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Biomedical subjects

D E Pittaway

Publications and source records attributed to D E Pittaway.

At least 37 records · Page 2Linked to original sources
PubMed1986

Cycle of conception endometrial biopsy.

Although controversial, the diagnosis of luteal phase inadequacy and its therapy may improve reproductive outcome, but an endometrial biopsy in the cycle of conception (COC) might theoretically interrupt an intrauterine pregnancy. Fifty-four biopsies obtained in the COC were identified, and patient outcome was documented. Eleven (20%) of the 54 women who underwent COC biopsy did not deliver viable infants. Two patients had ectopic pregnancies, and nine had early abortions, including one whose biopsy specimen contained an early implantation site and another with a trisomy 16 fetus. Although COC endometrial biopsy did not appear to increase the incidence of fetal wastage, biopsy information provided no predictive information suggestive of ultimate pregnancy outcome. Because no useful information is gained from a COC biopsy, we recommend either that pregnancy be avoided or a sensitive pregnancy test be employed for detection in a cycle in which a biopsy is to be performed.

Abortion, Spontaneous↗
PubMed1986

The use of CA-125 in the diagnosis and management of endometriosis.

CA-125, a cell-surface antigen, was measured by a radioimmunoassay in the serum of 414 women to determine its potential usefulness in the diagnosis and management of endometriosis. In women with minimal, mild, moderate, and severe endometriosis, the mean levels (+/- standard deviation) were 13.6 +/- 6.8, 22.8 +/- 15.5, 27 +/- 17, and 50 +/- 28 U/ml, respectively, and were significantly higher than mean levels (7.8 +/- 4.1) in 46 women with a normal laparoscopic examination. Higher mean CA-125 values also were observed in acute pelvic inflammatory disease, unexplained fertility, and pregnancy and during menstruation. The mean CA-125 value in women with treated endometriosis and a negative second-look laparoscopy was significantly lower than in women with untreated endometriosis. With the use of the 95% upper limit of 16 U/ml, the test had a sensitivity of 53% and specificity of 93%. The frequencies of elevated levels in minimal, mild, moderate, and severe endometriosis were 27%, 68%, 73%, and 100%, respectively. Changes in the CA-125 levels correlated with the clinical course of endometriosis in 37 of 44 (84%) women (P less than 0.001). The determination of CA-125 levels may assist in the evaluation and treatment of women with endometriosis.

Antigens, Neoplasm↗
PubMed1986

Ureteral abnormalities in women with endometriosis.

High-volume intravenous urography was performed in 63 women with surgically proven endometriosis. Subtle abnormalities were found in 15.9% of these women. No patient had urologic symptoms, and there was no evidence of hydroureter or ureteral obstruction on the IVP. Long-term follow-up study will be required to determine whether or not these lesions will progress and cause ureteral obstruction.

Adult↗
PubMed1985

Doubling times of human chorionic gonadotropin increase in early viable intrauterine pregnancies.

Although the doubling time of serum human chorionic gonadotropin has been assumed to be constant in early viable intrauterine pregnancy (prior to 6 to 7 weeks after menses), the range has varied between 1.4 and 3.5 days in the literature. To evaluate this variability of the doubling time, the mean doubling times at different ranges of human chorionic gonadotropin concentrations were determined in 49 normal pregnancies, and the doubling times at different intervals of gestation from both the day of the basal body temperature shift and the last menstrual period. The data obtained from the three different methods indicate that the doubling time of human chorionic gonadotropin is not constant but rather increases with increasing human chorionic gonadotropin concentration or gestational age. In addition, statistical analysis of the semilogarithmic plots of serum human chorionic gonadotropin concentrations indicated that the exponential rate of increase of serum human chorionic gonadotropin significantly decreases with gestational age. Since serum human chorionic gonadotropin doubling times increase and the exponential rate decreases with gestational age, estimates of normal values should be established for small sampling ranges and/or short intervals of gestation.

Chorionic Gonadotropin↗
PubMed1985

Evaluation of early pregnancy by serial chorionic gonadotropin determinations: a comparison of methods by receiver operating characteristic curve analysis.

Two methods of evaluating early pregnancies by serial human chorionic gonadotropin (hCG) determinations were evaluated by receiver operating characteristic (ROC) curve analysis. The first method used normal values (mean and upper confidence limits) of the hCG doubling time (DT) determined by a linear regression analysis of hCG concentrations from 35 normal pregnancies during the first 42 postmenstrual days. In the second method, normal values were determined at multiple sampling ranges of hCG concentrations from 49 normal pregnancies. In the evaluation of 91 pregnancies of which 58 progressed to viability, 25 spontaneously aborted, and 8 were ectopic gestations, the ROC curves demonstrated that for any given false-positive rate, the use of multiple normal values of DT was more sensitive than the use of a single mean DT determined by linear regression analysis. The study indicates that a more precise definition of the normal values of the hCG-DT results in improved early detection of abnormal pregnancies.

