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Biomedical subjects

D R Bromham

Publications and source records attributed to D R Bromham.

At least 37 records · Page 2Linked to original sources
PubMed1992

Peripheral plasma met-enkephalin levels in ovulatory and anovulatory human menstrual cycles.

OBJECTIVE: To test the hypothesis that met-enkephalin has a role in human ovulation and that plasma levels may differ between ovulatory and anovulatory ovarian cycles. DESIGN: This is a descriptive study comparing levels of plasma met-enkephalin, gonadotropins, and ovarian steroids in 12 ultrasonically confirmed ovulatory cycles and 12 anovulatory cycles. SETTING: The study took place in the infertility clinic of a large teaching hospital receiving primary and tertiary referrals of both private and public sector patients. PATIENTS: All patients (n = 16) had infertility greater than or equal to 3 years and normal findings on previous investigation including evidence of ovulation. INTERVENTIONS: Ovarian cycles were defined using transabdominal ultrasound scanning. Biochemical analyses were by radioimmunoassay. MAIN OUTCOME MEASURES: The differences between plasma met-enkephalin levels in the two groups of cycles were compared. RESULTS: Met-enkephalin levels are significantly higher in ovulatory cycles with a significant peak in the 2 postovulatory days (Duncan's multiple range test; P less than 0.05). CONCLUSION: Human ovulation is associated with cyclic elevation of plasma met-enkephalin. Further studies are required to elucidate causality.

Anovulation↗
PubMed1991

Autonomy and its limitations in artificial reproduction.

We have examined the concept of autonomy and some of its limitations. The choice between comprehensive and paternalistically modified information giving is not necessarily easy and the competence of a patient to comprehend and give informed consent in medically complex issues may be limited. In extreme cases, such as mentally defective persons, the consent-giver is unarguably incompetent to directly exercise autonomy and a substitute consent-giver or decision-maker is required. In most circumstances decision-making should be devolved to patients as much as possible, notwithstanding the faulty heuristics frequently displayed. This is not only because autonomy is an important principle in its own right but because an internally inconsistent decision is still likely to be closer to an individual's theoretical ideal decision than a decision based on a substitute decision-maker's values. We can see from the examples discussed that there are many instances where principles, guidelines, rules or laws propounded for the benefit of one party may restrain autonomy, beneficence and justice done to another. We would not wish to see anarchy occur in any branch of medicine but is there evidence that restricting the autonomy of the parties involved will necessarily prevent that? We argue that restraint on the autonomy of individuals in reproductive medicine should be kept to a minimum and that society is strongest where individuals have the greatest freedom to follow their personal beliefs.

Advisory Committees↗
PubMed1991

Effect of cervical traction with a tenaculum on the uterocervical angle.

The effect of cervical traction on the uterocervical angle was measured radiographically in 24 women undergoing diagnostic curettage. A radio-opaque guidewire was inserted through the cervical canal into the uterine cavity and a lateral pelvic X-ray taken before and after traction. The traction force was measured with a spring-balance attached to the tenaculum. Cervical traction in a caudal direction (force 2 N) reduced the median uterocervical angle, from 75 degrees to 10 degrees (P = 0.001). Moderate cervical traction straightens the uterus and the routine use of a tenaculum theoretically makes insertion of an intrauterine device safer and the passage of an embryo transfer catheter less traumatic.

Cervix Uteri↗
PubMed1991

Transsexualism.

Explore the source record for details and available documents.

Follow-Up Studies↗
PubMed1991

Endometriosis in primary medical care.

The role of the family doctor in the management of endometriosis is considered in three phases. With the exception of a small minority of cases in which there are superficial endometriotic lesions, it will be difficult for the general practitioner to confirm the diagnosis without referral for laparoscopy or similar gynaecological investigation. In the majority of patients, clinical diagnosis based on symptomatology and physical findings on pelvic examination is not reliable enough to be a sound basis on which to initiate medical therapy. However, the early referral of patients with a suspicious history allows prompter confirmation of endometriosis, if present, and the establishment of a treatment regime, if required. Where medical therapy is instigated, this is usually by the gynaecological team, but, for the convenience of the patient, her surveillance during treatment is conducted jointly with the referring doctor. Compliance with and continuation of therapy will largely depend on the knowledge and skill of the general practitioner in assessing the significance of side-effects of medication. A significant proportion of endometriosis sufferers experience recurrence of their symptoms, and it may be possible for the general practitioner to initiate re-treatment, with the same or alternative medication, prior to a re-evaluation by the gynaecological team.

