Search PubMed⌕ Search

Biomedical subjects

J B Lessing

Publications and source records attributed to J B Lessing.

At least 181 records · Page 10Linked to original sources
PubMed1993

Fetomaternal blood flow measurements and management of combined coarctation and aneurysm of the thoracic aorta in pregnancy.

A pregnant patient presented at 21 weeks of gestation with severe coarctation of the aorta and a large aneurysm (5.4 cm) of the ascending aorta. The patient developed hypertension at gestation week 17. Continuous Doppler wave velocimetry showed a low systolic/diastolic (S/D) ratio in the uterine arteries indicating reduced blood flow to the placenta. The presence of a severe coarctation, aneurysm of the ascending aorta, and hypertension associated with the hemodynamic changes of pregnancy, increases maternal and fetal risk. The literature reviewed disclosed that aneurysm expansion and dissection or rupture on the one hand, and fetal demise on the other, are the greatest risks. The challenge of treating both the patient and the fetus was managed successfully by correction of the coarctation at week 22. Blood pressure normalized a few weeks after the operation, and no expansion in aneurysm diameter was noticed. A normal S/D ratio in the uterine arteries indicated increased blood flow in the uterine arteries. A healthy female was born. Pregnant patients with coarctation of the aorta should have surgical correction preferably in the first or second trimesters.

Adult↗
PubMed1993

Embryonal reduction using transvaginal saline injection in a sextuplet pregnancy after ovulation induction with human menopausal gonadotropin.

A sextuplet pregnancy occurred in a first treatment cycle of ovulation induction with human menopausal gonadotropins. The serum 17-beta-estradiol concentration was 1245 pg/ml on the day of human chorionic gonadotropin administration. Embryonal reduction of four fetuses was carried out at nine weeks gestation using a transvaginal ultrasound-guided approach. Under general anesthesia, a 16-gauge in vitro fertilization needle was introduced through the posterior fornix and uterine wall, into the nearest gestational sac. The embryo was penetrated and 0.9% saline solution was injected until disintegration was noted, and confirmed by a lack of pulse for more than two minutes. The same procedure was applied to the three embryos in closest proximity to the needle. The patient delivered healthy twins in the 34th week of gestation after having had pre-term contractions for two weeks.

Abortion, Induced↗
PubMed1993

Uterine rupture with the use of a low-dose vaginal PGE2 tablet.

BACKGROUND: Prostaglandin E2 (PGE2) vaginal tablets, suppositories and gel are increasingly being used for the induction of labor. Ease of administration and supervision are their greatest advantage, while hyperstimulation and rupture of the uterus are the main risks. CASE: A 26-year-old woman, gravida 5, para 2, with no history of cesarean section, was induced at 40 weeks' normal gestation, because of mild pregnancy-induced hypertension. Half a tablet (1.5 mg) of PGE2 was inserted into the cervix. Three hours later, tetanic uterine contractions started. In a precipitated labor she delivered a female weighing 3,250 gr, about 20 minutes after the appearance of uterine contractions. Severe post partum hemorrhage occurred, and examination disclosed an isthmical uterine rupture. Subtotal hysterectomy was performed at laparotomy. The postoperative course was uneventful. CONCLUSION: The use of PGE2 should be of concern in multiparous patients, or those with scarred uteri. This case highlights the risk of even a small dose of PGE2 administered into the cervix.

Administration, Intravaginal↗
PubMed1993

[New methods for predicting sperm fertilizing ability].

There is no reliable method for screening for the fertilizing ability of sperm. 3 new methods are presented: the freezing test (FT), hypoosmotic swelling test (HOST) and migration-sedimentation test (MST). The first 2, test the functional integrity and stability of the sperm membrane under certain osmotic conditions. The MST determines ability to separate high quality sperm. All tests were performed using either fresh semen of husbands, or thawed semen of donors used for fertilization in the IVF unit. Results of the FT were not correlated with the fertilizing ability of sperm in IVF, but HOST results with fresh, but not thawed semen, were correlated. Fertilization of oocytes in IVF was significantly better when HOST value of fresh semen was 45% or more. Motility and morphological normality of sperm separated by MST were better in ejaculates that fertilized ova under in vitro conditions, than in those that did not. Sperm separation by MST of 25% or more of motile sperm, or of more than 1.5 million motile sperm in the sample, indicated statistically significant ability for oocyte fertilization in an IVF system.

