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Biomedical subjects

D H Riddick

Publications and source records attributed to D H Riddick.

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

Comparison of real-time ultrasonography, hysterosalpingography, and laparoscopy/hysteroscopy in the evaluation of uterine abnormalities and tubal patency.

In a study to assess real-time ultrasonography (US) as an alternative to hysterosalpingography (HSG) in the evaluation of uterine abnormalities and tubal patency, 61 women underwent US immediately before hysteroscopy/laparoscopy. Saline was instilled into the uterus to provide contrast during US. The findings were compared with surgical and preoperative HSG findings. With surgical findings as the standard, US was as accurate (sensitivity 98%, specificity 100%) as HSG (sensitivity 98%, specificity 92%) in demonstrating uterine abnormalities and provided a more complete assessment of the abnormality. US was as accurate (sensitivity 100%, specificity 91%) as HSG (sensitivity 96%, specificity 94%) in demonstrating the presence of tubal patency but less accurate in establishing which tubes were patent. Thus real-time US with fluid instillation provides an accurate alternative to HSG in screening for uterine abnormalities and tubal patency.

Fallopian Tube Patency Tests↗
PubMed1985

Prolactin production by explants of normal, luteal phase defective, and corrected luteal phase defective late secretory endometrium.

The production of prolactin by explants of late secretory endometrium has been correlated with the extent of decidual differentiation. This correlation is strengthened by the observation that luteal phase defective endometrium produces less prolactin than normal control endometrium in a 24-hour in vitro culture system. In the present study the prolactin production by explants of normal, luteal phase defective, progesterone-corrected luteal phase defective, and clomiphene- or follicle-stimulating hormone/luteinizing hormone-corrected luteal phase defective late secretory endometrium was measured over 96 hours at 24-hour intervals. Progesterone in physiologic concentrations was added to the culture medium to maintain tissue integrity and prolactin synthesis. The prolactin production of normal late secretory endometrium rose over 96 hours under progesterone stimulation. The luteal phase defective endometrium produced significantly less prolactin under the same conditions. Histologically proven corrected luteal phase defective endometrium, regardless of treatment method, produced prolactin not different from the normal controls of the same dates. From these results it is concluded that histologic correction of luteal phase defective endometrium is associated with a corresponding biochemical correction with use of prolactin as a metabolic marker. The findings also strongly support timed endometrial biopsy as the method of diagnosis and evaluation of treatment of luteal phase defect.

Biopsy↗
PubMed1985

Titrating the dose of bromocriptine when treating hyperprolactinemic infertile women.

We have shown that a smaller dose of bromocriptine is effective in lowering the PRL level to the normal range in some hyperprolactinemic women. Based on these findings, we recommend that when treating hyperprolactinemic women who desire conception, the dose of bromocriptine should be titrated according to the response of circulating PRL levels. This will minimize the dose, reduce cost, probably reduce side effects, and possibly avoid undesirable functional effects such as corpus luteum dysfunction.

Bromocriptine↗
PubMed1985

Ultrasonographic assessment of luteinized unruptured follicle syndrome in unexplained infertility.

Ultrasound can be used to monitor the growth and rupture of the dominant follicle. Thirty-three patients with unexplained infertility underwent serial sonography (mean, 3.2 scans/cycle) for luteinized unruptured follicle syndrome (LUFS). The incidence of LUFS was 9% (three patients) in the initial scan cycle. Three patients (9%) demonstrated rupture of a follicle significantly smaller than the mean (22.1 mm) (z less than 0.01) in the initial scan cycle. At standard radiology fees ($7000 +/ diagnosed LUFS) the cost/benefit ratio of this method of diagnosis will be controversial. It is suggested that scanning at reduced fees in the gynecologist's office, particularly in conjunction with postcoital tests, would decrease cost and increase the potential benefit.

Ambulatory Care↗
PubMed1984

Prolactin production from proliferative phase leiomyoma.

In vivo and in vitro endometrial stromal synthesis of prolactin occurs after progesterone-induced decidualization. Synthesis of prolactin by myometrium in vitro suggests that cells whose embryologic origin is the loose mesenchyme surrounding the paramesonephric ducts may retain the capacity to synthesize prolactin. Since physiologic myometrial synthesis of prolactin has not been demonstrated in vivo, prolactin genome expression in pathologic conditions was considered. Follicular phase leiomyomas were diced to 8 mm3 and cultured in Dulbecco's modified Eagle's medium (DMEM) with either no hormones, estradiol 200 pg/ml, progesterone 20 ng/ml, or estradiol and progesterone. Media were sampled and changed every other day for 8 days, followed by culture in tritium-labeled leucine DMEM for 2 days. Portions of leiomyomas were homogenized for initial prolactin content, and all samples were assayed for prolactin by radioimmunoassay. Follicular phase leiomyomas contained prolactin (47 +/- 15 ng/gm) in excess of normal serum values. Synthesis was demonstrated during all time periods from leiomyomas not exposed to progesterone. Progesterone variably suppressed the synthesis of prolactin until after 144 hours of culture. Determination of molecular weight on a 60 by 1.5 cm Sephadex G-100 column revealed identical estimates for pituitary, decidual, and leiomyoma prolactin. Tritium-labeled leucine incorporation into prolactin was confirmed by immunoprecipitation of Sephadex G-100 column fractions. Similar antigenicity was confirmed by parallel dilution curves for pituitary, decidual, and leiomyoma prolactin. Preliminary bioactivity in lymphoma proliferation assays confirmed prolactin activity. The conclusion reached was that proliferative phase leiomyomas contained elevated prolactin presumably secondary to in vivo synthesis. This synthesis was confirmed in vitro.

