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Biomedical subjects

E Kemmann

Publications and source records attributed to E Kemmann.

At least 73 records · Page 4Linked to original sources
PubMed1983

Hyperprolactinemia and headaches.

We investigated the frequency of headaches in women with menstrual abnormalities and hyperprolactinemia. Twenty-seven of 46 (58%) women with hyperprolactinemia indicated that headache episodes occur once or more per week; patients with sellar abnormalities (macroadenoma) or previous cranial or pituitary operation were excluded from this group of hyperprolactinemic patients. The headache episodes occurred significantly more frequently than in the control group (N = 56), where 27% indicated one or more headaches per week (p less than 0.01). In the vast majority of the women with hyperprolactinemia, headaches had preceded the finding of elevated prolactin levels for years and had not developed after the patients had become concerned about the pituitary gland. The clinical impression was that the headaches of these patients typically lack features of prodromal signs and unilaterality and resemble, in general, tension headaches; they may last for hours and often require medication. We could not demonstrate a relationship between prolactin levels and frequency or severity of these headache episodes. The etiology of these headaches is unclear. The therapeutic effect of bromocriptine deserves further investigation. In conclusion, we present data to suggest that headaches are commonly an associated finding in hyperprolactinemic women who have no evidence of significant pituitary enlargement.

Adenoma↗
PubMed1983

Amenorrhea associated with carotenemia.

Data are presented for ten women with anovulation, nine of them with amenorrhea, who have associated carotenemia. Classic explanations for carotenemia in amenorrheic patients have been weight loss or anorexia nervosa, yet carotenemia in our patients appeared to be diet induced. All patients consumed a pure or predominantly vegetarian diet; there was no intake of red meats. Clinical and laboratory data of the patients are presented. The amenorrhea of the patient is consistent with hypothalamic hypogonadotropic anovulation (HHA). It appeared that diet modification not only led to reduction in carotene levels, but also improved the menstrual status. The association of carotenemia and menstrual disorders is reviewed. The possibility that carotenemia is related to the development of HHA is discussed.

Adolescent↗
PubMed1983

Sequential clomiphene citrate-menotropin therapy for induction or enhancement of ovulation.

Either to induce ovulation in anovulatory infertility patients or to enhance ovulation in patients with mild endometriosis or luteal phase inadequacy, we utilized a sequential regimen of low-dose clomiphene citrate (CC) followed by human menopausal gonadotropin (hMG) injections on alternate days; duration and dosage of menotropin therapy was individualized by using serum estradiol levels for monitoring until the time of administration of human chorionic gonadotropins. Previous therapeutic efforts without menotropins had been unsuccessful in all patients. One third of 70 treated patients conceived during 156 treatment cycles. The pregnancy rate was 44% in anovulatory patients (n = 34), and 26% in patients with ovulation dysfunction (n = 23). Pregnancy rates declined with patient's age. Four of the 23 patients that conceived had a spontaneous abortion (17%). The multiple gestation rate was 10.5%. A relative inhibition of cervical mucus development was noted and shown to be caused by CC. Hyperstimulation occurred in three patients. The discussed CC-hMG regimen approaches the effectiveness of standard hMG therapy; but compared with standard hMG therapy, it has significant economic advantages and seems to have a markedly lower rate of multiple gestation. However, like standard hMG therapy, CC-hMG therapy requires careful monitoring specifically, because hyperstimulation may occur.

Adult↗
PubMed1983

The initial experience with the use of a portable infusion pump in the delivery of human menopausal gonadotropins.

The initial experience with the use of a portable infusion pump for the delivery of human menopausal gonadotropins (hMG) in the therapy of ovulation dysfunction of women who failed to conceive following (1) either clomiphene citrate (five patients with polycystic ovary syndrome) or danazol (three patients with mild endometriosis) and (2) standard intramuscular hMG-human chorionic gonadotropin therapy is reported. In six of these patients this approach was used because of suboptimal response of serum estradiol levels to standard hMG therapy, and all six patients had an increase in estradiol response with infusion therapy; therapy duration and total dosage of hMG were similar in both treatment modalities. Sonography suggested stimulation of several follicles with infusion therapy. Advantages and disadvantages of the use of the infusion pump for hMG therapy are discussed. In conclusion, hMG therapy via the infusion pump is feasible. This mode of administration appears to lead to more satisfactory follicular development in selected patients. Multiple follicular stimulation is to be expected. Self-administration of medication is readily achieved by the educated patient. Further consideration and exploration of hMG infusion therapy is suggested.

