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Biomedical subjects

H W Jones

Publications and source records attributed to H W Jones.

At least 127 records · Page 7Linked to original sources
PubMed1990

Immunoreactive epidermal growth factor concentrations in follicular fluid obtained from in vitro fertilization.

Immunoreactive epidermal growth factor (EGF) was measured in follicular fluid (FF) obtained at the time of oocyte retrieval for in vitro fertilization from cycles with (91 follicles) and without (128 follicles) the gonadotropin-releasing hormone agonist leuprolide acetate (LA). Follicular fluid immunoreactive EGF levels in the non-LA cycles correlated with androstenedione but not estradiol or progesterone levels from follicles with prophase I oocytes or from all follicles taken together, but not from metaphase I or metaphase II oocyte containing follicles alone. In non-LA cycles, FF immunoreactive EGF levels were lower in follicles that contained metaphase I or II oocytes than prophase I oocytes. Additionally, FF immunoreactive EGF levels were lower in follicles containing metaphase I or II oocytes from non-LA than LA cycles. We conclude that immunoreactive EGF is present in FF. Leuprolide acetate may affect FF immunoreactive EGF levels.

Androstenedione↗
PubMed1989

Peritoneal carcinomatosis of unknown primary site in women. A distinctive subset of adenocarcinoma.

STUDY OBJECTIVE: To define the clinical features and results of systemic treatment in women with adenocarcinoma of unknown primary site involving predominantly the peritoneal surfaces. DESIGN: Retrospective analysis of 18 patients treated at a single institution between 1978 and 1984. PATIENTS: All 18 women had abdominal carcinomatosis and had no primary site identified at laparotomy. Nine patients had limited residual tumor (maximal tumor diameter, 3 cm or less) after initial cytoreductive surgery, and 9 patients had extensive residual disease. INTERVENTIONS: In general, patients were treated according to standard guidelines for treatment of advanced ovarian carcinoma. All patients had initial laparotomy with attempted cytoreduction; of these 18 patients, 16 subsequently received cisplatin-based chemotherapy. Patients were restaged either clinically (10 patients) or with second-look surgery (8 patients). RESULTS: The median survival for all patients was 23 months. Five patients had complete response to chemotherapy, and three patients remain disease-free 41, 59, and 77 months after diagnosis. Patients with limited residual disease had longer median survival than did those with extensive residual disease (31 months compared with 11 months). CONCLUSIONS: Women with adenocarcinoma of unknown primary site involving predominantly the peritoneal surface should be distinguished from other patients with adenocarcinoma of unknown primary site because they have a more indolent disease course, a higher response rate to systemic therapy, and a chance for long-term, disease-free survival after therapy. Although optimal treatment is undefined, we recommend that these patients be treated using the guidelines established for therapy of advanced ovarian carcinoma, including initial surgical cytoreduction followed by cisplatin-based combination chemotherapy.

Adenocarcinoma↗
PubMed1989

Construction of a neovagina for patients with a flat perineum.

Vaginal dilatation affords an acceptable functional success rate for women with vaginal agenesis, provided there is an introitus with a pouch or dimple. In contrast, women with a flat perineum who lack labia majora, labia minora, and vaginal introitus have no alternative to development of a vagina-like orifice other than surgical vaginoplasty. This study addresses the anatomic and functional success rate of these women after undergoing modified McIndoe technique. Thirty-four patients with microphallus were assigned the female gender as the sex of rearing at the Johns Hopkins Hospital between 1951 and 1987. A majority of patients underwent surgical revision of the external genitalia and gonadectomy before 2 years of age. Family counseling was begun at birth. Of these patients, 15 (17 to 25 years old) who requested the ability to have sexual relations underwent modified McIndoe vaginoplasty. All 15 of these women have experienced satisfactory coitus. All but one patient have an adequate size vagina. Results of this group indicate that patients with ambiguous genitalia as a result of male hermaphroditism or microphallus can achieve functional success after vaginal creation with a modified McIndoe technique despite the presence of a flat perineum.

Coitus↗
PubMed1989

Preoperative assessment of myometrial invasion of endometrial adenocarcinoma by sonography (US) and magnetic resonance imaging (MRI).

The presence and/or depth of myometrial invasion of endometrial adenocarcinoma has important prognostic and therapeutic implications. Fifteen patients with histologically proven endometrial cancer underwent preoperative evaluation with sonography (US) and magnetic resonance imaging (MRI) to assess depth of invasion. Using criteria of greater than or equal to 50% of myometrial wall involvement as representing deep invasion, and less than 50% as superficial invasion, US was more accurate than MRI in five cases; in three MRI was more accurate than US; both MRI and US were equally accurate in four; neither was accurate in three. Polypoid lesions caused the greatest number of false positive reports of deep invasion with both MRI and US. Preliminary results indicate that US and MRI have promise as preoperative tests to assess the extent of myometrial invasion.