Cell Membrane↗
PubMed1993

[Comparison of ovulation induction protocols for in vitro fertilization].

In a retrospective study we evaluated 4 controlled ovarian hyperstimulation (COH) protocols for in vitro fertilization (IVF) treatment. Treatment cycles 4 through 8 were analyzed in patients, who in 3 previous attempts reached the stage of embryo transfer (ET) but did not conceive. The 426 recorded cycles included all indications for IVF, but not the male factor. The age range was 25-46 years. Patients underwent from 4 cycles (169 women) to 8 cycles (27 women). The COH protocols used included established combinations of menotropins, clomiphene citrate/hMG, and short and long protocols of GnRH analogs followed by hMG. There were no statistically significant differences in patient age, etiology and duration of infertility, or distribution of the various COH protocols among the groups of patients. No single protocol was significantly superior to any other when the pregnancy rate per cycle was assessed. The results did not justify changing a COH protocol which had lead to ET but not to pregnancy, for another protocol.

Adolescent↗
PubMed1993

High- and low-power CO2 lasers. Comparison of results for three clinical indications.

In this prospective study, three groups of patients were enrolled: group 1, patients with high grade squamous intraepithelial lesions (CIN 2 and 3) and carcinoma in situ (n = 56); group 2, patients with benign vulvar and perineal human papillomavirus lesions (n = 83); and group 3, patients with disseminated foci of penile shaft condylomatous lesions (n = 65). Each of the groups was randomly equally divided into two subgroups. One subgroup was treated with a laser beam with an output of 60 W and a spot size of 1-1.5 mm, creating high power density (HPD) ranging between 3,4000 and 7,640 W/cm2, while the other was treated with low power density (LPD) with an output of 20 W and the same spot sizes, creating an LPD ranging between 1,136 and 2,547 W/cm2. In group 1, the time to complete treatment was shorter using the HPD technique (P < .0003), and more satisfactory histologic edges were available (P < .007). HPD was also associated with a significantly shorter healing time and improved cosmetic results in groups 2 and 3 (P = .001). No difference was found in the time to complete therapy or the occurrence of infection when the different modalities were compared. The results of this study suggest that for specific disease entities, HPD is associated with better treatment outcomes than is LPD.

Carcinoma in Situ↗
PubMed1992

The predictive fertilization value of the hypoosmotic swelling test (HOST) for fresh and cryopreserved sperm.

BACKGROUND: The hypoosmotic swelling test (HOST) was recommended as a predictive test for in vitro fertilization (IVF) outcome. These results, however, were controversial and the results for thawed semen were insufficient. The present study was conducted in order to clarify the predictive value of the HOST for IVF in fresh and thawed sperm. METHODS: The hypoosmotic swelling test was performed in three groups: husband's fresh semen "subfertile" group, donor's thawed semen group, and donor's fresh semen "fertile" group. RESULTS: No correlation was found between HOST values and sperm characteristics in fresh or thawed sperm. Fresh sperm HOST values correlated with IVF fertilizations. No such correlations were found when thawed sperm was used. HOST values were significantly higher in the fresh fertile donor group than in the fresh subfertile group (P less than 0.001). Following the freezing and thawing process, HOST values decreased dramatically. Nevertheless, the fertilization rate was still higher compared to that of the fresh subfertile group (P less than 0.001). There were significantly more IVF cycles with no fertilizations when HOST values were below 45%. CONCLUSION: The HOST has a predictive value for fertilization of oocytes in IVF cycles when fresh semen, but not thawed sperm, is used. The freezing-thawing process affects the outer membrane of the spermatozoon and changes its characteristics, leading to a decrease in HOST values. Sperm characteristics that play a role in the fertilization process are not expressed directly by HOST values.

Cell Membrane↗
PubMed1992

Vaginal injury resulting from sliding down a water chute.

A 27-year-old woman was admitted to the hospital because of profuse vaginal bleeding from a vaginal laceration caused by the impact of water to the perineum after sliding down a water chute. At the time of the accident the patient was using a vaginal tampon. The potential mechanism for this trauma is discussed.