Adult↗
PubMed1982

Prevalence of oligomenorrhea and amenorrhea in a college population.

Menstrual disorders in college students have been reported as higher than in the general population. Several reasons, among them calorie-restricted diets, strenuous exercise, and college-related stress, have been attributed to this increased prevalence. During the period November, 1979, to January, 1980, 991 of 1,420 college students completed questionnaires which inquired about their menstrual history. The prevalence of oligomenorrhea in this group was 11.3% and that of amenorrhea was 2.6%. Significant factors associated with oligomenorrhea or amenorrhea in this group were weight loss (greater than 20 pounds) and jogging. In most women with oligomenorrhea or amenorrhea, menstrual irregularity was present prior to college entry. With the use of self-administered questionnaires, we could not identify any specific college stress to account for the presence of menstrual abnormalities in a college population.

Adolescent↗
PubMed1982

Postcoital testing in women during menotropin therapy.

The authors were interested in determining the predictive value of postcoital testing in women who undergo human menopausal gonadotropin (hMG) therapy for the induction of ovulation. Fifty consecutive patients were studied whose husbands had acceptable semen analyses; 24 of the patients conceived. Postcoital testing was done after hMG stimulation on the day human chorionic gonadotropins (hCG) were given or the day before. All but one patient had excellent cervical mucus quality. Sperm characteristics in cervical mucus were analyzed in regard to overall motility, number of active sperm per high-power field (HPF), and quality of movement. These data were correlated with outcome in terms of conception. A linear correlation could be shown between overall motility and pregnancy outcome once at least 40% motility was present; no pregnancy occurred in patients with 20% or less sperm motility. Once five or more active sperm/HPF were noted, the chance of pregnancy was about 60%; this chance was not increased with higher density rates. In all but one patient who conceived, sperm with maximum quality (+3 motility) were noted. Data were compiled in a postcoital score (range 0 to 12). Patients with a high score had a pregnancy rate of 70%, patients with an intermediate score, 23%, and none of the seven women with low scores conceived. Because menotropin therapy is costly, demanding, and potentially risky, it is suggested that one utilize results of postcoital testing as a guide in decisions about the continuation of such therapy.

Cervix Mucus↗
PubMed1982

Suture materials currently used in obstetric-gynecologic surgery in the United States: a questionnaire survey.

Questionnaires on the material and the size of sutures used in obstetric-gynecologic surgery were sent to the directors of 110 residency programs in the specialty in medical schools in the United States. Replies were received from 80 (73%) programs. The findings indicate that the use of chromic catgut still predominates, but that the newer synthetic absorbable materials such as polyglycolic acid and polyglactin 910 are becoming popular for some procedures, including certain steps in abdominal closure and in reconstructive tubal surgery. The increasing use of these materials for hysterectomy and cesarean section, heretofore exclusively the domain of chromic catgut, suggests that there is possibly under way a reorientation of attitudes about the materials used for sutures in obstetric-gynecologic surgery. The characteristics of catgut and of synthetic absorbable materials are herein described and compared in relation to their current use.

Abdomen↗
PubMed1981

Induction of ovulation with menotropins in women with polycystic ovary syndrome.

Twenty-four women with ovulatory infertility as a result of surgically or biochemically documented polycystic ovary syndrome (PCO) who had failed to conceive during clomiphene citrate therapy underwent a closely supervised menotropin treatment to induce ovulation. Evidence of ovulation was obtained in all patients treated, and major side effects were limited. Fourteen women conceived after an average of 2.4 treatment cycles; twin pregnancies occurred in 36% and spontaneous abortions occurred in 21%. Initial treatment cycles tended to be less successful than the subsequent treatment cycles. Serum 17 beta-estradiol (E2) levels were significantly augmented in the last 3 days before administration of chorionic gonadotropins (hCG) in treatment cycles resulting in conception compared to E2 levels in those cycles which resulted in ovulation only. A second hCG administration to trigger ovulation had to be given in 27% of the treatment cycles and seemed to be an indication of a less promising treatment cycle. Treatment cycles resulting in twin gestations did not differ from those resulting in singleton gestations; specifically, the E2 response was not increased. In summary, under a closely monitored regimen, menotropin therapy can be used in women with nonovulatory infertility as a result of PCO with considerable effectiveness and relative safety once clomiphene citrate treatment has failed.

Abortion, Spontaneous↗
PubMed1981

Response of blood coagulation parameters to elevated endogenous 17 beta-estradiol levels induced by human menopausal gonadotropins.

