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Biomedical subjects

N Gleicher

Publications and source records attributed to N Gleicher.

At least 109 records · Page 6Linked to original sources
PubMed1989

Ovarian development of the female child and adolescent: I. Morphology.

Ovarian morphology of 180 randomly selected females, aged 8-21, was investigated, utilizing standard sector scanning ultrasound techniques, at -1 year (1 year before menarche), year 0 (menarche) and years +1 to +8 (1-8 years postmenarche). According to strict morphologic criteria, seven ovarian patterns were recognized which varied in dominance with age in reference to menarche. Prior to menarche a multifollicular ovarian pattern (Type 1) dominates which after menarche is substituted by a predominantly active ovarian pattern (Type 5). Approximately 20% of postmenarcheal females do not develop this active pattern. In a relatively persistent percentage of females a microcystic (Type 2) ovarian pattern was recognized throughout all postmenarcheal years, suggestive of a normal transitional pattern from Type 1 to Type 5 ovaries. In contrast, multicystic (Type 3), hyperthecosis (Type 4), polycystic ("Mickey Mouse") (Type 6) and silent (Type 7) ovaries appear to represent abnormal ovarian developments. Based on percentage distributions, it is tempting to speculate that multicystic (Type 3) and/or hyperthecosis (Type 4) ovaries represent precursor ovaries to Type 6 (polycystic) ovaries. Confirmation of this hypothesis would have major clinical importance for the early diagnosis of the polycystic ovarian syndrome.

Adolescent↗
PubMed1989

Atraumatic antepartum subdural hematoma causing fetal death.

A case of atraumatic antenatal fetal subdural hematoma, severe enough to cause death, is reported. Although it is often associated with traumatic delivery, its occurrence before labor suggests that assumptions of causation require some medical investigation or corroboration before trauma is accepted as the etiologic factor.

Adult↗
PubMed1989

Conservative surgical management of interstitial pregnancy.

Conservative management of ampullary and isthmic tubal pregnancies has been increasingly advocated to preserve the affected tubes and results in excellent outcome. A similar approach to interstitial pregnancies is more difficult because of the vascularity of the cornual area. We report here a novel surgical approach to this problem in two patients. Both patients had an unremarkable postoperative course. Hysterosalpingograms performed 5 and 6 months postoperatively demonstrated bilateral tubal patency. It is suggested that conservative surgical management may replace either cornual resection or hysterectomy in selected patients with unruptured interstitial pregnancies.

Female↗
PubMed1989

The thromboelastogram and circulating lupus anticoagulant.

Abnormal lupus anticoagulant (LA) levels, as measured with the activated partial tissue thromboplastin and tissue thromboplastin inhibition tests, are associated with a predisposition toward thromboembolic phenomena. Thromboelastogram (TEG) measurements have been proposed as a standardized assay to predict such a predisposition. We therefore correlated LA and TEG assessments in 46 women who were either apparently healthy controls or who had abnormal LA levels with such conditions as endometriosis and repeated pregnancy wastage. The coefficient of correlation (Rho) was .3282 (P = .025). Seven patients with an abnormal LA demonstrated a normal TEG, and eight with a normal LA exhibited an abnormal TEG. Only nine had concomitant LA and TEG abnormalities. We conclude that LA and TEG apparently are not interchangeable as predictors of a hypercoagulable state. While this study did not address which of the two assays has a better predictive value for thromboembolic phenomena, it suggested that each can identify a different patient population.

Abortion, Habitual↗
PubMed1988

A successful program to lower cesarean-section rates.

Despite the consensus that national cesarean-section rates are excessive, they continue to rise. Currently, approximately one of every four deliveries is by cesarean section. We developed an initiative to reduce the number of cesarean deliveries to a rate of 11 percent of all deliveries at our inner-city hospital. Participation by attending physicians was voluntary and not linked to any sanction. The program included a stringent requirement for a second opinion, objective criteria for the four most common indications for cesarean section, and a detailed review of all cesarean sections and of individual physicians' rates of performing them. During the first two years of the program, the cesarean-section rate fell from 17.5 percent of 1697 deliveries in 1985 to 11.5 percent of 2301 deliveries in 1987 (P less than 0.05). The proportion of infants with five-minute Apgar scores lower than 7 increased from 3 percent in 1985 to 4.9 percent in 1987 (P less than 0.05), but neither the fetal mortality rate (11.9 per 1000) nor the neonatal mortality rate (11.2 per 1000) in 1987 differed significantly from the rates in 1985. A single maternal death, unrelated to cesarean delivery, occurred during the study. Rates of both primary and repeat cesarean sections decreased, although only the decline in the rate of primary cesarean sections, from 12 to 6.8 percent, was statistically significant (P less than 0.05). During the same period, operative vaginal deliveries (i.e., forceps deliveries and midpelvic procedures) declined from 10.4 to 4.3 percent (P less than 0.05) of total deliveries. We conclude that an initiative within an obstetrics department can reduce cesarean-section rates substantially without adverse effects on the outcome for mother or infant.

Apgar Score↗
PubMed1988

Autoantibodies and common idiotypes in men and women with sperm antibodies.

