Biomedical subjects

J R Brumsted

Publications and source records attributed to J R Brumsted.

36 records · Page 2Linked to original sources

PubMed1991

Operative laparoscopy with the Nd:YAG laser in the treatment of endometriosis and pelvic adhesions.

A multicenter, prospective trial was initiated to test the effectiveness and safety of the Nd:YAG laser equipped with artificial sapphire contact tips for the laparoscopic treatment of pelvic pain. Ninety-three women were enrolled in the study, 37 with endometriosis alone, 47 with endometriosis complicated by pelvic adhesions, and 9 women with adhesions alone. In over 90% of adhesions and 96% of endometriotic implants the Nd:YAG laser could be delivered to the site and be used to restore normal anatomy. The exception was deep bowel involvement with endometriosis, which was not treated. The majority of women had marked reduction or resolution of their symptoms for up to 12 months postoperatively. We conclude that the use of the Nd:YAG laser is an appropriate method to laparoscopically treat pelvic pain resulting from endometriosis or pelvic adhesions.

Abdominal Neoplasms↗

PubMed1991

Attempted transcervical occlusion of the fallopian tube with the Nd:YAG laser.

A prospective multi-center trial was initiated to test the efficacy and safety of transcervical occlusion of the fallopian tube with the Nd:YAG laser. A multi-center approach was deemed necessary because of the large sample size required to test adequately the effectiveness of sterilization procedures. However, efforts to continue the study as designed were abandoned because, of the 17 subjects completing the study, only four (24%) had bilateral tubal occlusion at the site of laser treatment. We conclude that the hysteroscopic method, as tested, is inadequate to provide permanent sterilization. Modification of the technique or alterations in patient preparation may improve the outcome.

Adult↗

PubMed1991

Recurrent spontaneous abortion.

Recurrent pregnancy loss is a condition with many different etiologies. The proper evaluation and care of couples suffering from this form of reproductive failure requires that the clinician be well versed in many aspects of the physiology of normal and abnormal early pregnancy. Topics relevant to the subject of recurrent spontaneous abortion, with special attention to recent advances, are examined in this review.

Abortion, Habitual↗

PubMed1991

Endometrial histology after first trimester spontaneous abortion.

The endometrial histology after spontaneous abortion was investigated by performing an endometrial biopsy in the two menstrual cycles subsequent to miscarriage in 12 women. In the first cycle, 66% (8/12) of the biopsies had the following abnormalities: (1) proliferative endometrium (n = 4), (2) proliferative glands and decidualized stroma (n = 1), (3) endometritis (n = 1), and (4) luteal insufficiency (n = 2). In the second cycle, 20% (2/10) of the biopsies demonstrated luteal insufficiency. Forty-five percent (10/22) of the first two cycles after spontaneous abortion demonstrated abnormal endometrial histology, with the first appearing more abnormal than the second (P = 0.06). Two conceptions occurred during the study period; both were uneventful term pregnancies. These findings suggest that a large proportion of the first two menstrual cycles after spontaneous abortion and curettage are abnormal, with the first cycle being more frequently abnormal than the second.

Abortion, Spontaneous↗

PubMed1990

Diagnosis and treatment of cornual obstruction using a flexible tip guidewire.

Proximal tubal obstruction, either unilateral or bilateral, is a frequent finding on hysterosalpingogram (HSG). Approximately two-thirds of the fallopian tubes resected for proximal tubal obstruction reveal an absence of luminal occlusion. The distinction between true pathologic occlusion and either spasm or plugging is crucial in determining therapy. We combined hysteroscopic cannulation of the proximal fallopian tube with laparoscopy in 11 patients with proximal tubal obstruction diagnosed by HSG and confirmed at laparoscopy. Hysteroscopic cannulation was able to be performed in 72% of the fallopian tubes attempted, and there was a postcannulation patency rate by HSG of 73%. Six of the 11 patients became pregnant after tubal cannulation and adjunctive distal tubal surgery. Hysteroscopic cannulation of the fallopian tube is a safe diagnostic procedure that can be used to identify those patients with true proximal occlusion, and may also serve as a therapeutic procedure in some of these patients.

