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Biomedical subjects

D Barad

Publications and source records attributed to D Barad.

At least 19 recordsLinked to original sources
PubMed2006

Unexplained infertility: does it really exist?

Recent medical literature has quite extensively addressed the use of various terminologies within the field of reproductive medicine. This discussion has, however, so far overlooked the fact that one of the most frequently made diagnosis, so-called unexplained infertility (UI), not only didactically but, even more importantly, clinically, appears unsustainable as an independent diagnosis. The arguments in support of such a contention are manifold. The diagnosis of UI is highly subjective. It is dependent on which diagnostic tests have been performed (or have been omitted) and at what level of quality. Paradoxically, a diagnosis of UI will, therefore, be more often reached if the diagnostic workup is incomplete or of poor quality. Supported by evidence from the literature, the argument is made that the conditions, most frequently misdiagnosed as UI, are endometriosis, tubal infertility (especially distal and peritubal disease), premature ovarian ageing and immunological infertility. Because of the obvious unreliability of a diagnosis of UI and the widely reported unevenness in diagnostic criteria, we recommend the abandonment of UI as a formal infertility diagnosis. Better efforts to reach infertility diagnoses more accurately should improve the diagnostic accuracy of hitherto frequently missed diagnoses, which often falsely have led to a diagnosis of UI.

Adult↗
PubMed1997

Clinical significance of methohexital, meperidine, and diazepam in breast milk.

Concentrations in breast milk of medications used during general anesthesia were measured to determine whether interruption of breast-feeding was indicated. Breast milk and maternal blood samples were obtained from nine women undergoing tubal sterilization under general anesthesia. Concentrations of methohexital, meperidine, diazepam, and nordiazepam were determined for each sample by gas chromatography. Methohexital levels declined rapidly after the first hour and were undetectable at 24 hours. Meperidine was present in both milk and blood during the recovery period but not at 24 hours. Infant-exposure indices for methohexital were less than 1% and ranged from 1.2% to 3.5% for meperidine. The maximum doses of methohexital and meperidine to an infant, in a 100 mL feeding 1 hour after induction of anesthesia were estimated to be 0.04 mg and 0.06 mg, respectively. Diazepam and nordiazepam were not detectable in any sample of milk or blood. The maximum possible infant-exposure index for diazepam would be 3%. The amounts of methohexital, meperidine and diazepam excreted into breast milk do not warrant interruption of breast-feeding.

Adult↗
PubMed1996

A randomized, placebo-controlled study on the effect of cyclic intermittent etidronate therapy on the bone mineral density changes associated with six months of gonadotropin-releasing hormone agonist treatment.

OBJECTIVE: Our purpose was to determine whether intermittent cyclic etidronate therapy blocks the decline in bone density associated with gonadotropin-releasing hormone agonist therapy. STUDY DESIGN: Thirty-one premenopausal subjects who needed treatment with leuprolide (Lupron) 3.75 mg monthly for 6 months were randomized to etidronate or placebo. Bone turnover was assessed by measurement of serum calcium, phosphorus, alkaline phosphatase, and fasting urinary calcium/creatinine ratios. Bone density was measured by dual energy x-ray absorptiometry. RESULTS: Gonadotropin-releasing hormone treatment produced a significant decrease (4% to 10%) in bone density at the anteroposterior and lateral spine in placebo-treated patients (11). No significant change was demonstrated in etidronate-treated patients (15). Significant increases in serum calcium, phosphorus, alkaline phosphatase, and urinary calcium/creatinine ratios were noted in the placebo group. No significant change in these parameters were evident in the etidronate group. CONCLUSION: Etidronate blocks bone mineral density changes associated with gonadotropin-releasing hormone agonist therapy and normalizes serum and urine indicators of bone turnover.

Adult↗
PubMed1995

Levels of interferon-gamma and tumor necrosis factor-alpha in sera and cervical mucus of fertile and infertile women: implication in infertility.

Concentrations of two immune cytokines, namely interferon-gamma (INF-gamma) and tumor necrosis factor-alpha (TNF-alpha), were determined in the sera and cervical mucus samples of fertile (n = 16), idiopathic infertile (n = 44), and immunoinfertile women (n = 45) to investigate their role, if any, in female infertility. Sera of idiopathic infertile women demonstrated significantly (P < 0.0001) higher levels of INF-gamma compared to those in fertile controls, whether expressed as pg/ml or pg/mg serum protein. Similarly, sera of immunoinfertile women demonstrated significantly (P = 0.0008) higher levels of INF-gamma compared to fertile controls and idiopathic infertile women. Cervical mucus of idiopathic infertile women also demonstrated significantly (P < 0.0001) higher concentrations of INF-gamma compared to those in fertile controls. Cervical mucus of immunoinfertile women demonstrated significantly (P < 0.0001) higher concentrations of INF-gamma compared to those in fertile controls and idiopathic infertile women. INF-gamma levels in serum did not significantly (P > 0.05) correlate (r = 0.12-0.43) with the concentrations in cervical mucus, when all the three groups were compared together. However, when the serum levels were compared with the cervical mucus concentrations by condition, only the idiopathic infertile group showed a significant (P = 0.005) correlation (r = 0.70). Serum levels of TNF-alpha did not differ significantly (P > 0.05) among three groups of women. Cervical mucus concentrations of TNF-alpha, however, varied among groups with levels being significantly (P = 0.04) higher-in idiopathic infertile women compared with fertile controls and in immunoinfertile women significantly (P = 0.0007) higher than in fertile controls as well as idiopathic infertile women. TNF-alpha levels in serum correlated (r = 0.65) significantly (P < 0.001) with the concentrations in cervical mucus when all the three groups were compared together or individually by infertility condition. These findings suggest the involvement of cytokines in infertility, and thus may have potential applications in diagnosis and treatment of female infertility.

