Biomedical subjects
Publications and source records attributed to H Pinkas.
Two cases of severe ovarian hyperstimulation syndrome following ovulation induction are described, one of them following in vitro fertilization and embryo transfer, and the other after conventional ovarian stimulation. This condition was associated with an acute reversible decline in renal function. The treatment and the possible pathophysiological mechanisms are discussed.
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We report on alterations in IL-2 production and cell proliferation following PHA stimulation of peripheral blood lymphocytes (PBL) from stage-I endometrial carcinoma (EC) patients, and on mechanisms involved in these alterations. Our study includes 3 groups: EC patients, post-menopausal women at high risk of developing EC, and age-matched healthy women. IL-2 production was markedly lower in most EC patients than in healthy controls. Varying levels of IL-2 were produced by PBL from women in the high-risk group. The proliferative response of PBL to PHA appeared to correlate with levels of IL-2 production. Our results suggest that macrophages are involved, in part, in the modulation of T-cell functions of EC patients.
Thirty consecutive patients with far-advanced cancer affecting the esophagus and gastroesophageal junction underwent palliative endoscopic neodymium-YAG laser therapy. No patients were excluded from treatment, regardless of age, extent of disease, or performance status. Sessions were performed every other day and concluded when an endoscope could be easily passed beyond the previously obstructed area. Treatment was completed in 3.3 sessions (seven days). Luminal patency was achieved in 97%, but did not always equate with functional success. Seventy percent (21 patients) were able to ingest all necessary calories and leave hospital for home (functional success). Reasons for discrepancy between technical success and functional success included radiation-induced pharyngeal dysphagia, anorexia, painful tumor load and debility, and treatment complications. Endoscopic laser therapy of far-advanced esophageal or gastroesophageal junction carcinoma was almost always technically feasible, with relatively low morbidity. While technical success could not always be equated with functional success, therapy was "completely" functionally successful in 70% of patients with far-advanced disease. Poor performance status at accession correlated best with poor functional outcome.
Eleven consecutive patients who underwent endoscopic Nd: YAG laser therapy for palliation of esophageal carcinoma were prospectively evaluated between July 1, 1982, and December 31, 1982. All patients with tumor recurrence after radiotherapy or surgery (eight patients) or whose medical condition precluded surgery or full-course radiotherapy (three patients) underwent treatment. Mean tumor length was 8.1 cm and most had almost complete luminal occlusion. Survival was compared with patients with esophageal cancer treated at our institution during the 3 years prior to initiation of laser therapy (1978-1981). Treatment was completed in a mean of 3.3 sessions (range, 2 to 6). Dysphagia improved in all and performance status improved in eight patients, some markedly. Five patients with tumor re-occlusion were retreated at a mean of 10 weeks after initial therapy. No concurrent dilations were employed. Compared with our institution's historical controls, laser-treated patients' survival was significantly increased, whether measured from time of onset of radiotherapy (36 vs. 17 weeks, p = 0.02) or from time of recurrent symptoms after radiotherapy (25 vs. 8 weeks, p less than 0.05).
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Endoscopic retrograde cholangiopancreatography (ERCP) is a useful adjunct to laparoscopic cholecystectomy. Preoperative ERCP is indicated if there is a high degree of suspicion for common duct stones, when severe gallstone-induced pancreatitis is present, or when there is uncertainty regarding the diagnosis. The best indicators of common duct stones preoperatively are an elevated bilirubin, a dilated common bile duct (CBD) on sonography, or stones visualized in the CBD on sonography. Mild gallstone pancreatitis and transient mild elevations in liver enzymes are not predictive of CBD stones and are not indications for ERCP. Postoperative ERCP is highly effective in clearing CBD stones. It has the advantage of being more readily available as compared to laparoscopic CBD exploration, and preserves all the advantages of the laparoscopic approach. Post-operative ERCP is indicated for retained CBD stones, evaluation and therapy of biliary injuries, and persistent biliary symptoms or abnormal liver enzymes and bilirubin. ERCP is the procedure of choice for the evaluation of laparoscopic biliary injuries. Major biliary injuries will generally require surgical therapy. Bile duct strictures are sometimes amenable to endoscopic therapy with dilation and stents. Biliary leaks are readily treatable with endoscopic therapy. Small cystic duct stump leaks and leaks from a duct of Lushka close within a few days with nasobiliary drainage. Larger leaks may require more prolonged drainage with stents and early supplemental percutaneous drainage of an accompanying biloma. Bilious ascites should be treated with nasobiliary drainage using low suction to be prevent contamination of the peritoneal cavity with intestinal flora, and simultaneous percutaneous ascites drainage. Biliary leaks, unless associated with major bile duct injuries, rarely require surgical therapy.
