Biomedical subjects

Jeffrey M Goldberg

Publications and source records attributed to Jeffrey M Goldberg.

7 recordsLinked to original sources

PubMed2003

Heterophile antibody blocking agent to confirm false positive serum human chorionic gonadotropin assay.

BACKGROUND: Persistently false positive human chorionic gonadotropin (hCG) test results in the absence of an intrauterine pregnancy may lead to a diagnosis of ectopic pregnancy or gestational trophoblastic neoplasia and unnecessary testing and therapy. CASE: A 38-year-old woman on oral contraceptives and a 53-year-old perimenopausal woman presented with persistently elevated serum beta-hCG levels from 30 to 225 mIU/mL. Both women had a history of working with mice. Urine hCG testing was negative. Serum beta-hCG levels for both patients were negative after pretreatment of their serum with a heterophile antibody blocking agent. CONCLUSION: These cases illustrate that serum heterophile antibodies can interfere with the hCG enzyme immunoassay and result in false positive values. The addition of heterophile blocking agent to the serum can exclude false positives, thereby preventing unnecessary evaluation and treatment.

Adult↗

PubMed2003

Laparoscopy for adnexal masses in the second trimester of pregnancy.

STUDY OBJECTIVE: To assess the safety of laparoscopic treatment of adnexal masses in the second trimester of pregnancy. DESIGN: Retrospective chart review (Canadian Task Force classification II-3. SETTING: Large tertiary care medical center. PATIENTS: Eleven women. INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: All masses were identified by ultrasound. The average gestational age at the time of surgery was 17 weeks, 4 days. In seven women the primary cannula was inserted in the left upper quadrant of the abdomen. Procedures were eight ovarian cystectomies, two oophorectomies, and one exploratory laparoscopy. Average operating time was 135 minutes (range 95-195 min). Average time exposed to carbon dioxide was 78 minutes (range 59-135 min). None of the masses was malignant. There were no fetal complications or malformations. No patients had preterm labor and all delivered at term. CONCLUSIONS: The increasing number of reported cases and our experience suggest that laparoscopic treatment of adnexal masses in the second trimester is safe and effective, but the surgeon must be skilled in advanced techniques of laparoscopic surgery.

Adnexal Diseases↗

PubMed2003

Laparoscopic microsurgical tubal anastomosis with and without robotic assistance.

BACKGROUND: We previously reported our results with laparoscopic microsurgical tubal anastomosis with robotic assistance. The purpose of this study was to compare the duration of the procedure and hospitalization, blood loss and clinical outcomes for laparoscopic microsurgical tubal anastomosis performed with and without robotic assistance. METHODS: This was a retrospective comparative case study in an academic tertiary referral centre. Laparoscopic microsurgical tubal anastomosis was performed on 10 women with robotic assistance and the subsequent 15 patients underwent the procedure without the robot. The length of the procedure, estimated blood loss (EBL), time until hospital discharge, tubal patency and clinical pregnancy rates were compared. RESULTS: The operative times were 2 h longer with robotic assistance (P < 0.001). The increased EBL with the use of the robot (70 +/- 68 ml versus 20 +/- 16 ml) was statistically but not clinically significant. The robot provided no benefit in patient recovery. Tubal patency and clinical pregnancy rates were not significantly different. CONCLUSIONS: Robotic assistance increases operative times of laparoscopic tubal anastomosis without an appreciable improvement in patient recovery or clinical outcomes.

Adult↗

PubMed2003

Robotic surgery.

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Forecasting↗

PubMed2002

Vitamin C and vitamin E supplementation reduce oxidative stress-induced embryo toxicity and improve the blastocyst development rate.