Adenocarcinoma↗
PubMed1989

Effects of the severity of tubo-ovarian disease and previous tubal surgery on the results of in vitro fertilization and embryo transfer.

The purpose of this study was to evaluate the ovarian response and in vitro fertilization/embryo transfer (IVF-ET) results in patients with tubal infertility and two ovaries, according to (1) the degree and extent of pelvic disease (isolated tubal or tubo-ovarian) and (2) previous adnexal surgical procedures. A total of 549 patients who underwent 1031 IVF-ET cycles were evaluated. Significant findings were as follows: (1) No differences were found in the number of preovulatory oocytes, fertilization rates, or serum estradiol levels in the follicular phase between any classes of tubo-ovarian disease. (2) Patients with a "frozen pelvis" had significantly fewer follicles aspirated than those in any other category, although they had equivalent numbers of preovulatory oocytes retrieved and pregnancy rates. (3) Patients with previous bilateral tubal ligation had higher pregnancy rates than patients with severe tubo-ovarian disease. (4) The type of prior pelvic surgical procedure had no effect on IVF-ET outcome. Although patients with no cause of infertility other than tubal ligation had better results, these patients had previously proven fertility. We conclude that neither the stage of tubo-ovarian disease nor any history of pelvic adhesions or tubal surgery has a significant impact on the efficiency of IVF-ET.

Adult↗
PubMed1989

Squamous carcinoma of the cervix complicating pregnancy: recurrence in episiotomy after vaginal delivery.

A patient developed recurrence of squamous carcinoma of the cervix in the episiotomy scar after vaginal delivery through the involved cervix. At the time of her radical hysterectomy, all margins and nodes were free of tumor, suggesting implantation at delivery as the etiology of the recurrence. Review of the literature revealed three other cases of episiotomy recurrence. All cases were either clinically unsuspected or had negative Papanicolaou tests during pregnancy. Careful surveillance and early therapy appear to give a more favorable prognosis for this unusual type of recurrence.

Adult↗
PubMed1988

Failure of fertilization in in vitro fertilization: the "occult" male factor.

Failure of fertilization in patients undergoing in vitro fertilization (IVF) deserves extensive analysis for better prediction of the success or failure of this therapeutic modality. Consequently, we retrospectively studied the 52 couples in whom fertilization failed during Norfolk series 18 to 25, in an effort to establish the precise causes of failure. In the initial evaluation, pure oocyte abnormalities were identified in 19.2% of the cases; 32.6% showed sperm abnormalities, and a combination of oocyte and sperm anomalies was found in 7.7%. In 40.4% of the cases, failure of fertilization could not be explained. Reassessment of sperm morphology by new, strict criteria increased the identification of sperm abnormalities to 61.5% and of combined sperm and oocyte anomalies to 13.4%, for a total of 74.9% of sperm factors involved, as opposed to 40.3% in the original evaluation. The incidence of unexplained failed fertilization was substantially reduced, to 11.5%. In a control group (tubal infertility) matched by age, date, and stimulation, in whom fertilization occurred, 83.3% had normal sperm parameters as judged by the new criteria for morphology evaluation. This paper emphasizes the need for a more accurate diagnosis of sperm abnormalities to establish the true incidence of this factor in failed fertilization and to obtain information of prognostic value to patients and clinicians.

Adult↗
PubMed1988

In vitro fertilization and embryo transfer (IVF/ET): an established and successful therapy for endometriosis.

The purpose of this report is to present a 6-year experience in the management of endometriosis with in vitro fertilization and embryo transfer (IVF/ET). We divided 136 patients who underwent 280 cycles into three groups: (1) previous history of endometriosis but normal pelvis at the time of oocyte retrieval, (2) stages I-II endometriosis (revised AFS classification), and (3) stages III-IV endometriosis. The stimulation protocols, estradiol (E2) responses, and distribution of terminal E2 patterns were similar in all groups. Group 3 had significantly fewer preovulatory and immature oocytes retrieved and fewer embryos transferred. The fertilization rate and the per cycle/per transfer pregnancy rates were similar in all groups. The miscarriage rate was higher in group 3, and the ongoing pregnancy rate per cycle was lower. Luteal phase E2 and progesterone levels were comparable in all groups. No differences were found when groups 2 and 3 were analyzed for the presence of one or two ovaries or the presence/absence of ovarian endometriosis. The overall fertilization rate, the per cycle/per transfer pregnancy rates, and the miscarriage rate were similar to those of tubal factor patients. We underscore the excellent outcome of patients with minimal or mild endometriosis in IVF/ET. We conclude that patients with moderate or severe endometriosis have a compromised reproductive potential, probably because of a reduced oocyte recovery rate and poor embryo quality.