Adult↗
PubMed1992

Abruptio placentae associated with perforated appendicitis and generalized peritonitis.

A primigravid woman at 35 weeks' gestation was admitted with abdominal pain, fever, and vomiting. Forceful contractions and signs of fetal distress suggested abruptio placentae. During caesarean section, seropurulent exudate and a perforated appendix were found; an appendectomy was performed. A mechanism linking appendicitis with abruptio placentae is suggested.

Abruptio Placentae↗
PubMed1992

High initial values of beta-subunits of human chorionic gonadotropin in ovum donation pregnancies indicate better implantation.

Fifty-five patients were treated by ovum donation, and a control group of 165 patients underwent IVF. The number of pregnancies obtained were 28 and 25, respectively. The initial beta-hCG values, as well as the PRs and implantation rates, in the ovum donation series were significantly higher than those of the IVF series. The clinical significance and potential application of these observations are discussed.

Chorionic Gonadotropin↗
PubMed1992

Improved fertilization rate in an in vitro fertilization program by egg yolk-treated sperm.

High fertilization and PRs have been achieved by using thawed donor sperm cryopreserved with medium containing EY. The aim of our study was to examine the possible effect of EY on the fertilizing capacity of fresh sperm in an IVF program. Preincubation of spermatozoa in EY for 2 hours at room temperature significantly improved fertilization (P less than 0.001) in couples who had low fertilization rates in previous cycles, whereas no effect was found concerning couples with high fertilization rates.

Egg Proteins↗
PubMed1992

Embryo reduction in multifetal pregnancies using saline injection: comparison between the transvaginal and the transabdominal approach.

A total of 30 patients with multifetal pregnancies, all resulting from treatment with superovulatory agents or assisted reproductive techniques, underwent embryo reduction. All patients had three or more fetuses (one sextuplet, two quintuplets, seven quadruplets and 20 triplets). The procedure was carried out using intra-embryonal injection of 0.9% sodium chloride solution. Embryo reduction was carried out via the transabdominal approach in 10 patients, performed at 11-12 weeks of gestation, and via the transvaginal route in 20 other patients, at 8-10 weeks of gestation. In the transabdominal group, one patient aborted following repeated attempts at embryo reduction while the other nine gave birth to healthy newborns (eight twins and one triplet). In the transvaginal group, four pregnancies are currently ongoing (all beyond 28 weeks of gestation), 14 pregnancies resulted in a delivery of at least one live newborn (13 twins and one singleton), one patient had a late abortion at 24 weeks' gestation and another was delivered at 27 weeks' gestation due to severe pre-eclampsia. Transvaginal ultrasound-guided needle procedures are commonly practised in most in-vitro fertilization units. The employment of this route for embryo reduction, performed at an earlier gestational age and with the use of a non-toxic substance such as 0.9% saline solution, is advocated.

Abdomen↗
PubMed1992

Migration sedimentation technique as a predictive test for the fertilizing capacity of spermatozoa in an in-vitro fertilization programme.

The migration-sedimentation technique (MST) has been proposed as a means of separating high quality motile spermatozoa. The present study was conducted in order to evaluate whether sperm performance following separation by MST predicts their fertilizing capacity in an in-vitro fertilization (IVF) programme. Ninety semen specimens were analysed for use in an IVF-embryo transfer (ET) programme. Each specimens was divided into two parts: one was processed in the IVF programme and was used after sperm swim-up separation for insemination of human ova. The other aliquot (0.2 ml) was separated by MST, and the sperm then characterized by their concentration, motility, degree of motility and morphology. Sperm characteristics after separation by MST were then correlated with the results of the IVF-fertilization rates. In 79 of 90 IVF-ET cycles, at least one oocyte was fertilized. All post-MST sperm characteristics were significantly higher in cycles with fertilizations compared to IVF cycles without fertilization. A larger percentage of the total motile spermatozoa were recovered after MST in semen specimens with fertilization, compared to semen specimens without fertilization (39.9 +/- 3.6 and 20.6 +/- 6.6%, respectively; P < 0.05). This value was correlated with the percentage of fertilized oocytes (r = 0.24; P < 0.02). More IVF cycles with fertilizations were recorded in cases in which the recovery of motile sperm was > 25% (P < 0.005), or when more than 1.5 x 10(6) motile spermatozoa were recovered after MST (P < 0.0001). As sperm characteristics after MST correlated significantly with their fertilizing capacity, the MST test could be used in evaluation of the fertilizing capacity of spermatozoa.

