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J V Hamerlynck

Publications and source records attributed to J V Hamerlynck.

At least 19 recordsLinked to original sources
PubMed1995

Suspected ectopic pregnancy. What to do when human chorionic gonadotropin levels are below the discriminatory zone.

OBJECTIVE: To assess the value of a noninvasive diagnostic strategy in cases of suspected ectopic pregnancy when transvaginal sonography (TVS) and serum human chorionic gonadotropin (hCG) measurement show inconclusive findings. STUDY DESIGN: Prospective study of 85 patients without pregnancy detectable on initial TVS together with low hCG levels (< 1,500 IU/L). The diagnostic strategy combined the results of TVS, hCG measurements and time, according to a strict algorithm. RESULTS: Overall test results of the strategy were excellent: sensitivity, 0.94; specificity, 1.00; likelihood ratio of a positive test result, infinity; likelihood ratio of a negative test result, 0.06. The strategy revealed a new diagnostic entity, trophoblast in regression (TIR). TIR represents patients with declining hCG levels and unknown locations of their pregnancies, presenting a benign clinical picture, and constituted 54% of the population studied. CONCLUSION: This noninvasive diagnostic strategy proved to be very reliable. Because the strategy integrated expectant management of patients with declining hCG levels, it prevented many unnecessary surgical procedures. This was of great benefit for both patients with early intrauterine pregnancies and those with TIR.

Algorithms↗
PubMed1993

Laparoscopy: a dispensable tool in the diagnosis of ectopic pregnancy?

Laparoscopy is regarded as the final decisive diagnostic test in suspected ectopic pregnancy. The new non-invasive diagnostic methods of transvaginal sonography and serum human chorionic gonadotrophin (HCG) monitoring now challenge this pivotal role of laparoscopy. In this prospective study the diagnostic value of an algorithm, combining transvaginal sonography with an HCG cut-off level between 1000 and 1500 IU/l (IRP) was tested in 208 consecutive women at risk for ectopic pregnancy. Three diagnostic categories are designated by the algorithm: intra-uterine pregnancy (n = 73), ectopic pregnancy (n = 89), and trophoblast in regression (n = 46). The latter category represents patients in whom no pregnancy could be located by transvaginal sonography, with an initial HCG concentration < 1500 IU/l, declining during follow-up. The algorithm has a sensitivity of 0.97, a specificity of 0.95, a likelihood ratio for a positive test of 19.4, and a likelihood ratio for a negative test of 0.03. The described diagnostic strategy thus proved extremely reliable in the safe management of patients at risk for ectopic pregnancy, and renders laparoscopy obsolete.

Algorithms↗
PubMed1993

Transvaginal sonography and human chorionic gonadotrophin measurements in suspected ectopic pregnancy: a detailed analysis of a diagnostic approach.

In this prospective study among 208 high-risk patients with suspected ectopic pregnancy, the diagnostic value of transvaginal sonography and serum human chorionic gonadotrophin (HCG) measurements were analysed in detail. The absence of an intra-uterine gestational sac obviously was the most constant sonographic finding among patients with ectopic pregnancy (n = 89), with a very high sensitivity (0.99) but a low specificity (0.41). The application of different HCG cut-off levels improved specificity to 1.00 for values exceeding 4500 IU/l. Clinical utility obviously decreased, as many patients presented with HCG values well below this level. The additional effect of adnexal findings was analysed. Sonographic identification of an ectopic pregnancy was very specific (0.99) but had low sensitivity (0.56) because many ectopics were not detected. The additional effect of HCG values on these results was minor. The low HCG cut-off levels advocated in recent studies are questioned by the results of our analysis: whereas the combined use of sonography and HCG measurements is shown to be of great benefit, the limitations are also documented, underlining the need for re-evaluation at intervals of patients with low HCG values. The question of which cut-off level should be used in practice, however, hinges on a difficult choice between a certain specificity and clinical utility.

Adnexa Uteri↗
PubMed1990

[Norplant].

Explore the source record for details and available documents.

Adult↗
PubMed1988

Results of artificial insemination at home by the partner with cryopreserved donor semen: a randomized study.

