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Biomedical subjects

C L Cook

Publications and source records attributed to C L Cook.

27 records · Page 2Linked to original sources
PubMed1984

Induction of luteal phase defect with clomiphene citrate.

The effect of clomiphene citrate and progesterone on luteal function in infertile women was studied. Endometrial biopsies were performed in 103 women immediately prior to menstruation. Group 1 (n = 62) had secretory endometrium with a histologic lag time of greater than or equal to 48 hours with respect to the subsequent menses, that is, luteal phase defect. Group 2 (n = 10) had normal histologic characteristics of the secretory phase. Group 3 (n = 31) had anovulatory endometrium. The last group was subdivided into those with polycystic ovary syndrome (n = 9) and those without the characteristic gonadotropin pattern of polycystic ovary syndrome (n = 22). Clomiphene citrate at doses of 50 to 250 mg daily for 5 days was administered for induction of ovulation, timing of ovulation, or treatment of luteal phase defect. An endometrial biopsy was obtained after three ovulatory treatment cycles. Only one fourth of the women with prior luteal phase defect had normalization of the biopsy specimen with clomiphene citrate, while one half of those treated with progesterone had normal specimens. Half of the normally ovulating women had induction of a luteal phase defect with clomiphene citrate. Only women with polycystic ovary syndrome had consistently well-timed endometrial histologic features with clomiphene citrate therapy. Despite successful induction of ovulation, 16 of the other 22 previously anovulatory women had endometrial histologic findings compatible with luteal phase defect. Increasing the clomiphene citrate dosage was unsuccessful in improving endometrial maturation. These results suggest that the use of clomiphene citrate may be associated with a high rate of luteal phase defect induction, except among women with polycystic ovary syndrome. Clomiphene citrate, even at high doses, appears to be ineffective therapy for luteal phase defect.

Anovulation↗
PubMed1984

Teaching laparoscopic sterilization.

First-year obstetrics-and-gynecology residents participated in the attempted sterilization of 411 women by either Falope Ring application (FRA) or bipolar electrocoagulation (LTC). Ability to complete the procedure, as well as intraoperative and immediate postoperative complication rates, was reviewed. Characteristics that predisposed women to complications were assessed. Complications were more common in 165 women who underwent sterilization with FRA than in those who had LTC. Two FRA patients (0.9%) required laparotomy because of bleeding. In addition, failure to establish a pneumoperitoneum led to a minilaparotomy in one case. Nineteen FRA women (11.5%) experienced minor complications. The only major complications with the use of LTC were the need for minilaparotomy in two women in whom a pneumoperitoneum could not be established. Minor complications occurred in 4 of 227 LTC cases (1.8%). Current or past patient characteristics did not influence outcome except in the cases of failure to establish a pneumoperitoneum; those women were significantly heavier than others in this series. Limited experience in the instruction of FRA may have contributed to the higher complication rate and to the greater number of problems complicating sterilization with FRA as compared to LTC.

Electrocoagulation↗
PubMed1983

Stability of human chorionic gonadotropin and its alpha subunit in human blood.

The stability of human chorionic gonadotropin (hCG) and its alpha-subunit in whole blood, plasma, and serum under a variety of sample handling conditions commonly encountered in clinics, hospital wards, physician's offices, and clinical service laboratories was investigated with the use of radioreceptor assay, radioimmunoassays, as well as hormone integrity determinations. The results clearly demonstrate that hCG and its alpha-subunit are stable in unfrozen whole blood, plasma, and serum for at least 6 days and in frozen plasma and serum samples for at least 6 months. Repeated freezing and thawing of the samples during this period had no effect. Separation of plasma or serum from erythrocytes is not needed for at least 12 hours. Hemolysis in samples resulted in a 20% to 30% decrease in hCG and its alpha-subunit levels, which may be attributable to sample dilution.

Alpha-Globulins↗
PubMed1983

Plasma gonadotropin and sex steroid hormone levels during early, midfollicular, and midluteal phases of women with luteal phase defects.

Thirteen women with luteal phase defects (LPD) confirmed by endometrial biopsies and 14 with histologically normal endometria were studied for early follicular and midfollicular phase follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels and for midluteal phase progesterone, estrogen, testosterone, and prolactin levels. The results showed that the women with LPD had significantly lower FSH levels and FSH/LH ratios in the early and midfollicular phases. LH levels, however, were similar in the LPD and normal women. During the midluteal phase, the LPD women showed significantly lower levels of progesterone and estrogen and normal levels of testosterone and prolactin. These findings reaffirm the prevailing concept that events surrounding follicular growth and development can indeed influence the quality of that cycle's corpus luteum. Furthermore, LPD as a result of hyperprolactinemia appears to be a different entity from that due to inadequate follicular phase FSH.

Adnexal Diseases↗
PubMed1982

Temperature-induced in vitro transformation of Leishmania mexicana. I. Ultrastructural comparison of culture-transformed and intracellular amastigotes.

Promastigotes of Leishmania mexicana growing exponentially in vitro at 26 degrees C in mammalian cell culture medium with 10% serum were transformed to amastigote-like forms by elevating the incubation temperature to 34 degrees C. During the first 24-48 h of the transformation process the slender flagellated promastigotes lost their flagella and became smaller and more ovoid. By 72 h, transformation was complete with greater than 95% of the parasites viable as judged by vital dye exclusion. Moreover, these newly transformed parasites were capable of infecting the macrophage-like tumor cell line P388D1, and could reconvert to the promastigote stage upon return to an incubation temperature of 26 degrees C. The transformed amastigote-like parasites survived only 3 days in culture even with daily renewal of the culture medium, possibly indicating the requirement for some factor or factors normally present in the intracellular milieu. Ultrastructural studies revealed the same gross changes observed under light microscopy, and also demonstrated a close similarity in cellular organelles and membrane structure between amastigotes within phagolysosomes of P388D1 and the culture-derived amastigote forms. By these biologic and morphologic criteria the transformed parasites appear to be amastigotes, though further biochemical studies are needed to confirm their strict analogy to intracellular forms. However, the temperature-induced transformation process itself should provide an excellent model system for studying the effects of environment on eukaryotic gene expression.

Animals↗
PubMed1982

Evaluation of Falope Ring sterilization by hysterosalpingogram.

One hundred eight women sterilized by laparoscopically directed application of Falope Rings were evaluated by postoperative hysterosalpingography (HSG). Operations were performed from November 1975 through March 1977 at Louisville General Hospital, Louisville Kentucky, by residents in obstetrics and gynecology. Local anesthesia was used for 30% of the procedures; general endotracheal anesthesia was used for the remainder. Xylocaine jelly was placed on each ring prior to its application. HSG was done on each woman at least three months following surgery. In three cases extravasation from one tube occurred. None of the women had extravasation from both tubes. One patient with intraabdominal spill had a repeat sterilization by laparoscopic cauterization. The remaining two patients, who have been followed for three years, have not used contraception and have not conceived. The clinical significance of extravasation on HSG following tubal sterilization has been questioned, as has the safety of postoperative hysterosalpingography. This study demonstrated a high rate of patency (2.8%). However, pregnancy did not occur in two patients with persistent postoperative tubal patency. The patency rate with Falope Ring sterilization is lower than that found by others at this institution when HSGs were used to evaluate women following laparoscopic cauterization.

Adult↗