To evaluate the adverse effects of exogenously induced reactive oxygen species (ROS) on mouse embryo development by using the 12-phorbol 13-myristate acetate (PMA)-activated leukocyte model as a source of ROS, and to examine the protective effect of antioxidant supplementation (vitamin C and vitamin E). Prospective study. Research laboratory. Effects of ROS on the blastocyst development rate in the presence and absence of antioxidant supplementation. After incubation with the PMA-activated leukocyte supernatant, the median (25th, 75th percentile) rate of blastocyst development significantly decreased from 73% (60%, 80%) after 3 hours to 30% (20%, 40%) after 6 hours compared with control reactions (86% [80%, 100%]). Co-incubating the embryos with vitamin C (50 microM) and the PMA-activated supernatant significantly increased the blastocyst development rate from 73% (60%, 80%) to 90% (80%, 91%) at 3 hours and from 30% (20%, 40%) to 91% (89%, 91%) at 6 hours-a level similar to that of control reactions. The blastocyst development rate increased after vitamin E supplementation (400 microM) at 6 hours, but not significantly and not by as much as after vitamin C supplementation. Exposure of mouse embryos to ROS for extended periods results in embryotoxicity. Vitamin C is more effective than vitamin E in reversing ROS-induced mouse embryo toxicity.

Animals↗

PubMed2002

Empiric vaginal metronidazole in the management of the ASCUS Papanicolaou smear: a randomized controlled trial.

OBJECTIVE: To determine whether empiric treatment with vaginal metronidazole in women with atypical squamous cells of undetermined significance (ASCUS) on Papanicolaou smear increases the number of cases that regress to normal on repeated cytologic studies. METHODS: A randomized double-masked trial was designed to compare women with ASCUS on screening Papanicolaou smear who received vaginal metronidazole, 37.5 mg twice daily, or placebo gel twice daily, for 5 days. Normalization of repeated Papanicolaou smear at 3 months was the primary end point. Regression to normal between the two groups was compared by chi2 analysis. Power analysis required 45 women per study arm to demonstrate a 50% improvement in regression to normal among the metronidazole-treated women, at alpha = 0.05 and 80% power. RESULTS: One hundred and six tubes of gel were dispensed, 54 metronidazole and 52 placebo. Eighty-four women (79%) returned for repeated cytologic examination at a mean of 6.5 months. Overall, 50 women (60%) had normal findings on repeated cytologic examination, and 34 (40%) had persistent abnormal findings. Twenty-two women had repeated ASCUS, and 11 had squamous intraepithelial lesions (SIL) on repeated cytologic examination. Regression to normal was found in 22 (54%) metronidazole-treated women and 28 (65%) placebo recipients. The number of cases of repeated ASCUS (31% versus 25%) or SIL (15% versus 10%) were similar between the two groups. CONCLUSIONS: Empiric vaginal metronidazole does not improve the management of women with ASCUS on Papanicolaou smear and should be discouraged.

Administration, Intravaginal↗

PubMed2002

Relationship between oxidative stress and embryotoxicity of hydrosalpingeal fluid.

BACKGROUND: Oxidative stress mechanisms are involved in the pathophysiology of many reproductive disorders. The objective of this study was to characterize oxidative stress parameters in hydrosalpingeal fluid (HSF) and examine their possible role in early embryo development. METHODS AND RESULTS: HSF was aspirated at laparoscopic salpingectomy in 11 infertile women. Reactive oxygen species (ROS), total (non-enzymatic) antioxidant capacity (TAC) and lipid peroxidation (LPO) were assayed. Two-cell mouse embryos were incubated with 25, 50 or 75% HSF and the blastocyst development rate was observed. ROS was detected in five of 11 (45%) HSF samples with a mean of 4.2 x 10(4) c.p.m. LPO was detected in all samples at a mean (+/- SD) value of 5575.4 +/- 6091.9 micromol/l malonaldehyde. The mean blastocyst development rate at 25, 5+/- 0 and 75% HSF and in the control group was 88.9 +/- 9.4, 65.7 +/- 19.1, 45.7 +/- 5.7 and 96.7% respectively (P < 0.0001). The blastocyst development rate was positively correlated to ROS concentrations (P < 0.02) but was not significantly related to LPO. CONCLUSIONS: The blastocyst development rate decreased with increasing concentrations of HSF. For the first time, the presence of ROS, LPO and TAC activity in human HSF was characterized. A possible role of oxidative stress in the embryotoxicity of HSF is suggested.

Animals↗