Adult↗
PubMed1992

Expression of the colony-stimulating factor-1 receptor (c-fms proto-oncogene product) in the human uterus and placenta.

This study describes the expression pattern in the human uteroplacental unit of c-fms, the proto-oncogene that encodes the receptor for colony-stimulating factor-1. Quantitative mRNA analysis showed that c-fms mRNA expression in placental tissues was lowest in first trimester samples and highest at the end of pregnancy. Expression of c-fms mRNA was also high in first trimester endometrium and term chorion. Although c-fms mRNA was approximately 3.7 kb in size on northern blots of all placental, endometrial, and chorion preparations, trophoblast-specific transcription of c-fms exon 1 was confirmed by primer-directed amplification of reverse-transcribed total RNA. Immunohistochemistry using both polyclonal and monoclonal anti-c-fms protein antibodies showed that c-fms protein was expressed over the entire trophoblastic area during the first trimester but became progressively restricted to the villous syncytiotrophoblast as pregnancy advanced. Of particular interest was the high level of c-fms protein expression in the intermediate trophoblasts of the villous sprouts during first trimester. The synthesis of c-fms protein was also detected in glandular epithelial cells and decidual cells of first trimester endometrium and in the extra-villous trophoblastic layer of the chorion.

Base Sequence↗
PubMed1992

Expression of colony-stimulating factor-1 in the human uterus and placenta.

Previous studies in the mouse have strongly implicated colony-stimulating factor-1 (CSF-1) in the regulation of placental development. In this study of human pregnancy, we detected CSF-1 in serum, endometrium, placenta, chorion, amnion, and amniotic fluid, with significant increases in serum and endometrial samples from the first trimester compared to levels in nonpregnant controls. CSF-1 mRNA was demonstrated in all of these tissues, except amnion, with a significant increase within the first trimester endometrial samples over nonpregnant control values. In addition to the major 4.0-kilobase mRNA, other species of CSF-1 mRNA were detected, which were shown to be due to alternative splicing within exon 6 and the alternative use of exon 9 or 10. In the endometrium, CSF-1 was localized to glandular epithelial and endothelial cells. In first trimester placenta, CSF-1 was in the cytotrophoblasts lining the villous core and in the cytotrophoblastic shell. During the second trimester, CSF-1 was localized to villous mesenchymal cells. By the third trimester, CSF-1 was only detected in cells lining the villous vessels. The detection of CSF-1 during gestation strongly supports a role for CSF-1 in the regulation of placental function in humans by autocrine and/or paracrine mechanisms.

Amnion↗
PubMed1991

Prolonged retention of laminaria fragments: an unusual complication of laminaria usage.

A single laminaria japonica was placed the day before an abortion requested by a 32-year-old nulliparous woman. On the day of the procedure, the laminaria was found to be tightly wedged in the cervix, and attempts at removal resulted in pushing the laminaria into the uterine cavity. The abortion was completed, and 3 days later, after placement of additional osmotic dilators, the intrauterine laminaria was crushed and removed. Fifteen months later, a small fragment of laminaria passed spontaneously. Hysteroscopy was performed, and approximately 30 fragments of laminaria were removed.

Abortion, Induced↗
PubMed1990

The use of two-component fibrin sealant for embryo transfer.

This is a report of our preliminary experience using fibrin sealant with a series of 38 patients undergoing IVF and ET. We used a two-component fibrin sealant to create a fibrin plug in the uterine cavity at the time of ET to decrease the possibility of embryo expulsion and also ectopic pregnancy. Our preliminary report proves that it is possible to obtain 26% pregnancies using this two-component biological glue instead of serum or culture medium for uterine embryo replacement. A prospective randomized study will be undertaken to evaluate whether the use of fibrin sealant could significantly improve IVF and ET results.

Culture Media↗
PubMed1990

Direct trocar insertion vs. Verres needle use for laparoscopic sterilization.

