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Biomedical subjects

H N Ho

Publications and source records attributed to H N Ho.

At least 109 records · Page 6Linked to original sources
PubMed1992

Treatment and outcome of unexplained recurrent spontaneous abortions in subclinical autoimmune disorders.

Patients with a history of three or more fetal losses before a gestational age of 20 weeks were examined. Only patients with normal chromosomal, hormonal and anatomic findings were included in this study. These patients were tested for the antinuclear antibody, the C3 and C4 levels, anti-ENA [Ro(SSA), La(SSB), SM, RNP, scl-70], anti-single-stranded DNA and anti-double-stranded DNA, lupus anticoagulant, anticardiolipin and antiphosphotidylserine. All of these patients were free of any symptoms, except for the repeated abortions. The results showed that 10 out of 213 (4.7%) patients with unexplained recurrent spontaneous abortions had abnormal serologic tests, and 28% of the abortions (nine out of 32 abortions) occurred during the second trimester. With treatment of low-dose aspirin alone, or in combination with prednisolone, two out of 11 pregnancies in these 10 patients resulted in repeated abortions (18%), which was significantly lower than their previous abortion rate where 32 out of 33 pregnancies resulted in abortions (97%). Four babies (three term and one premature) were delivered without any abnormalities and the other five pregnancies are beyond the 28th week of gestation and are progressing smoothly. This study revealed that subclinical autoimmune disorders may play a role in recurrent spontaneous abortions and adequate treatment can improve the pregnancy outcome.

Abortion, Habitual↗
PubMed1992

Pregnancy after transfer of frozen-thawed human embryos.

Cryopreservation of human embryos has been successfully applied in in vitro fertilization (IVF) and embryo transfer (ET) programs at the National Taiwan University Hospital since 1988. Our preliminary results with 120 frozen-thawed embryos in 31 transfer cycles showed that the survival rate of frozen embryos was 66%. Following transfer, the implantation rate and clinical pregnancy rate were 6.5% and 13%, respectively. Four clinical pregnancies and one preclinical pregnancy following a frozen-thawed embryo transfer were achieved. Two normal male babies have been delivered and another pregnancy is progressing without any problem.* Unfortunately, one pregnancy was terminated due to intrauterine fetal death discovered at the 10th week of gestation; chromosome abnormality (47, XX, +5) of the fetus was found. The single preclinical pregnancy showed an elevation of serum beta-human chorionic gonadotropin levels for three consecutive weeks following ET, but no definite gestational sac was visualized by transvaginal ultrasound.

Adult↗
PubMed1992

Combined cornual pregnancy and intrauterine twin pregnancy after in vitro fertilization and embryo transfer: report of a case.

A case of combined cornual pregnancy and intrauterine twin pregnancy after in vitro fertilization (IVF) and transfer of six embryos is presented. The case was diagnosed as intrauterine triplets ultrasonographically at seven weeks of gestation. Unfortunately, the patient suffered from severe lower abdominal pain and hypovolemic shock at 10 weeks of gestation, and an emergent laparotomy was done. During the operation, a ruptured cornual pregnancy with accompanying hemoperitoneum was found. Because fetal heart beats were not detected by intraoperative ultrasonography in the other two intrauterine fetuses, evacuation of the gestational contents through the uterine defect was done, and the rupture site was repaired. The incidence, mechanism and management of heterotopic pregnancies after in vitro fertilization and embryo transfer are discussed.

Adult↗
PubMed1991

The prevalence of recurrent spontaneous abortions, cancer, and congenital anomalies in the families of couples with recurrent spontaneous abortions or gestational trophoblastic tumors.

