Search PubMed⌕ Search

Biomedical subjects

D L Olive

Publications and source records attributed to D L Olive.

139 records · Page 8Linked to original sources
PubMed1986

Endometriosis: pathogenetic implications of the anatomic distribution.

The authors have reassessed the anatomic distribution of ectopic endometrium by the laparoscopic study of the location of implants, adhesions, and uterine position in 182 consecutive patients with infertility and endometriosis. The ovary was the most common site of implants with 54.9% having either unilateral or bilateral involvement. This was followed, in order of frequency, by the posterior broad ligament (35.2%), the anterior cul-de-sac (34.6%), the posterior cul-de-sac (34.0%), and the uterosacral ligament (28.0%). Adhesion formation followed the same anatomic distribution. No patients were noted to have endometriosis of the cervix and vagina. Endometriosis of the anterior compartment (anterior cul-de-sac, anterior broad ligament, and anterior uterine serosa) was significantly more common in patients with anterior uteri (40.7%) versus patients with posterior uteri (11.8%, P less than .0005). Exclusive anterior compartment disease was found only in patients with anterior uteri, and significantly more commonly in patients with severely anteflexed uteri (P less than .005). These data suggest that factors influencing implantation of retrograde menstrual debris include: the dependent pooling of peritoneal fluid as affected by uterine position; epithelial cell type at the site of implantation; unique ovarian susceptibility; route of entry; and mobility of the pelvic structures. The data support the Sampson hypothesis of retrograde menstruation as the primary model of development of endometriosis.

Broad Ligament↗
PubMed1985

Expectant management and hydrotubations in the treatment of endometriosis-associated infertility.

One hundred twenty-three infertility patients with laparoscopically documented endometriosis were managed expectantly for an interval of 1 to 25 months. Analysis revealed an overall pregnancy rate of 24.4% and a monthly fecundity rate (MFR) of 3.1%. Patients with mild disease had an overall pregnancy rate of 52.9% and an MFR of 5.7%. Women with moderate endometriosis did less well, but still demonstrated a pregnancy rate of 25% and an MFR of 3.2%. No pregnancies occurred with severe disease and expectant management. Postlaparoscopic hydrotubation was evaluated for its therapeutic effect with the use of multivariate analysis and maximum likelihood analysis. The results indicate that there is no decrease in the laparoscopy to conception interval, whereas a potential increase in cure rate cannot be adequately evaluated at this time.

Adult↗
PubMed1985

Peritoneal macrophages and infertility: the association between cell number and pelvic pathology.

Increased numbers of peritoneal macrophages have been repeatedly associated with infertility. Because the factors contributing to this intraperitoneal exudate are unknown, this study was carried out to determine which anatomic or endocrinologic abnormalities in infertile women might be associated with an increase in leukocyte numbers. The peritoneal fluid from 103 women was analyzed. Nonparametric data analysis demonstrated significantly greater cell counts in infertile women with endometriosis, compared with other infertile women (P less than 0.01) or fertile control subjects (P less than 0.005). Multiple regression analysis was then used to determine the relationship of individual variables to cell number without the influence of confounding factors. These data demonstrate that the best correlation with elevated macrophage number is in women who have infertility and no mechanical fertility factors (of which mild endometriosis is a subgroup). Thus, an increase in peritoneal macrophage number is not restricted to women with endometriosis but, rather, is seen in a subset of infertile women generally without mechanical or endocrinologic infertility factors.

Ascitic Fluid↗
PubMed1985

Evaluation of the anovulatory patient. When to proceed, when to refer.

The anovulatory patient presents the primary care physician with what is often a diagnostic and therapeutic challenge. To meet this challenge and avoid doing a disservice to the patient, the physician needs to have both a firm understanding of the disease process and an adequate understanding of available treatment methods. Anovulation must be considered before it can be recognized. Once it is suspected, a thorough yet judicious approach to diagnosis must be undertaken. In these days of diagnosis-related groups (DRGs) and prospective reimbursement, a thoughtful, logical, cost-effective approach to the diagnosis of anovulation is more critical than ever. Finally, once the diagnosis is achieved, investigation of the etiologic factor can proceed in an orderly, stepwise fashion. There is no place for a shotgun approach in the work-up of the anovulatory patient. Even more important to the primary care physician is a firm understanding of when to refer. While straightforward aspects of the patient evaluation are best accomplished at the local level (indeed, the tertiary care center could not and should not try to cope with total referral), complex diagnostic and therapeutic regimens should be handled by the reproductive endocrinologist. Patients with hyperprolactinemia, those who have failed ovulation induction with clomiphene citrate (Clomid), those with suspected outflow tract anomalies, and hypoestrogenic patients surely should be evaluated and treated in consultation with the specialist. This approach of careful, efficient initial assessment coupled with appropriate use of the reproductive endocrinologist and tertiary referral center leads to optimum care of the anovulatory patient.