To elucidate the relationship between estrogen and thrombosis, we studied blood coagulation parameters in women whose ovaries were stimulated with human menopausal gonadotropins (hMG). Daily hMG administration over 1 to 2 weeks in seven anovulatory women increased plasma 17 beta-estradiol levels fivefold over the pretreatment value. Of the coagulation parameters, the fibrinogen level increased significantly from an initial value of 248 +/- 11.7 mg/dl (mean +/- SEM) to 353 +/- 32.2 mg/dl after hMG treatment (P less than 0.05), with a significant positive correlation between estrogen and fibrinogen levels (r = +0.762). In addition, a thrombokinetics study showed that the maximal rate of change in optical density of the prothrombin time and activated partial thromboplastin time was significantly increased, suggesting that the coagulation factors involved in extrinsic, intrinsic, and common pathways could be increased by estrogen. Antithrombin III levels decreased gradually during hMG administration. Thus, increased endogenous estrogen levels appear to induce the so-called "hypercoagulable state" through both an increase in coagulation factors in the coagulation cascade system and a decrease in antithrombin III, a potent natural inhibitor of activated coagulation factors. Patients on a regimen of hMG treatment for induction of ovulation serve as excellent models for the study of alteration of "natural" estrogen-mediated coagulation parameters.

Adult↗
PubMed1981

Oral contraceptive exposure of amenorrheic women with and without prolactinomas.

The purpose of this study was to determine the extent of oral contraceptive (OC) exposure of women with secondary amenorrhea of hypothalamic-pituitary etiology. In 93 of 126 women with secondary amenorrhea sufficient data were obtained regarding menstrual history and OC exposure: 26 patients had evidence of a prolactinoma, an additional 26 patients had idiopathic hyperprolactinemia without evidence of a pituitary tumor, and 41 had "pure" dysfunction hypothalamic-pituitary amenorrhea. After stratification by age at diagnosis and parity the estimated odds ratio for past oral contraceptive usage showed no differences among the three groups (odds ratios between 0.74 and 1.48). Using the chi-square test the proportion of subjects who had regular menses before oral contraceptive intake and developed anovulation immediately after discontinuance ("post pill amenorrhea") in the three groups also showed no difference (x2 = 0.60, P = 0.74). These data indicate that non-ovulatory patients are likely to have been exposed to OC, and do not indicate that patients with prolactinomas differ in the extent of their OC exposure from other specified groups of patients with secondary.

Adenoma↗
PubMed1981

Androgenic response in anovulatory women during menotropins stimulation.

Menotropins (human menopausal gonadotropin [hMG]) are used to induce follicular maturation and ovulation in anovulatory infertile women. To determine how hMG stimulation affected ovarian androgen production during such therapy, plasma androstenedione (A) and testosterone (T) levels were measured at the beginning and end of hMG therapy in 5 patients with anovulatory hypogonadotropism (group 1) and 15 patients with anovulatory polycystic ovary syndrome (group 2). Mean pretreatment levels of plasma estradiol (E2), T, and A were significantly higher in group 2 compared with group 1. Stimulation with hMG caused E2 levels to reach the same maximum value in both groups. Testosterone levels increased from 0.2 +/- 0.03 ng/ml (mean /+- SE) to 0.4 %/- 0.038 ng/ml for group 1 patients, and from 0.53 +/- 0.06 ng/ml to 0.8 +/- 0.1 ng/ml for group 2 patients. Androstenedione levels increased from 1.5 +/- 0.47 ng/ml to 2.1 +/- 0.4 ng/ml and from 4.37 +/- 0.77 ng/ml to 5.8 +/- 1.1 ng/ml in groups 1 and 2, respectively. The influence of hMG on plasma androgen levels was studied in women who received several treatment cycles before they became pregnant. In these women plasma androgen levels reached the same values in all cycles, including the final cycle in which the patient became pregnant. The data indicate that patients treated with hMG become pregnant despite marked gonadal androgen production. These observations suggest that hMG therapy promotes steroidogenesis in both the granulosa and theca cells of the follicle.

Androstenedione↗
PubMed1981

Hyperprolactinemia.

The ability to measure serum prolactin levels has led to the characterization of hyperprolactinemia as a clinical entity. In women galactorrhea and amenorrhea are symptoms of elevated prolactin levels; in men, impotence seems to be a clinical correlate. In the differential diagnosis, concern about the presence of a pituitary adenoma is preeminent. Management of microadenomas is controversial; both active therapy and conservative follow-up have been advocated. For larger lesions, neurosurgery or radiation becomes necessary. Drug therapy to reduce prolactin levels is now available.

Adenoma↗