Abortion, Spontaneous↗
PubMed1988

In vitro (organ culture) studies of the toxicity of specific A-gliadin peptides in celiac disease.

Specific peptides of known amino acid sequence were prepared from alpha-gliadin (A-gliadin) by cleavage of the protein with cyanogen bromide and chymotrypsin and purification of the resulting peptides. The three peptides derived from the cyanogen bromide cleavage spanned the complete sequence of A-gliadin (266 residues). Four peptides derived from chymotryptic digestion covered the N-terminal sequence through residue 68. These peptides were tested for toxicity in celiac disease by organ culture of biopsied small intestinal tissues taken from patients with active celiac disease. Enterocyte height was used as a measure of peptide effect on cultured tissues. Five of seven peptides tested significantly inhibited increase of enterocyte height in the cultures and were considered toxic on this basis. The largest common sequences among the toxic peptides were -pro-ser-gln-gln- and -gln-gln-gln-pro-; these sequences were absent from the nontoxic peptides. The relationship of these sequences to the damaging effect of gliadins on the small intestinal mucosa in celiac disease remains to be investigated.

Biopsy↗
PubMed1988

The efficiency of human reproduction after in vitro fertilization and embryo transfer.

Two hundred ninety-seven nonpregnant patients were used to study the possibility of early transient implantation as a parameter of the efficiency of in vitro fertilization (IVF) procedures. Ten patients without embryo transfer (ET) were used as controls. The luteal estradiol, progesterone, and human chorionic gonadotropin were measured by radioimmunoassay (RIA). In 31 cases, a transient elevation of hCG occurred after complete serum clearance of exogenous hCG, suggesting that the transient increase in hCG was of embryonic origin. In addition, five patients were found to have prolonged clearance of hCG, which was due not to individual variation in clearance, but to a minimal production of hCG by trophoblastic tissue. These data suggest that implantations occurred in 12.1% of our so-called "nonpregnant" patients.

Chorionic Gonadotropin↗
PubMed1988

Mechanisms and factors of early pregnancy wastage in in vitro fertilization-embryo transfer patients.

Although the pregnancy rate per transfer of the Norfolk In Vitro Fertilization-Embryo Transfer (IVF-ET) program has been reported as between 25% and 35%, the viable pregnancy rate per transfer is only 15% to 20%. An understanding of the mechanism(s) and etiologic factors of miscarriage among IVF patients might suggest changes that could prevent some early pregnancy wastage. Forty-seven consecutive single pregnancies and 26 miscarriages (October 1985 to November 1986) were included in this study. Factors such as implantation time, date of corpus luteum rescue (CLR), embryo quality, and corpus luteum activity after rescue were studied and compared between term pregnancy and miscarriage groups. Results are discussed in detail in this paper.

Abortion, Spontaneous↗
PubMed1988

Does ulcerative colitis behave differently in the elderly?

The clinical course of all new patients with ulcerative colitis or indeterminate colitis aged 65 years or older diagnosed in one health district (population 274,000) between 1 January 1975 and 31 December 1984 has been compared with that of all new patients 55 years or younger diagnosed in the same period. Elderly patients were admitted more often in a first attack and were more likely to receive systemic steroids. No elderly patient required urgent surgery and no patient in either group died of ulcerative colitis or its complications. The mortality amongst elderly patients with ulcerative colitis was no greater than expected in a population of the same age. The prognosis for ulcerative colitis in elderly patients is the same as for younger patients.

Age Factors↗
PubMed1988

Surveillance in ulcerative colitis: burdens and benefit.

A review of all patients with ulcerative colitis in one health district between 1975-84 revealed an incidence and prevalence of 7.1 and 84/100,000 population respectively. One hundred and ninety five new patients were diagnosed and 313 patients seen and followed up in the clinic for 1168 patient years. None of these patients died from colitis or a complication. On routine colonoscopy three cases had high grade dysplasia and two asymptomatic carcinomas (Duke's stage A and B). Eighty four patients were known to have ulcerative colitis, but were lost to follow up from the hospital clinic; the total time they were not under hospital surveillance was 315 patient years. At the end of the study these patients were contacted or clinical details obtained from their general practitioners. Five of these patients subsequently presented with symptomatic carcinomas (two Duke's B, one Duke's C and two with metastases); three of these five patients have died from their tumours. Of 48 patients thought to have only mild colitis on initial investigation 21 (43%) had substantial colitis (and two carcinomas) on colonoscopy after eight years of disease. Therefore, patients with apparently distal colitis should be followed in the clinic as well as those with known extensive colitis. For a surveillance programme in a district general hospital, eight patients per 100,000 population need to be seen weekly, 12 colonoscopies/100,000 population need to be carried out annually and the cost for each carcinoma detected is approximately 6015 pounds.

Adolescent↗