Endometriosis↗
PubMed1989

The effect of anticoagulants, enzyme inhibitors and long term storage on the extraction of known concentrations of methionine enkephalin in human plasma.

The stability of methionine enkephalin (M-E) during long term storage was investigated using various anticoagulants and enzyme inhibitors, eg EDTA, heparin, trasylol, citric acid. Plasma was stored for different lengths of time up to six weeks. High pressure liquid chromatography (HPLC) was used to separate and quantify M-E. We found that EDTA, heparin or trasylol per se are ineffective in preserving M-E for short term extraction. Blood collected in chilled heparin tubes with citric acid crystals and the plasma further acidified with hydrochloric acid gave the highest recovery. With storage times up to six weeks further degradation was marked in samples taken in plain tubes but did not occur with tubes containing citric acid crystals and hydrochloric acid.

Anticoagulants↗
PubMed1988

Fetomaternal macrotransfusion in the Yorkshire region. 1. Prevalence and obstetric factors.

The prevalence of fetomaternal macrotransfusion (FMMT), defined as fetomaternal haemorrhage (FMH) greater than or equal to 10 ml, was calculated in a series of 15,724 postpartum Kleihauer tests recorded in six hospitals. The mean prevalence in this retrospective survey, the largest published to date, was 0.83% (SEM 0.22) but values varied according to the technique used to quantify the volume of FMH. A number of obstetric factors that have been suggested as influencing the occurrence and extent of FMMT were examined. The frequencies of these factors in cases with FMMT were compared with those in a control group without FMMT selected from the same population. Manual removal of the placenta (P less than 0.0001) and fetal distress in labour (P less than 0.0001) occurred significantly more frequently in the case group. We are unable to confirm previous reports that other obstetric factors may influence the occurrence and extent of FMMT.

Cross-Sectional Studies↗
PubMed1988

Fetomaternal macrotransfusion in the Yorkshire region. 2. Perinatal outcome.

The perinatal outcome associated with fetomaternal macrotransfusion (FMMT), defined as fetomaternal haemorrhage greater than or equal to 10 ml, was investigated in a study group of 179 cases of FMMT and compared with the outcome in 322 controls selected from the same population. Perinatal mortality and morbidity occurred more frequently in the case group (P less than 0.01). The mean Apgar score at 1 min and the cord haemoglobin level differed significantly between the case and control groups (P less than 0.01) and showed a significant inverse correlation with the estimated volumes of FMMT (P less than 0.0001). There was no significant difference in birthweight between the case and control groups. The mean estimated volumes of FMMT associated with perinatal mortality and with low cord haemoglobin (less than or equal to 9.0 g/dl) were significantly higher than the mean volume in the case group as a whole, which suggests the possibility of adapting these observations to a screening procedure.

Apgar Score↗
PubMed1987

Nasal absorption of progesterone in women.

Absorption profiles were obtained from women following the administration of ointment containing 20, 30 and 40 mg of progesterone to the nasal mucosa. There were no significant differences in area-under-curves between groups receiving the drug in one nostril but when 40 mg doses were divided between two nostrils there was a significantly greater area-under-curve suggesting that the area of mucosa applied with the drug is more important than dosage.

Absorption↗
PubMed1985

Platelets and uric acid in the prediction of preeclampsia.

Fifty-four pregnancies that were subsequently complicated by preeclampsia had platelet parameters and uric acid levels measured during pregnancy. The expected fall in platelet count and rise in platelet volume parameters and uric acid levels beyond those that occur in normal pregnancy were seen only in the week before delivery.

Blood Platelets↗
PubMed1985

Oestrogen measurement to predict multiple pregnancy from gonadotrophin therapy in amenorrhoea.

Twenty-four hour urinary oestrogen results obtained in 20 amenorrhoeic patients undergoing human menopausal gonadotrophin (hMG) therapy have been analysed in detail in an attempt to improve their value in predicting multiple conception. Of 96 treatment cycles 88 were acceptably stimulated including 76 presumed ovulatory (midluteal serum progesterone concentration greater than or equal to 30 nmol/l). Conception occurred in 27 (26% of all, 33% of ovulatory cycles), of which 10 were multiple (37%). The chance of conception or multiple conception could not be related to luteal progesterone or preovulatory peak urinary oestrogen levels (at least within the clinically imposed limits of the oestrogen values). Discriminant analysis applied to all oestrogen results in individual cycles failed to predict conception, but in the conception cycles was 86% successful in predicting a single or multiple conception. Multiple conceptions were associated with an earlier but slower rise in oestrogen excretion during the last 5 days of hMG therapy, although the starting and final oestrogen levels were approximately the same. Unfortunately, the differences were small and as conception cycles were in the minority and could not be distinguished from non-conception cycles the oestrogen results could not be used reliably in practice to predict multiple pregnancy.