Culture Techniques↗
PubMed1984

A randomized study of dexamethasone in ovulation induction with clomiphene citrate.

Improved understanding of follicular dynamics has led to a reevaluation of suppression of adrenal androgens in ovulation induction. To test whether adrenal suppression during clomiphene citrate (CC) therapy would improve ovulation/pregnancy rates, 64 anovulatory patients who had not previously received CC were randomly assigned to receive either 50 mg CC on days 5 to 9 alone or with 0.5 mg dexamethasone (CC + DEX). Patients were then screened for dehydroepiandrosterone sulfate (DHEA-S) (normal range, 80 to 320 micrograms/dl), prolactin, testosterone, and semen analysis of the partner. Nine patients discontinued participation prior to completing the first treatment cycle, and ten patients were found to have either elevated prolactin (4), severe male factors (3), or tubal disease (3) and were discontinued. CC was increased 50 mg/day per cycle through 150 mg/day until ovulation occurred. Once the patient was ovulatory on therapy, a properly timed postcoital test and endometrial biopsy for luteal phase defect were performed. If anovulatory at 150 mg/day of CC or demonstrating abnormal postcoital test or endometrial biopsy at 150 mg/day of CC, patients were crossed to the other arm of the treatment protocol. The results revealed a significantly higher rate of ovulation (P less than 0.01) and conception (P less than 0.05) in the CC + DEX-treated group. When correlated with DHEA-S levels, this improvement occurred in patients with DHEA-S greater than 200 micrograms/dl (P less than 0.05).

Adrenal Glands↗
PubMed1983

Human myometrium: a new potential source of prolactin.

Human myometrium is shown for the first time to produce prolactin in vitro. This prolactin is similar to pituitary prolactin by criteria of immunologic identity, gel chromatography and bioassay. The de novo synthesis of myometrical prolactin is supported by no detectable prolactin in initial tissue homogenate, nondetectable prolactin production during the first 24 hours of culture, cycloheximide inhibition of prolactin production with recovery of production in control medium, and tritiated leucine incorporation into prolactin. Although human myometrium is capable of producing prolactin without the addition of exogenous hormones, the addition of estrogen and progesterone, respectively, enhances and suppresses prolactin production in contrast to decidualized human endometrium where opposite effects on prolactin production are found.

Culture Techniques↗
PubMed1983

Prolactin production during in vitro decidualization of proliferative endometrium.

Decidua obtained in the late luteal phase of the human menstrual cycle has been shown to produce immunoreactive prolactin (PRL). The amount of PRL produced is a function of the extent of decidual differentiation. Further, the maintenance of decidualization and PRL production in specimens of late luteal phase in explant culture is dependent on the presence of progesterone (P). To further examine P's effect on decidualization, PRL production was monitored during P-induced decidualization of proliferative endometrium in vitro. Samples of proliferative endometrium obtained from six hysterectomy specimens were cultured in Dulbecco's modified Eagle medium in the presence of no hormones, 200 pg/ml estradiol (E2) 20 ng/ml P, and 20 ng/ml P with 200 pg/ml E2. It was found that P alone or with E2 caused PRL production and histologic decidualization. However, E2 slowed the histologic progression of P-induced decidualization on days 2 and 4 and decreased the rate of PRL production (p less than 0.01) on days 6, 8, and 10 of culture. These data indicate that P alone is capable of inducing decidualization and initiating PRL production. Further, E2 can modify the rate and/or extent of this P-mediated phenomenon.

Cell Differentiation↗
PubMed1983

Term decidua response to estradiol and progesterone.

Immunoreactive prolactin (PRL) is produced from decidualized endometrium from the late luteal phase until the time of delivery. The induction of decidualization and the initiation of PRL production in the proliferative endometrium is dependent on progesterone (P) in vitro. This induction process is slowed by estradiol (E2). To determine whether this hormone dependency extends to term, decidua from labor and nonlabor term pregnancies was cultured in explant for response to P (100 ng/ml) and E2 (10 ng/ml) as evidenced by PRL production. On the first (n = 7) and eighth to ninth (n = 9) days of explant culture in nonlabor patients, P exposure resulted in significantly (p less than 0.01) more PRL production than in nonhormonal controls, and this increase was not inhibited by E2 at either time interval. In labor-exposed decidua, no significant response was noted to either P or E2 over 24 hours of culture. In all groups, tissue variability in PRL production was extensive. In nonlabor decidua, a significant interaction between basal PRL production and response to progesterone was noted (p less than 0.01). The role of P as an initiator and stimulator of PRL production extends to term; however, no clear effect of E2 is demonstrated. In labor-exposed decidua, this P response is eliminated. Whether this is a result of, or occurs prior to, labor is undetermined.