A randomized, prospective trial was designed to compare direct trocar insertion with prior peritoneal insufflation with a Verres needle for laparoscopic tubal sterilization. Direct trocar insertion resulted in fewer instrument insertions (21.8% vs. 7.8%) and use of smaller volumes of CO2 (2.67 vs. 2.32 L). Direct trocar use resulted in a decrease in operating time from 9 minutes, 40 seconds in the needle group to 7 minutes, 30 seconds in the trocar group. Minor omental injuries occurred in a small percentage of each group, while serious complications occurred once in each group.

Adult↗
PubMed1989

Availability of donated oocytes from an ambulatory sterilization program.

An oocyte donor program was established at the Women's Medical Pavilion, Dobbs Ferry, New York, in 1987 for women lacking normal ovarian function. The oocytes were donated voluntarily in stimulated cycles by women undergoing laparoscopic sterilization. If the donors agreed to use ovulation-induction agents and be monitored, they were compensated for their time and inconvenience. Between Nov 15, 1987, and Feb 15, 1988, 194 laparoscopic sterilizations were performed. Only 41 women (21%) met certain of the eligibility criteria. Of the remaining group, only five (12%) agreed to participate. The preliminary results suggest that tubal ligation patients are reluctant to donate oocytes despite enthusiastic counseling, the relatively small risks involved and offers of financial compensation.

Adult↗
PubMed1989

Association of previous abdominal surgery and significant adhesions in laparoscopic sterilization patients.

Many surgeons believe that women who have undergone laparotomy are not good candidates for laparoscopic sterilization. Many of those women are admitted for minilaparotomy. However, women without previous surgery can also have adhesions. We compared the incidence of significant adhesions in women with and without histories of abdominal surgery. We also examined the outcomes in each group after 955 laparoscopic sterilizations. Two hundred sixty-three women (28%) had had previous surgery. Of them, 61 (23%) displayed significant adhesions. Of the remaining 692 patients, 19 (2.7%) had significant adhesions. There were no major complications in either group. Thus, a history of previous abdominal or pelvic procedures increased the risk of significant adhesion formation nearly tenfold. Since no major complications occurred in those women, we conclude that while such patients are at increased risk, that risk is not inordinate and does not justify the routine use of minilaparotomy.

Abdomen↗
PubMed1984

Glycosylated hemoglobin (HbA1) and hemoglobinopathies in pregnancy.

Glycosylated hemoglobin (HbA1) is considered to be representative of prior blood-glucose levels and is being used in pregnant and nonpregnant diabetic patients as a possible index of both long and short-term glucose-control. Factors other than blood-glucose concentration have been reported to affect its value. Variant hemoglobin is one of them. HbA1 and blood-glucose levels were measured in pregnant patients at high risk for diabetes for screening for abnormal carbohydrate metabolism. HbA1 was measured by cation exchange column chromatography and glucose was measured by hexokinase reaction. The mean HbA1 in patients with normal blood sugars was 6.17 +/- 0.6 percent. A value of HbA1 of less than 5 percent as measured by cation exchange column chromatography was highly predictive (P less than 0.001) of hemoglobinopathies (S or C). The mean HbA1 of randomly selected matched patients with "normal" Hb was 5.94 +/- 0.72 percent. In patients with thalassemia, HbA1 values as measured by cation exchange column chromatography were elevated despite normal carbohydrate tolerance. While interpreting the results of HbA1 in the management of pregnant diabetics, the above fact should be kept in mind.

Blood Glucose↗
PubMed1984

Use of glycosylated hemoglobin as a screen for macrosomia in gestational diabetes.

Glycosylated hemoglobin and blood sugar levels in the fasting state and two hours after oral 100 g glucose load were measured in 180 patients. Glycosylated hemoglobin was measured by cation exchange column chromatography, and blood sugar was measured by hexokinase reaction. Patients with an elevated postprandial and/or fasting blood sugar level (positive screen) subsequently underwent three-hour glucose tolerance test. The mean value of glycosylated hemoglobin in patients with a negative screen and normal hemoglobin was 6.17 +/- 0.61%; and the value for glycosylated hemoglobin in patients with class A diabetes and normal hemoglobin electrophoresis was 6.85 +/- 0.73% (P less than .001). A glycosylated hemoglobin value greater than 6.78 (mean + 1 SD) was considered elevated. Glycosylated hemoglobin values were elevated in 21 of 33 patients with gestational diabetes and in 27 of 147 patients with normal blood sugar levels. The sensitivity and specificity of glycosylated hemoglobin for the diagnosis of gestational diabetes were 63.6 and 81.6%, respectively. Fifty percent of patients with an initially elevated glycosylated hemoglobin value delivered macrosomic infants, whereas no patient with a normal glycosylated hemoglobin value had a macrosomic infant. An elevated glycosylated hemoglobin value may alert the obstetrician of a potentially elevated mean blood sugar level and may warrant aggressive management of gestational diabetes.

Birth Weight↗