Adult↗

PubMed1990

CA-125 secretion by luteal phase endometrium in vitro.

The source of CA-125 in normal women and the mechanisms which control CA-125 production remain to be defined. This study was initiated to examine the pattern of secretion of CA-125 from luteal phase endometrium. Endometrial samples were obtained during the early luteal phase (histological days 16-18) and late luteal phase (histological days 25-27) from ovulatory women with a laparoscopically normal pelvis. The tissue was maintained in explant culture using Trowell's T-8 medium with either no additions (NA), progesterone (P), oestradiol (E2), or E2 + P. The concentration of CA-125 in spent media from the second day in culture was determined by immunoradiometric assay. In early luteal endometrium, the concentration of CA-125 in spent media from the NA treated wells was significantly higher than when the endometrium was exposed to either P or E2 + P. Similar differences were noted between treatments for the late luteal endometrium. Within each treatment, there was a higher concentration of CA-125 in the spent media from the late versus the early luteal endometrium. We conclude that the endometrium is a potential source of serum CA-125 and that endometrial CA-125 is suppressed by P in both the early and the late luteal phase. Further, there appears to be an increase in endometrial CA-125 secretion from the early to the late luteal phase.

Antigens, Tumor-Associated, Carbohydrate↗

PubMed1990

Successful treatment of a persistent cyst, developing after ovarian transposition, with leuprolide acetate.

Persistent ovarian cysts are considered to be the most troublesome complication of ovarian transposition. Transabdominal drainage or surgical removal is often required. This paper reports the successful use of leuprolide acetate, a GnRH agonist, in the treatment of a symptomatic and persistent ovarian cyst which developed after ovarian transposition. The benefits of this therapy over others are discussed.

Adult↗

PubMed1990

A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis.

This study was initiated to test the hypothesis that treatment with clomiphene citrate (CC) and intrauterine insemination (IUI) results in increased fecundity when compared with periovulatory intercourse in couples with either unexplained infertility or surgically corrected endometriosis. Sixty-seven couples entered a randomized, prospective trial comparing CC/IUI with observation. During the study, there were 14 pregnancies in 148 treated cycles (fecundity = 0.095) compared with 5 pregnancies in 150 untreated cycles (fecundity = 0.033). Using life-table analysis and the log-rank test, the difference in fecundities was statistically significant. Pregnancy outcome was not significantly different between the two groups. When comparing conception with nonconception cycles during treatment, no differences between the size of the lead follicle or the number of dominant follicles was detected. We conclude that treatment with CC/IUI improves fecundity in couples with unexplained infertility or surgically corrected endometriosis.

Clomiphene↗

PubMed1990

Postoperative adhesion formation after ovarian wedge resection with and without ovarian reconstruction in the rabbit.

A rabbit model was used to examine adhesion formation after ovarian wedge resection with and without reapproximation of the ovarian cortex. A wedge resection was completed on one ovary with a scalpel, and the ovarian cortex was reapproximated using microsurgical technique. In the contralateral ovary, a wedge resection was performed using the Nd:YAG laser and the cortex was left to heal by secondary intention. A second laparotomy was performed and the adhesion scores were compared between the two adnexa. In 17 of 19 rabbits, the adhesion score was greater on the side where ovarian reconstruction had been performed. No difference was noted in adhesion scores when, in our preliminary studies presented herein, laser and scalpel wedge resections were both followed by reapproximation of the cortex. These data have ramifications for conservative ovarian surgery performed both at laparotomy and laparoscopy.

Animals↗

PubMed1990

Serum concentration of CA-125 during the first trimester of normal and abnormal pregnancies.