Culture Media↗
PubMed1983

Hysteroscopic metroplasty: surgical technique and obstetric outcome.

Congenital Müllerian abnormalities, particularly the septate uterus, may result in recurrent abortion or premature labor. Twenty-five patients found to have a septate uterus during evaluation for infertility or recurrent abortion were treated by hysteroscopic metroplasty with laparoscopic visualization. Surgical outcome was excellent, intraoperative and postoperative morbidity was negligible, and the postoperative course was similar to that following laparoscopy alone. Preoperative fetal wastage in 17 previously fertile patients was 90%. Of 11 patients, 6 or more months postoperatively, 10 had conceived: 5 delivered vaginally at term, 2 delivered by cesarean section, and 2 pregnancies are in progress. One pregnancy miscarried at 21 weeks secondary to an incompetent cervix. With hysteroscopic metroplasty, septa can be incised successfully with lower morbidity and as good a surgical outcome as with abdominal procedures. If further studies confirm the pregnancy outcome reported, then hysteroscopic metroplasty should become the treatment of choice for the septate uterus.

Abortion, Habitual↗
PubMed1983

Endometrial biopsy during treatment of luteal phase defects is predictive of therapeutic outcome.

Luteal phase deficiency (LPD), as diagnosed by endometrial biopsy, is not a single disorder but rather a spectrum of dysfunction that reflects both endometrial cycle and ovarian cycle abnormalities. Forty-three patients were diagnosed as having LPD by two consecutive abnormal cycles. Seven patients (16%) with hyperprolactinemia received bromocriptine, and one hypothyroid patient received thyroid replacement. The remaining patients were treated sequentially with progesterone suppositories, clomiphene, the combination, and follicle-stimulating hormone and luteinizing hormone. If no conception occurred in 6 months on a given type of therapy, treatment was advanced. Patients were rebiopsied on each medication. In all, 33 of 41 (81%) compliant patients conceived. No viable pregnancies occurred without normal endometrial maturation, regardless of the treatment modality employed. When compared with time-life table projections, pregnancies occurred at rates comparable to those of a normal population once normal endometrial maturation was obtained with therapy. The endometrial biopsy accurately reflects the functional state of both the ovarian cycle and the endometrial cycle and can be used to determine adequacy of therapy, thereby improving conception rates in patients with LPD and eliminating the need for therapeutic trials.

Adult↗
PubMed1983

The uterus as an endocrine compartment.

Evidence has begun to accumulate over the past several years that the uterus is a much more complex organ than was previously thought. Data would suggest that the uterus is a tissue that actively secretes a variety of substances that act locally and at distant sites from the uterus in the control of normal nonconceptual physiologic events, in gestation, and in influencing pathophysiologic symptoms. This article discusses the data underlying the concept of the uterus as an endocrine compartment with particular emphasis on the physiology of the decidualized endometrial stroma.

Decidua↗
PubMed1982

The significance of lymphocytic-leukocytic infiltrates in interpreting late luteal phase endometrial biopsies.

The effectiveness of the endometrial biopsy in diagnosing luteal phase defects as a cause of infertility depends upon the accurate determination of a histologic date based on the morphologic features of tissue. The criteria--edema, predecidual reaction, stromal mitosis, and lymphocytic-leukocytic infiltrate--used to interpret such biopsies were based on changes occurring in the normal ideal menstrual cycle. The present study examines the criteria used for dating endometrium as applied to endometrial biopsies for luteal phase deficiency. It was determined that one of these criteria, lymphocytic and leukocytic infiltration, correlated with subsequent onset of menses and not with the other indications of histologic maturity during the late secretory phase.

Biopsy↗
PubMed1982

Luteal phase defect as a marker of imminent ovarian failure.

A case of premature ovarian failure in a patient serendipitously studied with regard to clinical and histologic parameters during the 2 years preceding her diagnosis is presented. Progressively decreasing ovarian function was observed, beginning with a luteal phase defect and culminating in afollicular ovarian failure. Concepts concerning the etiologies and pathophysiology of premature ovarian failure are reviewed, and similarities to the natural climacteric are discussed.

Adult↗
PubMed1981

Prolactin production by luteal phase defect endometrium.

The production of prolactin (PRL) by explants of late secretory endometrium obtained during normal cycles (n = 61) and that by similar explants obtained during luteal phase deficient (n = 17) cycles was compared. The amount of prolactin produced in vitro correlated with the degree of histologic decidualization in both normal and luteal phase defect endometria. However, samples of luteal phase defect endometrium produced significantly less prolactin (p less than 0.01) than did control tissues of the same ideal menstrual dates. These data indicate that the amount of prolactin produced by late secretory endometrium in explant culture can be used as an additional criterion for the diagnosis of luteal phase defects and may also provide a method for evaluating the response of the endometrium to progesterone.

Culture Techniques↗