A possible cause for implantation failure following embryo transfer is the rejection of pre-embryos by the maternal immune system. To elucidate the mechanisms underlying the rescue of the pre-embryo from maternal rejection, immunosuppressive activity was investigated in culture media containing human oocytes fertilized in vitro by employing the graft-versus-host reaction and the active rosette test. Normal donor lymphocytes were incubated with culture medium containing either fertilized or nonfertilized oocytes. Control experiments were carried out using lymphocytes incubated in culture medium only, as well as in culture medium containing human sperm. In 67% of the tests (12 out of 18), graft-versus-host reaction was inhibited, as compared to 29% of those performed with medium in which oocytes failed to fertilize (p less than .03), and 33% with medium in which only sperm was present. The frequency of an inhibitory active rosette test was similar in both groups. It is possible that immunosuppressive properties are acquired by the human pre-embryo as it grows in culture. Detection of such substances, which could contribute to the establishment of pregnancy, may improve monitoring of embryo quality prior to transfer.
Five normally menstruating women were treated in an attempt to induce development of multiple follicles. They were randomly divided into two groups. The first group, consisting of three women, was treated with a combination of follicle stimulating hormone (FSH) and human menopausal gonadotropin (hMG) (combination FSH/hMG). The second group, two women, was treated with hMG only. Following a nonconceptual cycle, the treatments were exchanged. The increment patterns of serum estradiol during the follicular phase and progesterone levels in both groups were identical. Ultrasonographic scanning revealed similar number and size of the growing follicles, which subsequently terminated in the same oocyte recovery rate in both groups (7.6 +/- 3.4 oocytes/procedure in the combination FSH/hMG and 8.0 +/- 2.5 in the hMG-only group). Fertilization and cleavage rates were also similar. These data indicate that high FSH/LH levels in different ratios do not alter ovarian response and oocyte fertilization potential.
PROBLEM: Neonatal outcome of in vitro fertilization (IVF) pregnancies has been described by different authors, but several issues have yet to be resolved. The aim of the present study was to evaluate neonates conceived in vitro and to direct special attention to neonatal morbidity and prevalence of minor abnormalities. The information that has been accumulated so far is scant. METHOD: The first 100 babies conceived in vitro, and subsequently born in our institute, were investigated and compared with the general, spontaneously conceived newborn population. All infants were examined by a senior neonatologist, and the data that were recorded included gestational age at delivery, birth weight, gender, major malformations, minor congenital abnormalities, neonatal mortality, and neonatal morbidity (including asphyxia, jaundice, meconium aspiration, hypoglycemia, and hypocalcemia). RESULTS AND CONCLUSIONS: The data indicate that the IVF neonates assessed had a higher rate of low birth weight (37%), twinning (30%), and preterm birth (20%) in comparison with the general reference population (p < 0.05). However, no differences were encountered either in the rate of small for gestational age infants or the incidence of major malformations and minor abnormalities between these groups of newborns. The overall neonatal morbidity in IVF babies was found to exceed that of the general population. Nevertheless, at birth, there were no clinical pathognomonic signs typical of IVF babies, although more detailed metabolic, endocrine, and neurobehavioral studies are still required to confirm that newborns conceived in vitro do not differ from those conceived spontaneously in any of these respects.