Anovulation↗
PubMed1985

Routine ultrasound scanning for the detection and management of twin pregnancies.

One thousand five hundred fifty-one private patients underwent routine ultrasound scanning in part to detect twins. Five thousand nine hundred fifty private patients acted as controls and underwent ultrasound scanning only when indicated by conventional obstetric standards. When diagnosed, twin pregnancy was treated with increased bed rest, nutritional counseling and careful monitoring, with delivery in a tertiary-level center. No significant differences between the two groups could be demonstrated in maternal age, parity or incidence of twin pregnancy. A significant difference could be shown, however, in the early detection of twin pregnancy. By the end of the 24th week, 94% of the twins in the routinely scanned group had been diagnosed as compared to only 68% in the controls (p = 0.03). A significant improvement in perinatal outcome was also demonstrated in the routinely scanned patients as compared to the controls. The incidence of any unfavorable outcome in any infant was reduced from 60% in the controls to 25% in the routinely scanned patients (p = 0.0007). This reduction was due to a reduced incidence of low birth weight, smallness for gestational age, prematurity, depressed Apgar scores and stillbirths. When all twins diagnosed prior to the 25th week of pregnancy were compared with those diagnosed after that week, similar findings were demonstrated.

Adult↗
PubMed1985

Patient education in a women's hospital: attitudes of the medical and nursing staffs.

A survey was conducted among the medical and nursing staff of Prentice Women's Hospital in an attempt to examine attitudes toward patient education. Ninety-two percent of the obstetrician-gynecologists were surveyed, as were 81% of the nursing staff. Areas of evaluation included current practices at the hospital, attitudes toward patient education, principles of patient education, attitudes toward territorial imperative, perceptions of educational background, and perceptions of current role. Results indicate considerable disorganization in educational practices at the present time. Attitudes toward and understanding of principles of patient education did not differ between the two groups studied. However, there was strong disagreement in issues of patient ownership. Perceptions of educational training of, as well as current roles played by, each profession in educating the patient were highly polarized. The implications of such interprofessional conflict are discussed.

Attitude of Health Personnel↗
PubMed1984

Choriocarcinoma associated with term gestation.

Fifty-one patients with choriocarcinoma associated with term pregnancy were treated at the John I. Brewer Trophoblastic Disease Center of Northwestern University Medical School from 1962 through 1981. An overall remission rate of 61% was achieved: 65% for 43 patients who received all of their treatment at the center and 38% for eight patients who received treatment elsewhere before referral to the center. This remission rate was significantly less (P less than 0.005) than the 87% remission rate obtained in patients with choriocarcinoma after hydatidiform mole, abortion, or ectopic pregnancy combined. Three factors were determined which significantly influenced response to treatment in these patients: (1) time from delivery to treatment greater than 4 months (41% versus 80%, P less than 0.0005); (2) presenting symptomatology other than abnormal uterine bleeding (40% versus 87%; P less than 0.001); and (3) metastases to sites other than the lung and/or vagina (22% versus 72%, P less than 0.01). There appeared to be no advantage to treating all patients with choriocarcinoma after term pregnancy with initial multiple-agent chemotherapy unless other high-risk characteristics were present.

Choriocarcinoma↗
PubMed1982

Fluorescence polarization immunoassay IV. Determination of phenytoin and phenobarbital in human serum and plasma.

Fluorescence polarization immunoassays for phenytoin and phenobarbital in human serum or plasma are described and shown to be clinically useful. No sample pretreatment, extraction, or phase separation is required. A determination can be made with less than 20 microL of sample in 15 min, with incubation at ambient temperature. Abnormal concentrations of protein, lipid, hemoglobin, or bilirubin do not interfere. In addition, drug metabolites and commonly co-administered drugs do not affect the assay results at clinically significant concentrations. Analytical recoveries of each of the two anticonvulsant drugs from serum averaged 101%. Between-assay CVs were less than 6.5%, with sensitivities of 0.5 mg/L. Comparison of this method with "high-performance" liquid chromatography, homogeneous enzyme immunoassay, and radioimmunoassay for phenytoin determinations yielded correlations of 0.99, 0.98, and 0.99, respectively. Similar comparison studies for phenobarbital yielded correlation coefficients of 0.99, 0.98, and 0.99, respectively.