A prospective study was initiated to closely examine maternal serum concentrations of CA-125 during the early first trimester of normal and abnormal pregnancies. Sequential serum specimens were obtained from 43 women with a normal intrauterine pregnancy, 20 with a surgically confirmed ectopic gestation and 10 whose pregnancies ended in spontaneous abortion. In normal pregnancies the CA-125 levels increased significantly from the first week after the missed menses (39.9 +/- 8.2 U/mL [mean +/- SEM]) to the second week (48.3 +/- 6.9 U/mL) (P less than .05) and from the second to the third week (62.5 +/- 9.8) (P less than .05). After the third week after the missed menses the mean CA-125 serum concentrations plateaued, but levels observed during the fourth (59.6 +/- 8.8 U/mL) and fifth (48.8 +/- 7.2 U/mL) weeks were still significantly greater than at week 1. In addition, the mean CA-125 concentrations were significantly higher in normal pregnancies than in ectopic gestations during the second, third and fourth weeks after the missed menses. Although there was a tendency for the CA-125 levels to be lower in women who had a spontaneous abortion when compared to normals, these differences were not statistically significant. Serum levels of CA-125 may prove useful in monitoring early pregnancy.

Abortion, Spontaneous↗

PubMed1989

Observation of production of immunoactive prolactin by normal human connective tissue in cell culture.

Data from our in vitro studies indicate a new source of prolactin (PRL)-like activity, normal human connective tissue. Fascial cells from primary culture and subsequent passages produced an extracellular antigen which specifically reacted in a radioimmunoassay RIA developed to detect human pituitary PRL. An initial peak or first surge of fascial PRL-like activity occurred between 4 and 15 d in primary culture. Ibuprofen, cytotoxic levels of 0.01% azide, or 7.5 mM EDTA and medium lacking serum [fetal bovine serum (FBS)] significantly (P less than or equal to 0.05) reduced PRL-like activity levels, whereas female steroids, 257 to 342 milliosmolarity, 1 to 3.6 mg/ml glucose, 2 to 20% FBS, and dialyzed FBS (MWCO approximately 1 kDa) were without effect. Optimum production of PRL-like activity occurred at pH 7.3. A second surge began after 18 d and continued until passage indicating that perhaps two populations of cells produced PRL-like activity in primary culture. Production of PRL-like activity by cells from early passages (1 and 2) became detectable at confluence, was serum-dependent, showed two patterns (tonic, rising to plateau), and averaged 3.2 fg.cell-1.3 d-1 feed interval. Cells from late passages showed morphologic damage from repetitive trypsinization, aging, and reduced production of PRL-like activity with aberrant production pattern. Production of PRL-like activity was maintained in an unusual long-term culture. These in vitro studies demonstrate the most recently recognized and ubiquitous source of human extrapituitary PRL or PRL-like activity, normal connective tissue (fascia).

Abdominal Muscles↗

PubMed1989

Absence of progestational activity of oral spironolactone.

Menstrual irregularity is a recognized side effect of spironolactone when used as a treatment for hirsutism in women. This effect has been attributed to the progestational activity of spironolactone observed in animal models. However, when oral spironolactone was given to women with appropriately estrogen-primed endometrium, secretory transformation of the endometrium was absent in comparison with control cycles. When control cycles were repeated with the addition of spironolactone, a decidualized endometrial response was seen. These findings suggest that spironolactone at clinically used dosages does not act as a progestin or an antiprogestin on the human endometrium.

Endometrium↗

PubMed1989

A second puncture probe for laparoscopic delivery of the Nd:Yag laser.

A prospective trial was initiated to determine the efficiency and safety of a laparoscopic second puncture probe designed to deliver the Nd:Yag laser. A contact technique was used to treat 32 women with either endometriosis (N = 23) or post-inflammatory pelvic adhesions (N = 9). The delivery system proved to be safe and provided easy access to all areas of pelvic pathology. The potential advantages over the CO2 laser include improved hemostasis, decreased plume formation, the ability to incise adhesions safely without a backstop, and effective transmission of the laser energy through fluids.

Adnexal Diseases↗

PubMed1989

Prostaglandin F2 alpha synthesis and metabolism by luteal phase endometrium in vitro.