Chorionic Gonadotropin↗
PubMed1985

The efficacy of early pregnancy monitoring with serial chorionic gonadotropin determinations and real-time sonography in an infertility population.

Ninety-one pregnancies were monitored prospectively with serial human chorionic gonadotropin (hCG) determinations and real-time sonography. The monitoring process included an initial hCG doubling time (DT) followed by sonographic examination for fetal heart motion at 7 to 8 weeks in the asymptomatic patient. In women with an abnormal DT or who developed symptoms, repeat hCG determinations and/or sonography were performed. A single DT correctly identified 95% of the successful pregnancies (58) and 64% of the abnormal pregnancies (25 abortions and 8 ectopic gestations) in asymptomatic women. With repeat hCG determinations and/or sonography, 88% of the spontaneous abortions (before aborting) and 100% of the ectopic pregnancies (before tubal rupture) were identified. As a result of the early diagnosis, conservative surgery was performed in six of eight women with tubal pregnancies. The presence of fetal heart motion was a reliable indicator that an intrauterine pregnancy will progress to viability in both the symptomatic (89%) and asymptomatic patient (93%). We conclude that the combined use of serial hCG determinations and real-time sonography provides efficacious monitoring of the early high-risk pregnancy.

Abortion, Spontaneous↗
PubMed1985

Ovarian surgery in an infertility patient as an indication for a short-interval second-look laparoscopy: a preliminary study.

The usefulness of a short-interval second-look laparoscopy (SLL) after ovarian surgery was examined. In 23 infertile women who had either bilateral wedge resection (BWR) of polycystic ovaries, an oophorocystectomy (OC), or resection of endometriomata (RE), adhesions were graded before and after surgery and before and after laparoscopic lysis for each ovary. At SLL, periovarian adhesions involving at least one ovary were observed in all women. Of the 22 women who wanted to become pregnant, 3 of 3 with BWR, 1 of 3 with OC, and 6 of 16 with RE conceived. In the women with residual adhesive disease in both or the only remaining adnexa after SLL, there were no pregnancies; whereas 67% of the women with at least one adnexa free of disease became pregnant (P = 0.005). This preliminary study indicates that ovarian surgery does result in significant adhesion formation and that SLL offers an opportunity to reassess the pelvis, to lyse adhesions, and to establish a postoperative prognosis.

Adult↗
PubMed1985

Spironolactone in combination drug therapy for unresponsive hirsutism.

Clinical and laboratory evaluations of nine hirsute women were performed for determination the efficacy of combination drug therapy. Each patient had previously failed to respond to single drug therapy with oral contraceptives (OC), dexamethasone (DEX), or spironolactone (S) and received S (100 to 150 mg) and either an OC (mestranol, 0.05 to 0.08 mg, and norethindrone, 1 mg) or DEX (0.5 mg) daily. Total testosterone, dehydroepiandrosterone sulfate, free testosterone, and sex-hormone-binding globulin were measured before therapy and 4 to 6 weeks after initiation of therapy and were compared with the responses to OC (n = 7), DEX (n = 8), and S (n = 6). A satisfactory clinical response in the rate of hair growth was defined as at least a doubling of the time interval between adjunctive therapies (electrolysis, shaving, or bleaching) and patient satisfaction with treatment. The responses of the androgenic parameters were not statistically different between combination and single drug therapy. Although all patients noted a subjective improvement in hair growth, eight of nine fulfilled the criteria for a clinical response (P less than 0.001). Transient diuresis was the only side effect noted. The study suggests that combination drug therapy is an efficacious and well-tolerated approach to the management of unresponsive hirsutism.

Contraceptives, Oral↗
PubMed1984

One ovary or two: differences in ovulation induction, estradiol levels, and follicular development in a program for in vitro fertilization.

The choice of clomiphene citrate (CC) and human menopausal gonadotropin (hMG) protocols for stimulation of ovarian follicular maturation has traditionally not been made with regard to the anatomic status of the pelvis. To evaluate whether hormone production and/or follicular development vary based on the number of ovaries and/or the method of stimulation, 117 cycles were reviewed. Forty-five women received CC, 29 with two ovaries and 16 with one ovary. Seventy-two women received hMG, 50 with two ovaries and 22 with one ovary. Among women receiving CC, those with two ovaries tended to have higher initial estradiol levels and a greater number of large (greater than or equal to 15 mm) follicles. Among women receiving hMG, those with two ovaries tended to have higher estradiol levels, but the number of large follicles (greater than or equal to 15 mm) was similar. With either stimulation protocol, women with two ovaries developed a higher total number of follicles than women with one ovary. The total number of follicles in women with one ovary was similar for hMG and CC stimulations. The number of oocytes recovered at laparoscopy was greater in women with two ovaries who received hMG in comparison with CC, but did not significantly vary between women with one or two ovaries who received CC nor between women with one or two ovaries who received hMG. The number of oocytes was also similar for the women with one ovary regardless of stimulation protocol.