Amenorrhea↗
PubMed1982

Anovulatory and ovulatory infertility: results with simplified management.

A simplified scheme for the management of anovulatory and of ovulatory (usually called unexplained) infertility was evaluated in 244 women. Eighteen patients were excluded because of primary ovarian failure, 164 were treated for ovulatory failure, and 62 with ovulatory infertility remained untreated. Twenty-five patients had a properly validated negative postcoital test. In the remaining 201 patients the two-year conception rates were 96% in patients with amenorrhoea, 83% in those with oligomenorrhoea, 74% in those with luteal deficiency, and 88% in those with ovulatory infertility. Comparison with normal rates implied that amenorrhoea represents a pure form of ovulatory failure that is completely correctable whereas in other conditions unexplained factors also contribute to infertility though to a much smaller extent than was previously thought.

Adult↗
PubMed1982

The value of a single serum progesterone measurement in the midluteal phase as a criterion of a potentially fertile cycle ("ovulation") derived form treated and untreated conception cycles.

A single midluteal serum progesterone concentration was obtained in 212 untreated cycles in 113 infertile patients, including 138 cycles in 72 patients in whom tubal, seminal, and cervical causes of infertility had been excluded. There were 16 conception cycles in the latter group. In an extended study a total of 21 untreated singleton conception cycles have been observed with a mean progesterone value of 40.7 nmol/l (12.8 ng/ml), 95% confidence limits of 28 to 53 nmol/l (8.8 to 16.7 ng/ml), and a range of 27 to 53 nmol/l (8.5 to 16.7 ng/ml), which extended significantly above as well as below the conception range, indicating that there is an optimal range for fertility with both an upper and a lower limit. The lower limit is of greater practical importance; and, partly to allow for assay variation, we suggest it should be taken as 30 nmol/l (9.4 ng/ml). It provided a clinically reliable criterion of potential fertility ("ovulation") in related studies. Our findings in treated conception cycles suggest that a higher value may be needed after treatment with clomiphene or gonadotropins because of the contribution from other stimulated follicles.

Adult↗
PubMed1982

Prognostic value of the postcoital test: prospective study based on time-specific conception rates.

Time-specific conception rates were studied prospectively after a carefully validated post-coital test (PCT) in a consecutive series of 80 ovulatory women without any pelvic or seminal cause for their previous infertility. The PCT was performed on endocervical mucus collected 6-18 h after intercourse. The definition of a negative result, indicated by the absence of forward-moving sperm, depended on the finding being repeated in a second cycle and on the presence each time of fully developed mucus, indicated simply by its abundance, ductility and clarity. The time to conception was inversely related to the number of motile sperm seen. Simpler analysis showed a fivefold greater chance of conception associated with a positive compared with a negative PCT; after 2 years the cumulative conception rates were 84 and 16% respectively.

Adult↗
PubMed1981

Normal fertility in women with post-pill amenorrhoea.

After exclusion of primary ovarian failure and causes of infertility not due to contraception 48 patients with post-pill amenorrhoea (PPA) and 47 patients whose amenorrhoea did not follow oral contraception received treatment aimed at inducing ovulation. In the patients with PPA the cumulative conception rate was 91% at 12 months from the start of treatment and 98% at 24 months. 80% gave birth to a child by 18 months and 95% by 30 months. These rates were similar to those of the non-PPA group and to previously published normal rates. Hence PPA poses no serious threat to fertility, unlike the tubal damage that may result from use of an intrauterine device. Whatever their previous menstrual history women, especially the nulliparous, who are concerned about their future fertility should be recommended oral contraception in preference to an intrauterine device.

Amenorrhea↗
PubMed1981

Post-pill amenorrhea: a causal study.

The distribution of distinguishable disorders in 102 patients with post-pill amenorrhea has been compared with that in 166 other patients with secondary amenorrhea, including 123 patients who had never used oral conception. In the post-pill group there was a 13% to 21% excess of patients who had a functional disorder without any weight loss or psychological disturbance to account for it and who typically were estrogenized and demonstrated intact feedback systems by their ovulatory response to clomiphene (the so-called cycle initiation defect). This excess might be explained by biased selection of oral contraception, but it seems wiser to assume a causal relationship, which amounts to a true risk of post-pill amenorrhea in less than 1 per 1000 users. No risk was revealed of primary ovarian failure, hyperprolactinemia, or pituitary tumor.

Adolescent↗