This study extends our previous work on the genetics of recurrent spontaneous abortion and of gestational trophoblastic tumors in an ethnically homogeneous population of Chinese in Taiwan by comparing the prevalence of recurrent spontaneous abortions, cancer, and congenital anomalies in the first-, second-, and third-degree relatives of the index couples to that of normally fertile couples from the same population. The rationale for this study was to provide another test for our hypothesis that genes linked to the major histocompatibility complex are responsible for the diseases in the index couples. If they are, these genes should segregate with a higher frequency in the relatives of the index couples than in the relatives of normally fertile couples and lead to a higher prevalence of these diseases in the extended families. Such a difference was found and adds support to our hypothesis that major histocompatibility complex-linked genes affect growth, development, and susceptibility to cancer.

Abortion, Spontaneous↗
PubMed1991

Restriction fragment length polymorphism analysis to study the genetic origin of complete hydatidiform mole.

To determine the genetic origin of the complete hydatidiform mole, 20 abnormal pregnancies were studied with restriction fragment length polymorphism with five genomic probes: EJ 6.6, beta-globin gene, 3'alpha-hypervariable region, J-Bir, and St14. In the 12 cases of molar pregnancy, pure paternal origin was proved in 11 cases, but both maternal and paternal inheritance were shown in only one case. In the cases with pure paternal origin, all of the restriction fragment length polymorphisms were homozygous, although those of the fathers were heterozygous at 15 loci. In the four cases that mimicked hydatidiform mole but were diagnosed as hydropic change of villi, both paternal and maternal inheritance were noted. In the four pregnancies with blighted ovum, both paternal and maternal inheritance were shown in three cases; and in one case with a balanced translocation between chromosomes 13 and 14, only paternal inheritance was noted. This study showed that most of the complete hydatidiform moles were caused by fertilization of an empty egg by a duplicated haploid sperm, but rare exceptions may exist.

Adult↗
PubMed1991

Translaparoscopic tubal embryo transfer: preliminary experience at National Taiwan University Hospital.

Forty-six couples with various causes of infertility were treated by tubal embryo transfer. Oocyte retrievals were carried out under ultrasound guidance transvaginally and embryos were transferred 48 hours later by laparoscopy into fallopian tubes. Totally 52 cycles were stimulated and 45 retrievals were performed with an average of 8.1 oocytes per retrieval. The average fertilization rate was 54.8%. The implantation rate was 23.8% and the pregnancy rate was 53.5% per transfer. The pregnancy rate per transfer was comparable whether 3 or 4 embryos were transferred. Nine (39.1%) of the 23 pregnancies had multiple pregnancies. Six cases (26.1%) aborted in the first trimester and the remaining 17 were ongoing or term delivery.

Adult↗
PubMed1991

Immunotherapy for recurrent spontaneous abortions in a Chinese population.

The efficacy of immunotherapy for the treatment of recurrent spontaneous abortions was tested in patients selected from the same ethnically homogeneous population of Chinese in Taiwan in whom the immunogenetics of gestational trophoblastic tumors and of recurrent spontaneous abortion had been studied. The patients, who included both primary and secondary aborters, were randomly assigned to three groups: those who were immunized with their own lymphocytes (controls) (49); those who were immunized with their husbands' lymphocytes (39); and those who were immunized with third party lymphocytes (11). The data were analyzed individually for the primary and secondary aborters and collectively for both groups combined. The number of babies born, the number of current pregnancies, and the number of recurrent abortions were not statistically significantly different between the control and the immunized groups, and a similar small number of congenital abnormalities (4-9%) occurred in both the control and immunized groups. The increase in the blocking effect for the mixed lymphocyte reaction was not related to the success of the postimmunization pregnancies. Thus, this study does not show any significant improvement in the rate of livebirths in women immunized with their husbands' lymphocytes or with third party lymphocytes compared to that in a placebo-controlled group of women.

Abortion, Habitual↗
PubMed1991

Selective reduction of multiple pregnancies in the first trimester or early second trimester.

