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Biomedical subjects

E Caspi

Publications and source records attributed to E Caspi.

At least 91 records · Page 5Linked to original sources
PubMed1990

Ovarian pregnancy: a report of twenty cases in one institution.

A series of 20 cases of primary ovarian pregnancy that were diagnosed and treated in one institution is reported. The prevalence rate of 1:3600 deliveries seems to be increasing in past years and comprises 3.3% of all extrauterine pregnancies. Clinical presentation, possible pathogenesis, diagnostic steps, preferred management, and future fertility are detailed. Inasmuch as all our 18 fertile patients used an intrauterine contraceptive device before the operation, special emphasis is made on the controversial relationship between use of intrauterine contraceptive devices and ovarian pregnancy.

Adult↗
PubMed1990

Maternal ECG recorded by internal monitoring closely mimicking fetal heart rate in a recent fetal death.

A case of intrapartum fetal death in which the maternal heart rate was recorded by internal fetal monitoring is presented. The electrical activity of the maternal heart was transmitted via the fetal body and the recording mimicked a "normal" fetal heart rate (FHR). The patient was referred because of sudden abdominal pain and bleeding; Doppler fetal heart tones were not heard. Because internal monitoring was synchronous with the maternal pulse, ultrasonography was performed and established the diagnosis of fetal demise. Awareness and usage of simple modalities are mandatory for proper diagnosis in such cases.

Adult↗
PubMed1990

Pregnancy rate and ovarian hyperstimulation after luteal human chorionic gonadotropin in in vitro fertilization stimulated with gonadotropin-releasing hormone analog and menotropins.

The value of luteal phase supplementation with human chorionic gonadotropin (hCG) was assessed after a combined protocol of ovarian stimulation, using a long acting gonadotropin releasing hormone analog (GnRH-a) and human menopausal gonadotropins (hMG), in a randomized prospective study of 36 consecutive cycles in an in vitro fertilization (IVF) program. The patients were allocated on the transfer day to either luteal phase supplementation with hCG (Group A, n = 18) or none (Group B, n = 18). Nine patients of Group A conceived as compared with 3 in Group B. Five patients, all in Group A, developed ovarian hyperstimulation syndrome (OHSS) (3 moderate and 2 severe forms). Analysis of the hormonal profiles disclosed similar progesterone (P), estradiol (E2), and E2/P ratio up to the 6th post ovum pick-up day. Then, E2 and mainly P levels decreased only in Group B resulting in a rising E2/P ratio. These findings stress the importance of luteal support in IVF cycles treated with GnRH-a. In light of the increased risk of OHSS among hCG treated patients, further studies are needed to assess the optimal preparation needed.

Chorionic Gonadotropin↗
PubMed1990

Reproductive outcome after conservative surgery for unruptured tubal pregnancy--a 15-year experience.

The fertility outcome is presented in 118 patients after conservative surgery for unruptured tubal pregnancies. This patient group experienced 142 pregnancies, 127 of which were intrauterine (89.4%). The intrauterine pregnancies (IUPs) occurred in 83 patients (70.3%) and 63.5% (75/118) had live births. The recurrence rate of tubal pregnancy was 12.7%. Of the 65 patients with a normal contralateral tube 53 (81.5%) followed surgery with an IUP, 76.1% a live birth, and 7.7% a recurrent tubal pregnancy. Fifty-seven percent of the patients with a single tube followed with an IUP, and 47.6% had a live birth. The recurrence of tubal pregnancy in this group was 28.5%. Of the patients who underwent expression of tubal gestation, 60.6% followed with an IUP, and 57.5% with a live birth with no recurrence of tubal pregnancy.

Female↗
PubMed1990

Male genital mycoplasmas and Chlamydia trachomatis culture: its relationship with accessory gland function, sperm quality, and autoimmunity.

To study the effect of mycoplasmas and Chlamydia trachomatis infection on semen quality, these microorganisms were cultured from the semen and anterior urethra respectively, in a group of 175 infertile men suspected of a silent genital infection with a poor postcoital test. Chlamydia infection, but not mycoplasmas, was parodoxically more frequent in the apparently normal than oligotetratoasthenozoospermia patients. Mycoplasmas male infection, but not chlamydia, was more frequent in cases with female, mechanical, and/or organic infertility factors. Infection was unrelated to the accessory gland evaluation or sperm variables. However, seminal antisperm antibody activity was significantly increased in cases with any positive culture. By this local antibody increase, chlamydia and mycoplasmas may significantly reduce sperm egg penetration ability.

Chlamydia Infections↗
PubMed1990

Midluteal gonadotropin-releasing hormone analog administration in early pregnancy.