Castration↗
PubMed1984

Sonographic depiction of endometrial changes occurring with ovulation induction.

Endometrial thickness and texture were evaluated with serial pelvic sonograms in ten normal, menstruating women and 107 patients undergoing ovulation induction for in vitro fertilization. Serial sonograms were performed in the control group every other day throughout the menstrual cycle, whereas the sonographic examinations of the ovulation induction patients were performed daily in a four- to eight-day time interval after their medications were completed and prior to laparoscopy for follicular aspiration. Endometrial thickness increased (defined as a persistent change greater than or equal to 1 mm) in 21 of 53 women (40 percent) who received human menopausal gonadotropin (HMG). Of the 54 women treated with clomiphene citrate (CC), five of 12 (42 percent) at 50 mg daily, 13 of 33 (39 percent) at 100 mg daily, and one of nine (11 percent) at 150 mg daily were found to have endometrial thickening. Although the frequencies of endometrial thickening in the high-dose CC and HMG groups were not significantly different (P = 0.09), the peak estradiol (E2) levels in the CC (150 mg) group (E2 = 944 +/- 165 pg/ml) were significantly higher (P less than 0.001) than those in the HMG group (E2 = 584 +/- 26 pg/ml). The relatively low frequency of endometrial thickening in women receiving CC (150 mg) despite very high E2 levels, and the decreased incidence of endometrial thickening relative to increasing dosages of CC may reflect an antiestrogenic effect of CC on the endometrium. In those patients undergoing ovulation induction, the texture of the endometrium remained the same in 98 cycles and changed during nine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Antiestrogenic effect of clomiphene citrate: correlation with serum estradiol concentrations.

The antiestrogenic effect of clomiphene citrate (CC) on cervical mucus was evaluated in women receiving 150 mg CC daily for 5 days. Daily cervical mucus scores and serum estradiol (E2) concentrations were determined in control (n = 25) and CC (n = 24) cycles. E2 concentrations were significantly higher in the CC-treated women (mean +/- standard error of the mean, 1254 +/- 102 pg/ml versus 337 +/- 18 pg/ml, P less than 0.0001). Despite supraphysiologic E2 concentrations, however, cervical mucus scores were significantly reduced in the CC-treated group (P less than 0.01). These data indicate that CC exerts a direct suppressive effect on cervical mucus despite markedly increased E2 concentrations.

Adult↗
PubMed1984

Endometriosis and corpus luteum function. Is there a relationship?

More than 100 years after the first description of endometriosis, the pathophysiology of the disorder still remains an enigma. In addition to infertility, an increased frequency of clinically apparent spontaneous abortions (32% vs. 8-15% in the normal population and 19% in the infertile one) has been found in women with endometriosis and secondary infertility. Treatment of endometriosis with conservative surgery, danazol or both results in a frequency of spontaneous abortion within the range of the normal population's. Although the factors involved in the pathophysiology of endometriosis are probably multiple, abnormal corpus luteum function is a common mechanism that might explain both the infertility and the spontaneous abortions. Several studies suggested a relationship between endometriosis and corpus luteum function, which may be mediated by prostaglandins. However, not all the data have been supportive. We developed a hypothetical scheme (modified from Drake) that outlines possible mechanisms of endometriosis mediated by the adverse effects of increased prostaglandins. Further investigation of this scheme may provide new information about the pathophysiology of endometriosis.

Abortion, Spontaneous↗
PubMed1983

Prevention of acute pelvic inflammatory disease after hysterosalpingography: efficacy of doxycycline prophylaxis.

In an attempt to minimize the infectious morbidity of hysterosalpingography, the efficacy of oral doxycycline prophylaxis was examined. The records and hysterosalpingograms of 278 consecutive women (group 1) were reviewed to correlate the radiologic findings and the development of acute pelvic inflammatory disease (PID) after hysterosalpingography. Four women (1.4%) developed PID and all four had tubal dilatation. The overall frequency of PID in women with dilated tubes was 4/35 (11%). Subsequently, 56 of 326 women (group 2) with tubal dilatation received oral doxycycline prophylaxis. No cases of PID were observed in the 56 women who had antibiotic prophylaxis (p less than 0.02) or in group 2 as a whole. The study suggests that the risk of infection after hysterosalpingography is very low when nondilated tubes are present (0/398 women of groups 1 and 2). The relative risk of PID in women with peritubal disease or proximal tubal occlusion, although apparently low, remains to be determined. Furthermore, in the highest-risk group of women with dilated tubes, doxycycline prophylaxis was effective in reducing infection after hysterosalpingography.

Doxycycline↗