Nine cases of multiple pregnancies, including 7 sets of triplets and 2 sets of quadruplets, were enrolled for selective fetal reduction between March 1989 and July 1990 at the National Taiwan University Hospital. Under transabdominal or transvaginal ultrasound guidance, potassium chloride was injected into the fetal cardiac chamber to kill the selected fetus during the 10-14th gestational week. The number of fetuses was reduced to two in all cases. No maternal complications occurred during the procedure. Six gravidas have given birth to 6 sets of healthy twins; two pregnancies are progressing smoothly at 26 and 23 weeks of gestation, respectively, and one case underwent spontaneous abortion 4 weeks after the procedure. Selective fetal reduction under ultrasound guidance is an acceptable method of preventing high perinatal mortality and morbidity of immature fetuses in grand multiple pregnancies.

Abortion, Induced↗
PubMed1991

Treatment of patients with unexplained infertility: gamete intrafallopian transfer (GIFT) versus tubal embryo transfer (TET).

This study compares the results of 65 cycles of gamete intrafallopian transfer (GIFT), and 19 cycles of tubal embryo transfer (TET) in couples with unexplained infertility (UI). Oocyte retrievals were carried out by laparoscopy in GIFT and transvaginally in TET, in which the embryos were transferred by laparoscopy into the fallopian tubes 48 hours later. The mean age, duration of infertility, serum estradiol levels on the day of human chorionic gonadotropin administration, number of large follicles (mean diameter greater than 10 mm) and the number of oocytes recovered were similar between these two groups. From the 65 GIFT cycles, 20 clinical pregnancies resulted (30.8%). From the 19 cycles of TET, 10 conceptions occurred (52.6%). The implantation and pregnancy rates after TET were higher than that after GIFT, but the differences were not statistically significant. The data suggest that GIFT has a similar success rate to TET in couples with UI.

Adult↗
PubMed1991

Pregnancy following oocyte donation and tubal embryo transfer in patients with premature ovarian failure: report of two cases.

Two pregnancies in patients with premature ovarian failure utilizing donated oocytes, in-vitro fertilization (IVF) and tubal embryo transfer (TET), are reported. The recipients received cyclic hormone replacement therapy for six months to prepare the endometrium for implantation. An evaluation cycle was tested to document that the hormone milieu established by the hormone replacement protocol was similar to that of a natural ovulatory cycle. During the oocyte donation cycle, the recipient received incremental estrogen replacement treatment of flexible length during the follicular phase of the donor's stimulated cycle to synchronize the recipient's endometrium to the donor's embryo. Concurrently, the donor underwent controlled ovarian hyperstimulation and transvaginal ultrasound-guided oocyte retrieval. After fertilization of the donated oocytes with sperm from the recipient's husband and cleavage of the fertilized oocytes into the 2- to 4-cell stage, laparoscopic embryo transfer into the recipient's fallopian tube was performed. Case 1 received 4 embryos by the TET procedure. Pregnancy was confirmed by visualization of a gestational sac in the uterine cavity 3 weeks after TET, but miscarriage occurred at the tenth gestational week. In Case 2, the pregnancy was established after TET of 2 embryos. Estrogen and progesterone supplements were maintained until day 100 after TET. The patient delivered a healthy male baby, weighing 2,520 g at 38 weeks of gestation.

Adult↗
PubMed1991

The use of a long-acting gonadotropin-releasing hormone analog(D-Trp-6-LHRH) for improvement of ovarian stimulation in assisted conception programs.

To assess the efficacy of gonadotropin-releasing hormone analog (GnRHa) as an adjuvant in controlled ovarian stimulation in assisted conception programs, 114 infertile patients, who were treated by in vitro fertilization and embryo transfer (n = 61) or tubal embryo transfer (n = 53), were randomized sequentially to receive ovarian stimulation according to two protocols. In protocol 1 (n = 57), long-acting GnRHa (D-Trp-6-LHRH) microcapsules were administered intramuscularly at menstruation and ovarian stimulation using follicle-stimulating hormone (FSH) and human menopausal gonadotropin (hMG) was started 2 to 3 weeks later when the pituitary was completely suppressed. In protocol 2 (n = 57), patients received FSH and hMG from day 3 of the cycle without GnRHa pre-treatment. We found that premature luteinization did not occur in patients treated with protocol 1, and the number of cycles cancelled was also decreased. The days of ovarian stimulation and the amount of hMG required to achieve adequate follicular development were significantly higher in protocol 1 than that in protocol 2. Similarly, the mean serum estradiol levels on the day of human chorionic gonadotropin administration, number of large follicles (mean diameter greater than 10 mm), number of oocytes recovered and number of embryos obtained were also significantly higher in patients treated with protocol 1. The data suggest that the use of D-Trp-6-LHRH as an adjuvant in ovarian stimulation is associated with a lower incidence of cycle cancellation and an improvement in ovarian response in assisted conception programs.