The incidence of GnRH-analog administration in the presence of undiagnosed pregnancy is discussed. Immediate hormonal supplementation avoids luteolysis. The report includes two cases, one without hormonal replacement, in which preclinical pregnancy occurred, and the second, where P was supplemented immediately upon diagnosis of pregnancy.

Administration, Oral↗
PubMed1990

Follicle cysts after menstrual versus midluteal administration of gonadotropin-releasing hormone analog in in vitro fertilization.

The incidence and behavior of follicle cysts after different timing of gonadotropin-releasing hormone analog (GnRH-a) administration was studied in 321 in vitro fertilization (IVF) cycles. Group M included 198 cycles in which GnRH-a was injected at menstruation. Of these, 171 (88.6%) were without cysts (group M1) and 27 (13.6%) with cysts (group M2). Group L comprised of 123 cycles in which GnRH-a was administered in the midluteal phase. Of them, 70 (56.9%) were without cystic finding (group L1), 19 (15.4%) with follicle cysts (group L2), and 34 cases (27.6%) with visible corpus luteum at the time of GnRH-a initiation (group L3). Both groups with follicle cysts demonstrated a higher luteinizing hormone peak and continuous elevated estradiol (E2) levels. In group M2, the E2 rise and the cysts persisted longer compared with group L2. Gonadotropin treatment was accordingly postponed until the cysts regressed spontaneously. Only two cases of group M2 required aspiration of the cysts. Follicle cyst formation is not related to the timing of GnRH-a administration and their occurrence did not have adverse effects on IVF outcome.

Embryo Transfer↗
PubMed1990

The comparison of early follicular and midluteal administration of long-acting gonadotropin-releasing hormone agonist.

Long-acting GnRH-a (D-Trp6 microcapsules, 3.2 mg) was intramuscularly injected, either in early follicular phase (group A) or midluteal phase (group B). Two hundred sixteen cycles were randomly allocated. Ovarian suppression was significantly more prompt in group B. Follicle cysts were diagnosed in 19% and 16% of groups A and B, respectively; their appearance and regression were significantly more rapid in group B cycles. More ampules of human menopausal gonadotropin were needed in group B. The number of oocytes retrieved was not significantly different between the groups. However, in group A more mature oocytes and more embryos with good morphology were achieved in the patients. Cancellation rate was 2.8% in groups A and B. Pregnancy rate and outcome were similar in both groups.

Adult↗
PubMed1990

The role of tubal pathology and other parameters in ectopic pregnancies occurring in in vitro fertilization and embryo transfer.

Contradictory findings were reported concerning the role of tubal disease in the genesis of ectopic pregnancy in in vitro fertilization and embryo transfer (IVF-ET). We report on six ectopics that occurred in 141 IVF-ET pregnancies (4.3%). All of the six cases were among 84 patients with tubal disease, and none occurred in the remaining 57 patients with other etiological factors. No correlation was found in other parameters including: ovulation induction, number of embryos transferred, and luteal support. A comparison between the ectopics and six matched controls demonstrated similar estradiol levels, but beta-hCG levels on day 15 to 17 after ET were lower. Homolateral salpingectomy was performed in all six cases, but a contralateral resection was carried out in three of them. More comprehensive studies are needed to clarify whether tubal pathology really increases the risk for ectopic gestation in IVF-ET.

Adult↗
PubMed1990

Binovular human ovarian follicles associated with in vitro fertilization: incidence and outcome.

Binovular follicles were found in 15 (0.3%) of 4,695 follicles containing oocytes. These binovular follicles were either with adjacent cumulus complexes (9 cases), or separate corona radiata and common cumulus mass (1 case), or two oocytes within a single zona pellucida (5 cases). In each of the latter form, there was a smaller and a larger oocyte. All the smaller oocytes and two larger ones possessed a germinal vesicle, whereas the remaining three larger oocytes were mature and developed normally. Though being exposed to the same intrafollicular milieu, there can be a difference in the maturity of the nucleus and characteristics of the cytoplasm of both oocytes.

Adult↗
PubMed1990

High-output left ventricular failure after dextran use in an operative hysteroscopy.

High-output left ventricular failure occurred in a patient after a difficult case of hysteroscopic lysis of adhesions using dextran as a distension medium. The excessive dissection in the uterine wall, the long duration of the operation, and the large volumes of dextran probably caused intravasation of dextran into the systemic circulation inducing a significant shift of fluids from the third space. This was possibly assisted by the large volume of fluids given intravenously in a 45-kg patient initiating the reported sequence of events.

Adult↗
PubMed1990

Cervical internal os cerclage: description of a new technique and comparison with Shirodkar operation.