Differences in prostaglandin (PG) F2 alpha synthesis and degradation were sought between early luteal endometrium (histology day 15 to 22, n = 6) and late luteal endometrium (histology day 23 to 28, n = 6). In addition, alterations in PGF2 alpha synthesis and degradation in response to 17 beta-estradiol (E2) and progesterone (P) were examined to clarify the mechanism of steroid modulation of endometrial PG production (n = 12). Endometrium was maintained in tissue culture and the concentration of PGF2 alpha and 13,14 dehydro-15 keto F2 alpha (DHKF2 alpha) was determined in spent media by radioimmunoassay. Prostaglandin F2 alpha and DHKF2 alpha output from luteal endometrium exposed to P and E2 + P were both significantly reduced when compared with no addition or E2 treatments. This implies that the modulation of PGF2 alpha output by P in vitro is secondary to altered synthesis. There was an increase in PGF2 alpha output from late luteal endometrium when compared with early luteal endometrium in the P and E2 + P treatments, but DHKF2 alpha remained unchanged. These data imply that the temporal increase in PGF2 alpha output is the result of alterations in both PG synthesis and catabolism.

Culture Techniques↗

PubMed1988

Physicochemical characterization and functional activity of fibroid prolactin produced in cell culture.

Evidence from our laboratory with the use of cultured (primary and passaged) cells has extended our initial observation that human uterine fibroid is an extrapituitary source of prolactin. Fibroid prolactin antigen in conditioned medium reacted specifically in radioimmunoassay for human pituitary prolactin. Control experiments demonstrated that the radioimmunoassay results were not spurious due to degradation of tracer 125I-labeled prolactin. Immunoparallel dilution curves indicated antigenic relatedness of pituitary and fibroid prolactin. In a calibrated Sephadex G-100 column, fibroid prolactin eluted in the same region (20.3 to 20.9 kd) as purified pituitary prolactin. Glycosylated prolactin, detected by concanavalin A affinity column chromatography, appeared to constitute only a small percentage of fibroid prolactin made in culture. The ratio of fibroid prolactin bioactivity (lactogen Nb2 lymphoma bioassay) to antigen (radioimmunoassay) was 0.77. These data indicate that human uterine fibroid tissue produces a molecule similar to or, perhaps, identical with pituitary prolactin.

Cells, Cultured↗

PubMed1988

Reproductive outcome after medical management of complicated pelvic inflammatory disease.

A significant proportion of women with PID will have their disease complicated by a TOC. We conclude that it is appropriate in women with this stage of PID to treat initially with clindamycin and an aminoglycoside. In addition, since more than half of the women will suffer reproductive difficulties, efforts to improve early diagnosis and therapy should continue. Based on our data, an early infertility evaluation is indicated in women wishing to conceive after complicated PID.

Aminoglycosides↗

PubMed1987

Norethindrone inhibition of testosterone secretion by an ovarian Sertoli-Leydig cell tumor.

A woman with severe hyperandrogenemia and virilization was found to have a fall in serum testosterone (T) concentration while taking an oral contraceptive containing norethindrone (500 vs. 164 ng/dL). Subsequent surgical exploration revealed an ovarian Sertoli-Leydig cell tumor. In vitro, the tumor secreted T (mean, 1.88 ng/mg X 4 h). hCG did not stimulate T secretion. In addition, norethindrone inhibited T secretion (0.33 ng/mg X 4 h). We conclude that norethindrone directly suppressed T production by the Sertoli-Leydig cell tumor.

Adult↗

PubMedDate not supplied

Serum concentration of protein CA-125 in women with pelvic inflammatory disease.

The concentration of the protein CA-125 in serum was determined in women with a normal pelvis visualized at laparoscopy (control group, n = 15) and compared with serum levels of this protein in women with pelvic inflammatory disease (PID) (n = 14). Mean serum concentrations of CA-125 were similar in the two groups: 17.4 +/- 2.3 (SE) units/ml for the control group vs. 17.0 +/- 4.3 units/ml for those with PID (P greater than 0.05). In addition, women with chlamydial cervicitis, histologically confirmed endometritis, and laparoscopically documented salpingitis had CA-125 levels that were not significantly different from those of controls. We conclude that serum levels of CA-125 will not be useful in the diagnosis of PID.

Antigens, Tumor-Associated, Carbohydrate↗