate.

Adult↗
PubMed1996

Cyclosporine pharmacokinetics and risk of recurrent rejection in recipients of simultaneous pancreas/kidney transplants.

Recipients of a simultaneous pancreas/kidney transplant (SPK) appear to have a greater incidence of acute rejection than do recipients of a kidney-alone transplant. These patients are also susceptible to multiple rejection episodes. Because of this, optimal immunosuppression is imperative in these patients. Cyclosporine A (CsA)-based immunosuppression remains the mainstay of therapy, and therefore, optimization of this often unpredictable drug is necessary. We looked at 14 consecutive SPK recipients and assessed the utility of a single 1-month pharmacokinetic study in predicting the risk of acute rejection. Each pharmacokinetic study was analyzed by both monoclonal fluorescence polarization immunoassay (TDX) and high performance liquid chromatography (HPLC). Due to the small sample size and the high rate of primary rejection (12/14 patients), we chose a novel endpoint, that of recurrent rejection. Seven of the 14 patients studied developed recurrent rejection. The patients without recurrent rejection had significantly higher areas under the concentration curve (AUCs) than did patients with recurrent rejection: 4,663 +/- 1,460 vs. 2,454 +/- 1,717 ng-h/ml (p < 0.05) by HPLC and 6,669 +/- 2,556 vs. 3,661 +/- 1,956 ng-h/ml (p < 0.05) by TDX. We propose that a single 1-month AUC has potential utility in identifying a subset of SPK patients with poor CsA absorption at risk for recurrent rejection.

Adult↗
PubMed1996

Comparison of room temperature and warmed local anesthetic solution for tumescent liposuction. A randomized double-blind study.

BACKGROUND: The tumescent technique of local anesthesia has been accepted as the standard of care for liposuction surgery. Large volumes of a dilute solution of lidocaine, epinephrine, sodium bicarbonate, and triamcinolone are infused into the subcutaneous fat. The technique eliminates the need for general anesthesia and provides greater safety and improved esthetic results. OBJECTIVE: A study was designed to evaluate the benefit of warming of the local anesthetic to 40 degrees C prior to infiltration and thus to determine whether warming provides improved patient comfort. METHODS: A double-blind randomized cross-over study was performed in 16 patients undergoing outpatient tumescent liposuction. Pain scores were determined using a visual analog pain scale. RESULTS: The mean pain score was significantly lower for areas treated with the 40 degrees C warmed solution. CONCLUSION: Warming of local anesthetic solution for tumescent liposuction significantly reduces pain as perceived by the patient and is recommended in all tumescent liposuction surgery.

Adult↗
PubMed1996

Ovarian angiotensin-converting enzyme activity in humans: relationship to estradiol, age, and uterine pathology.

The present study was designed to measure angiotensin-converting enzyme (ACE) activity in the human ovary and in serum and to relate this activity to age, serum estradiol levels, and uterine and endometrial pathology. ACE activity was determined in 56 females by a radiometric assay using [3H]hippuryl-glycyl-glycine as substrate. Ovarian ACE activity, but not serum ACE, was found to increase with age (P < 0.01) and was significantly greater in postmenopausal subjects (n = 31; 1.35 +/- 0.05 nmol/mg.min) than in subjects with active ovaries (n = 21; 0.65 +/- 0.2 nmol/mg.min; P = 0.0033). Ovarian ACE activities in fertile women in the preovulatory phase (n = 14) and the postovulatory phase (n = 7) were not statistically different (0.66 +/- 0.23 and 0.63 +/- 0.17 nmol/mg.min, respectively). Serum ACE activities were similar in females with active and nonactive ovaries (87.6 +/- 5.0 vs. 81.7 +/- 5.3 nmol/mL-min, respectively). Serum estradiol levels in fertile women were significantly higher than those in postmenopausal women (P = 0.0023). Serum estradiol levels were negatively correlated with age (r = -0.46; P = 0.0041) and were not correlated with either serum ACE activity (r = 0.080; P = NS) or ovarian ACE activity. In summary, human ovarian ACE activity, but not serum ACE, is positively correlated with age. Serum estradiol levels decrease with age, but are not correlated with either ovarian or serum ACE activity. Endogenous serum estradiol levels had no apparent effect on ovarian or serum ACE activity. The presence of uterine pathology affects ovarian ACE activity. The cause of the increased ovarian ACE activity is not clear, but may be related to the aging process.

Adult↗