Adult↗
PubMed1990

Sharing of human leukocyte antigens in primary and secondary recurrent spontaneous abortions.

The prevalence of recurrent fetal loss and its relationship to sharing of human leukocyte antigens within couples was examined in a large, ethnically homogeneous Chinese population in Taiwan: 91 couples with primary recurrent spontaneous abortion, 32 couples with secondary recurrent spontaneous abortion, and 51 normal fertile couples. There was an excess of human leukocyte antigen sharing in both types of recurrent aborters. The primary aborters shared human leukocyte A and DQ antigens and three or more of the human leukocyte A, B, DR, and DQ antigens. The secondary aborters did not have an excess of sharing at any one locus but they did share three or more of the human leukocyte A, B, DR, and DQ antigens. There was no excess of antipaternal cytotoxic antibodies in any group of aborters, and the primary aborters had a lower level of mixed lymphocyte reaction blocking factor than normal couples or secondary aborters. Previous studies showed that couples in whom a gestational trophoblastic tumor developed in the woman shared human leukocyte B and DQ antigens and three or more of the human leukocyte A, B, DR, and DQ antigens. These studies provide substantial support for the role of recessive genes linked to the major histocompatibility complex in the pathogenesis of recurrent spontaneous abortions and of gestational trophoblastic tumors.

Abortion, Habitual↗
PubMed1989

Differences between white and Chinese populations in human leukocyte antigen sharing and gestational trophoblastic tumors.

The prevalence of gestational trophoblastic tumors varies widely among different populations: it is lowest in whites (3 to 6/100,000) and highest in Chinese (68 to 202/100,000). This observation suggests that the origin of the disease is different in the two populations. To test this hypothesis, we examined couples in whom the woman developed a gestational trophoblastic tumor in a white population (Pittsburgh) and a Chinese population (Taiwan) for sharing of human leukocyte A, B, DR, and DQ antigens, which we consider markers for sharing of major histocompatibility complex-linked recessive genes affecting both embryogenesis and carcinogenesis. No human leukocyte antigen sharing occurred between partners in Pittsburgh, but there was significant human leukocyte antigen sharing in Taiwan. The latter couples shared human leukocyte antigen B (p less than 0.04) and human leukocyte antigen DQ (p less than 0.007) and shared three or more human leukocyte A, B, DR, and DQ antigens (p less than 0.02) significantly more frequently than did normal couples. However, there was no increased sharing of any specific human leukocyte antigen allele. These findings support the hypothesis that gestational trophoblastic tumors occur on a sporadic basis in whites and on a genetic basis in Chinese.

Asian People↗
PubMed1989

A unique antigen, RT11, in the placenta of the rat.