Chromatography, High Pressure Liquid↗
PubMed1982

The association between endometriosis and spontaneous abortion. A retrospective clinical study.

Two hundred sixty-three patients with a diagnosis of endometriosis or adenomyosis were studied in a retrospective fashion. The association between endometriosis resulted in a spontaneous abortion rate of 44.3%, Patients with adenomyosis spontaneously aborted 35.1% of their pregnancies. These figures are significantly increased in comparison to those pertaining to the general population. Uterine pathology occurring with endometriosis is discussed in relation to secondary infertility. Hypotheses that may explain the relationship between endometriosis and spontaneous abortion are discussed briefly.

Abortion, Spontaneous↗
PubMedDate not supplied

The peritoneal environment in endometriosis.

The local environment of peritoneal fluid (PF) surrounding the endometriotic implant is immunologically dynamic and links the reproductive and immune systems. Peritoneal fluid contains a variety of free floating cells, including macrophages, mesothelial cells, lymphocytes, eosinophils and mast cells. Macrophages are attracted to the peritoneal environment more abundantly than any other cell type. These scavengers promote cellular growth and viability through secretion of growth factors and cytokines. It is now becoming evident that cytokines play an important role in reproduction at various levels, including gamete function, fertilization and embryo development, implantation and postimplantation survival of the conceptus. Peritoneal fluid has been shown to affect negatively ovum capture by the fimbria, sperm survival, spermatozoon-oocyte interaction and embryonic development. We have recently identified the presence of two pro-inflammatory chemoattractant cytokines for monocyte/macrophages (MCP-1) and for granulocytes (interleukin-8, IL-8) in the PF. Concentrations of both IL-8 and MCP-1 are not only elevated in PF of women with endometriosis compared to those without endometriosis, but they are related to the severity of the disease. Over the past 70 years, at least a dozen theories have been proposed to explain the histogenesis and aetiology of endometriosis. It appears that the aetiology is multifactorial, and today a composite theory of retrograde menstruation with implantation of endometrial fragments in conjunction with peritoneal factors to stimulate cell growth is the most widely accepted explanation for peritoneal endometriosis.

Animals↗
PubMedDate not supplied

Intracervical placement of catheter balloon at hysterosalpingography.

OBJECTIVE -- To describe the technique of hysterosalpingography with endocervical placement of the balloon of the catheter rather than endometrial placement. PATIENTS -- 48 consecutive patients undergoing hysterosalpingography in the course of infertility work-up at a university hospital. METHOD -- With the patient in the lithotomy position, the cervix is visualized and cleansed. The catheter and balloon are inserted in the cervical canal and inflated with the contrast agent. The contrast agent is injected slowly at low pressure, and three to six spot films are obtained. Only gentle traction can be applied by this method, so oblique views are obtained early in the examination. RESULTS -- Balloon placement was atraumatic. Although good views were obtained more frequently than with traditional techniques, about one-quarter of the studies were unsatisfactory. CONCLUSION -- This method is easy, atraumatic, and allows excellent visualization of the entire endometrial cavity and upper intracervical canal.

Catheterization↗
PubMedDate not supplied

Hemizona index (HZI) demonstrates excellent predictability when evaluating sperm fertilizing capacity in in vitro fertilization patients.

The objective of this work was to assess the power of the hemizona assay to predict in vitro fertilization (IVF) results using receiving operating characteristics (ROC) analysis. In a tertiary medical center setting, 94 couples undergoing IVF were included in the study comparing their fertilization results to sperm function during the hemizona assay. Using ROC analysis, fertilization in IVF (mature oocytes only) was compared to performance of the sperm in the sperm-zona pellucida binding test as expressed by hemizona index (HZI; [number of test sperm bound/number of control sperm bound] x 100). The IVF results were as follows: 32 patients had no fertilization (0%), 55 patients fertilized all of the oocytes (100%), and 7 patients fertilized between 14% and 85% of the oocytes. Modified ROC analysis was used to determine the best threshold for fertilization success or failure, depending upon how the data are viewed. A HZI of 40-43 separated the 100% fertilization group from the other groups, with a true positive rate of 87% and a true negative of 83%. Conversely, a HZI of 4-5 separated the 0% fertilization versus partial or total fertilization, with a true positive rate of 100% and true negative rate of 71%. Sperm performance in the hemizona assay as measured by the HZI reflects performance in IVF and benefits couple evaluation and counseling.

Female↗