Internal os cerclage for cervical incompetence was performed in 90 patients who had previous McDonald procedure failure (70 patients) or had unfavorable cervical anatomy (short or lacerated cervix) for primary McDonald type cerclage (20 patients). Two different techniques were used: the Shirodkar operation (n = 44) with Mersilene band, and a simpler new technique (n = 46). The new technique is characterized by anterior colpotomy for exposure of the internal os, and a 0.6 mm nylon suture encircling the cervix to be tied high in the posterior fornix. The pregnancy outcome for both groups was similar. Late abortions of 8.7 and 11% and premature deliveries of 13 and 18% occurred in the new technique and the Shirodkar groups, respectively. The removal of the suture was generally difficult in the Shirodkar group and in eight patients analgesia and sedation were required. In the new technique group, the removal was easier and in only one patient was sedation required (p less than 0.0001). Severe vaginal discharge was found in 52% of the Shirodkar patients and none in the other group. Apparently the monofilament nylon suture prevented this side effect. It seems that the new technique is simpler to perform, involves fewer side effects, the removal of the suture is easier, and it is as effective as the Shirodkar procedure.

Cervix Uteri↗
PubMed1990

Fetal outcome following inadvertant administration of long-acting DTRP6 GnRH microcapsules during pregnancy: a case report.

Early follicular use of long-acting analogues of gonadotrophin releasing hormone (GnRH) in IVF programmes has caused some concern with respect to its teratogenic potential. In the case reported here, an injection of DTRP6 GnRH microcapsules was given in the 5th week of a spontaneous unsuspected pregnancy. No deleterious effect or teratogenesis of the embryo could be demonstrated at birth or 18 months later.

Adult↗
PubMed1990

Ovarian response in repetitive cycles induced by menotrophin alone or combined with gonadotrophin releasing hormone analogue.

The number of oocytes retrieved for in-vitro fertilization (IVF) has a major influence on the number of embryos developed and pregnancy success. This study was designed to investigate the ovarian response in the same patient under the same and different stimulation protocols. In group A, 19 patients underwent two consecutive cycles, both stimulated with human menopausal gonadotrophin (HMG). Group B comprised 27 patients who experienced two successive cycles treated with the combination of long-acting gonadotrophin releasing hormone analogue (GnRHa) and HMG. Group C included 27 patients whose first cycle was stimulated with HMG alone, and their second with a GnRHa/HMG combination. The mean number of HMG ampoules administered and the duration of treatment were similar in both cycles of group A and B patients while in group C, both the amount and duration of HMG administration were significantly higher and longer in the combined protocol compared to HMG alone. This study demonstrates an identical ovarian response using the same mode of stimulation in repeated cycles, and a significantly improved response with the GnRHa/HMG combination compared with HMG alone in the same patient.

Chorionic Gonadotropin↗
PubMed1990

Hormonal changes related to impairment of cervical mucus in cycles stimulated by clomiphene citrate.

The levels of luteinizing hormone (LH), follicular stimulating hormone (FSH), 17-oestradiol (E2), progesterone (P), and testosterone (T) were determined for the early, midfollicular and periovulatory phase of spontaneous and clomiphene citrate (CC) induced cycles in 5 patients who responded with appearance of hostile cervical mucus (Group A) and 5 patients whose cervical mucus remained unchanged during the same treatment (Group B). The patients with hostile mucus were further investigated during a third cycle stimulated by CC and ethinyloestradiol (EE). Patients treated with CC for induction of ovulation who developed hostile cervical mucus showed higher levels of LH and T in the midfollicular phase of the menstrual cycle and significantly higher levels of T in the periovulatory period compared to patients with unchanged mucus. EE treatment induced a drop in the elevated LH and T levels and improved the cervical score. No change in E2 levels was noted. A direct effect of EE on the cervical glands together with the centrally mediated lowering of serum T are suggested to be responsible for improving the cervical mucus.

Cervix Mucus↗
PubMed1990

Penicillin-tetracycline prophylaxis in cesarean delivery: prospective and randomized comparison of short and long term therapy.

A prospective and randomized study was undertaken to determine the safety and efficacy of low price and discouraging bacterial resistance agents, given for 12 hours versus 72 hours, as prophylaxis at cesarean section. Ninety six patients received penicillin (ten million units) intravenously and tetracycline (0.25 g) intramuscularly at cord clamping and 12 hours postoperatively (table I). Among them 14% of febrile morbidity was recorded (table II). Eighty seven patients received the same treatment followed by oral ampicillin (2 g) and tetracycline (1.5 g) per day, for a further 60 hours (table I). Maternal febrile morbidity was not further reduced by the oral additional treatment (table II). This regiment prophylactic effect is comparable to previous reported data concerning other protocols, and even better, while expenses are reduced and efficacy for important pathogens such as chlamydia and mycoplasma is obtained. No side effects of the drugs were recorded.

Adult↗