Cell Separation↗
PubMed1991

The efficiency of cryopreserved semen versus fresh semen for in vitro fertilization/embryo transfer.

The efficiency of cryopreserved donor semen versus fresh donor semen in an in vitro fertilization/embryo transfer programme was evaluated. Thirty-nine in vitro fertilization/embryo transfer cycles were performed using fresh donor semen (group A) and 74 cycles were carried out using cryopreserved semen (group B). All patients underwent a uniform controlled ovarian hyperstimulation using high doses of human menopausal gonadotropins. Oocytes were retrieved transvaginally under ultrasound imaging. Semen (fresh or frozen-thawed) were prepared for insemination by a washing technique. Each ovum was inseminated with 500,000-600,000 motile spermatozoa. No significant difference was noted between the two groups regarding female age, duration of infertility, and number of ova retrieved per aspiration. Even though the fertilization rate in group B was significantly lower than in group A (55.5 +/- 3.8 vs 70.4 +/- 3.5, P = 0.008), pregnancy rates per embryo transfer were similar--39.3 and 38.5%, respectively.

Adult↗
PubMed1991

Atypical response to luteinizing hormone-releasing hormone (LH-RH) agonist (suprefact nasal) in induction of ovulation in in vitro fertilization (IVF).

Animal and human research has indicated the presence of receptors to luteinizing hormone-releasing hormone (LH-RH) in the ovaries. However, the role of these receptors is not yet clear. Forty-five patients were treated with Suprefact (D-Serg-Des-Gly10-GnRGH), starting in the midluteal phase of a nonstimulatory menstrual cycle. The Suprefact (300 micrograms t.i.d.) was administered as a nasal spray until the administration of human chorionic gonadotropin (hCG). On the third to fifth day of the following menstrual cycle, the patients were treated with a high dose of human menopausal gonadotropin (hMG). hCG was administered when at least two follicles reached a mean diameter of 18 mm. Five of these patients who ovulated spontaneously and had normal menstrual cycles did not respond to the stimulation with hMG. Treatment was stopped after 12 days of hMG administration. During the following cycle of the five patients, levels of gonadotropins were found to be in the normal range, and all of them responded as expected to hMG administered for 3 days only (hMG test). These findings suggest that LH-RH agonist may interfere with ovarian steroidogenesis.

Administration, Intranasal↗
PubMed1991

Avoidance of cancellation of potential hyperstimulation cycles by conversion to in vitro fertilization-embryo transfer.

OBJECTIVE: The study was undertaken to minimize the rate of ovarian hyperstimulation and to avoid cancellation of human treatment cycles in women treated with human menopausal gonadotropin (hMG) for induction of ovulation. SETTING: Patients were treated in the fertility clinic and in vitro fertilization unit of our institution, which is a government, university-affiliated hospital. PATIENTS: Ninety anovulatory patients were treated with hMG. Of these, 12 were at high risk for ovarian hyperstimulation. The criteria for potential ovarian hyperstimulation syndrome were rising excessive 17 beta-estradiol levels of greater than 1,500 pg/mL in the presence of multiple follicles with a mean diameter greater than 15 mm. These patients were transferred for continuation of treatment to our in vitro fertilization-embryo transfer (IVF-ET) unit. INTERVENTIONS: The patients underwent ova retrieval by the ultrasonically guided transvaginal approach. RESULTS: Of the 12 patients, 5 conceived (41.6%). Two patients had a mild ovarian hyperstimulation syndrome, and 1 had a moderate syndrome and was hospitalized for observation for 48 hours. CONCLUSION: In view of the results, we suggest that IVF-ET should be considered in cases in which ovarian hyperstimulation syndrome is imminent, rather than withhold human chorionic gonadotropin and cancelling the treatment cycle.

Adult↗