In the course of exploring the antibody response in the unsensitized WF (u) female pregnant by a DA (a) male, we prepared a hybridoma that secreted an antibody (mAb 213) that was specific to the a haplotype but identified an antigen different from Pa. This antigen was designated RT11. It is present from the twelfth day of gestation on the collagen fibers of the placenta and of all organs in fetal and adult rats. It is particularly prominent on red blood cells; in the yolk sac epithelium; in the walls of the endodermal sinus, blood vessels and bronchioles; and in capsules and trabeculae. A very small amount is present on DA lymphocytes, since 17-20% of them react with mAb 213 by cytofluorimetry. The RT11 antigen is absent from the basal and labyrinthine trophoblast cells, from the parenchymal cells of all organs, and from T and B cells. This distribution pattern is completely different from that of the Aa and Pa antigens. Inhibition and absorption studies showed that RT11 is not an integral part of the collagen molecule. The SDS-PAGE analysis of the immunoprecipitates of RT11 from radioiodinated whole-membrane extracts of red blood cells and from the glycoprotein fraction thereof showed that it is an unglycosylated protein of molecular weight 29,000. The evidence to date suggests that RT11 is a blood group antigen. Studies on the genetic control of the expression of RT11 were undertaken to determine whether a gene linked to the MHC was involved and whether the control mechanism was unigenic or polygenic. Backcrosses generated using inbred strains--(DA x BN)F1 x DA-- and using complementary congenic strains--(DA.1N x BN.1A) F1 x BN.1A--showed that the expression of RT11 was under polygenic control, and that both an MHC-linked gene (1.2 cM from RT1.Aa) and genes not linked to the MHC are involved. By contrast, the expression of the Pa antigen is under the control of an MHC gene only.

Animals↗
PubMed1989

Tubal cyst following tubal sterilization: a delayed complication.

Clinical pictures and histopathological findings in 15 patients of tubal cyst following tubal sterilization were analyzed. The interval between tubal sterilization and occurrence of tubal cyst was 10 years (ranged from 4 to 21 years). Clinically 8 cases (53%) suffered from lower abdominal pain, 5 cases (33%) from hypermenorrhea coexistent with uterine myoma and 2 cases (13%) from irregular menstruation. Five out of 9 patients with ultrasound examination were suspected to have tubal cyst before operation. The size of tubal cyst ranged from 1.5 to 9.0 cm in diameter with mean 3.4 cm. Eleven were unilateral and 4 were bilateral. Histologically they showed flattened mucosal epithelial cells with absence of epithelial plica, compression atrophy of muscular layer, suture stitch or granuloma and intact fimbria with clear serous fluid. Thus, the differential diagnosis of adnexal cyst in patients with a past history of tubal sterilization should include tubal cyst.

Adult↗
PubMed1989

Recurrent fetal loss with circulating lupus anticoagulant: report of 2 cases.

Lupus anticoagulant (LAC), an autoantibody, in maternal circulation is responsible for a high incidence of fetal loss. We record 2 cases of recurrent fetal loss in association with LAC. The presence of LAC was diagnosed by prolonged activated partial thromboplastin time (aPTT), but was not correctable by dilution with normal plasma. During their subsequent pregnancies, these two women were treated with prednisolone and a low dose of aspirin (100 mg/day). Normal values of aPTT were achieved in both cases after treatment. Preeclampsia developed in one of the women, and a live premature infant was delivered by cesarean section. However, a successful term pregnancy was achieved in the other case. Corticosteroid and low-dose aspirin appear to improve fetal outcome in cases with LAC.

Abortion, Habitual↗
PubMed1989

Reduced stimulating effect on one-way mixed lymphocyte culture by parturient's and neonatal cord blood cells.

One-way mixed lymphocyte culture (MLC), using the peripheral blood T, B cells and monocytes of 16 unmarried women who were never pregnant (i.e. nulligravidas) and 18 parturients, and the umbilical venous blood T, B cells and monocytes of 18 newborns as stimulating cells, were used to react with the peripheral mononuclear cells of a type "O" blood of a 29-year-old healthy man. We demonstrated that the stimulating effects were much lower in the parturients and the newborns than in the unmarried nulligravidas. The stimulating indices were significantly different, especially in the B cells. Mean stimulation index was 4.843 in unmarried nulligravidas, 1.249 in parturients and 1.284 in newborns. Our results seem to suggest that pregnancy produces some alternations on both the maternal and the fetal cells, making the maternal and the fetal immune systems fail to recognize each other.

Adult↗