The use of cryopreserved semen offers the possibility of home insemination by the instructed partner. A comparative study was designed whereby participants were randomly allocated to use home or clinic insemination for six cycles. If no pregnancy had occurred after six cycles, the site of insemination was switched to the opposite location for a maximum of six further cycles. Fifty-three women with primary infertility fulfilling all entry criteria entered the study. In the first 6 cycles out of 29 home starters, 13 pregnancies were conceived, whereas in 24 clinic starters 11 pregnancies occurred, yielding no statistical difference in pregnancy rate. Of 138 couples who did not meet the criteria in the same period, 45 opted for home insemination, resulting in 20 home-inseminated pregnancies. Again, for comparable subgroups no statistical difference in pregnancy rate between home and clinic insemination was found.

Evaluation Studies as Topic↗
PubMed1987

Postponement of withdrawal bleeding in women using low-dose combined oral contraceptives.

Postponement of menses is widely practised by women using oral contraceptives. One-hundred volunteers, consisting of three groups of women, each group using a different extensively used contraceptive regimen, were tested and compared. The test period consisted mainly of a double (monophasics) or extended (triphasics) pill cycle without a tablet-free interval. Based on daily records of vaginal bleedings as well as on the results of a questionnaire, it could be concluded that postponement of the withdrawal bleeding for twenty extra days was generally effective; the occurrence of the bleedings was related to the duration of postponement of menses and to the contraceptive regimen that was used. However, the introduction of a seven-week cycle pill is not yet a promising alternative since the majority of the volunteers preferred the inconvenience of a monthly withdrawal bleeding.

Adult↗
PubMed1986

[Current developments in the study and management of unwanted childlessness].

After some introductory remarks on the investigation of the infertile couple in general, more specific new technologies in diagnosis and ways of treatment of infertility are discussed. In the infertile male with a varicocele the advantages of phlebography and embolisation over surgical ligation of the internal spermatic vein is presented. The value of the hamster ovum penetration test in order to evaluate the fertilizing capacity of spermatozoa is commented. A new method for diagnosis of immunologic infertility in men is briefly explained as well as the possibility for treatment of immunologic infertility by means of corticosteroids. In women the indications and disadvantages of LHRH ovulation induction are presented as well as the advantages of monitoring follicle growth during ovulation induction or stimulation by means of ultrasound. The major breakthrough in infertility therapy of course is in vitro fertilization (IVF): only a few indications other than tubal occlusion are commented and the impact and some future aspects of IVF for other medical disciplines are briefly discussed.

Adult↗
PubMed1985

Phase II trial of medroxyprogesterone acetate in advanced ovarian cancer: an EORTC Gynecological Cancer Cooperative Group Study.

Progestin therapy of ovarian carcinoma in the past has been reported to lead to varying response rates. A multicenter phase II study of high-dose MPA was conducted in 53 patients with epithelial ovarian cancer who had received adequate trials of conventional therapy with cytotoxic agents. Forty-one patients were included for response and toxicity evaluations. Only one partial response has been recorded with a duration of 20 weeks. Stabilization of disease was observed in 7 patients. The present investigation shows that MPA given at the present high dose is not effective in patients extensively pretreated with chemotherapy.

Adenocarcinoma↗
PubMed1984

Randomised trial comparing two combination chemotherapy regimens (Hexa-CAF vs CHAP-5) in advanced ovarian carcinoma.

186 patients with advanced epithelial ovarian carcinoma were treated with either a combination of hexamethylmelamine, cyclophosphamide, methotrexate, and 5-fluorouracil (Hexa-CAF) or cyclophosphamide and hexamethylmelamine alternating with doxorubicin and a 5-day course of cisplatin (CHAP-5). Treatment with CHAP-5 resulted in more complete remissions as determined by laparatomy or peritoneoscopy (p = 0.004), better overall response (p = 0.0001), and longer overall survival and progression-free survival (p less than 0.002). Therapy, histological grade, and Karnofsky index were reliable predictors of overall response, whereas therapy, FIGO-stage, and size of residual tumour before chemotherapy were independent predictors for complete remission and for prolonged survival. Peripheral neurotoxicity was a major problem in patients assigned to the CHAP-5-group and was likely to be due to the simultaneous administration of hexamethylmelamine and cisplatin. The CHAP-5 regimen is one of the most effective regimens for the initial treatment of ovarian cancer.

Altretamine↗