Antisperm antibodies have been implicated as a causative factor of infertility and pregnancy wastage. Since concomitant autoimmune phenomena were reported in men with antisperm antibodies, we investigated known antisperm antibody-positive sera from 25 women, 27 men, and the respective seminal plasma samples. The investigated autoimmune panel included a search for antinuclear antibodies, autoantibodies (in IgG, IgM and IgA isotypes) to seven phospholipids (cardiolipin, phosphatidylserine, phosphatidylglycerol, phosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, and phosphatidic acid), to four histone subfractions (H1, H2A, H3, H4), and to four polynucleotides [ssDNA, dsDNA, poly(I), and poly(dT)], total immunoglobulin levels, and sperm antibody titers. The sera were also evaluated for the presence of a common anti-deoxyribonucleic acid antibody, and anticardiolipin antibody idiotypes. Levels of sperm antibody titers were significantly lower in women than in men. Both men and women with antisperm antibodies demonstrated elevated total IgG levels compared with those of normal control subjects. Only women showed elevated levels of total IgM. Sera from 24% of women and 11% of men with antisperm antibodies demonstrated antinuclear antibody titers greater than 1:40. The most striking autoantibody abnormalities were found among antiphospholipid antibodies. Sera from women with antisperm antibodies demonstrated higher autoantibody production than was found in their male counterparts. A significant correlation was found between antisperm antibodies and IgM anticardiolipin and IgA anti-phosphatidylinositol in women and between sperm antibodies and IgA phosphatidylserine antibodies in men. The presence of anticardiolipin and anti-deoxyribonucleic acid antibody idiotypes was significantly more frequent in women than in men. By means of discriminant analysis and variables selected by this mathematical model, the identification of 24 of 25 women and 26 of 27 men with antisperm antibodies was correctly predicted. These results suggest that women and men respond differently to sperm antigens. The apparent cross-reactivity between sperm antibodies and other autoantibodies, usually associated with autoimmune disease, suggests that a polyclonal B cell activation, similar to that seen in autoimmune diseases, occurs in patients with sperm antibodies.

Adult↗
PubMed1988

The reproductive autoimmune failure syndrome.

The association between reproductive failure and abnormal autoimmune function has been recognized for decades in association with such established autoimmune diseases as systemic lupus erythematosus. Recent investigations have expanded this association to women who demonstrate similar humoral abnormalities as patients with defined autoimmune diseases but do not express any of the clinical symptoms required for the diagnosis of an autoimmune disease. The observation that abnormal autoimmune function in clinically asymptomatic patients can lead to reproductive failure has led us to define the reproductive autoimmune failure syndrome as a diagnostic entity. The present article summarizes evidence suggesting that the occurrence of reproductive autoimmune failure syndrome may be teleologically related to the woman's need for increased self-tolerance in face of antigenic exposure to the maternal haplotype of the fetus during normal pregnancy. This need for increased self-tolerance is documented by higher normal autoantibody levels in women than in men and may also be responsible for the highly increased incidence of autoimmune diseases in women in comparison with men. Under this concept, abnormal autoimmune function may lead to reproductive failure at different stages of the reproductive process, depending on the quality and possibly quantity of the abnormal autoimmune response.

Abortion, Habitual↗
PubMed1988

Immunologic aspects of IUD action.

Embryo implantation has been demonstrated to depend on specific lymphocyte populations within the uterine cavity. Intrauterine devices (IUD) exert their contraceptive action by prevention of embryo implantation via presently still unknown mechanisms. Therefore, mononuclear cell populations from mice uteri which either contained silastic or copper (Cu) IUD fragments or were sham-operated were evaluated, utilizing monoclonal antibodies against specific cell markers. Uterine horns, bearing IUD fragments, were significantly heavier than sham-operated horns. In Cu-IUD animals this effect extended even into the non-treated contralateral horn. The total number of lymphoid cells in IUD-bearing horns was significantly higher than in sham-operated horns. This observation was also made in non-treated contralateral Cu-IUD horns but not in contralateral horns of silastic-IUD-treated animals. Significant differences in percentages as well as absolute number of various lymphoid cell populations were noted between IUD-treated and sham-operated animals. Again, the effect was more pronounced in Cu-IUD-treated animals and extended in those animals into the contralateral horn. IUD-containing horns also demonstrated a significantly increased number of mast cells, with Cu-IUDs again resulting in a significantly more pronounced effect in both treated and contralateral horns. Sham-operated mice achieved a 67% pregnancy rate in both uterine horns. In contrast, IUD-treated animals demonstrated a significantly reduced pregnancy rate with silastic IUD fragments (15% and 30% for treated and contralateral horn, respectively) and a 0% pregnancy rate for Cu-IUD-treated animals (in either horn).

Animals↗
PubMed1988

Preliminary experience with transcervical balloon tuboplasty.

We developed a new technique, transcervical balloon tuboplasty, an adaptation of established balloon angioplasty techniques that facilitates recanalization of proximally occluded oviducts. Sixteen patients with obstruction of the proximal portion of one or two fallopian tubes (based on at least two hysterosalpingograms and one laparoscopic examination) were selected for the procedure. Four patients (25%) were found to have patent oviducts on intraoperative third tubal patency evaluation and were therefore excluded from study. Of the remaining 12 patients, tubal patency was achieved in at least one fallopian tube in 7 patients (58%), as demonstrated by hysterosalpingogram immediately after the transcervical balloon tuboplasty procedure. On follow-up 2 months to 1 year afterward, two pregnancies and one delivery occurred. We conclude that transcervical balloon tuboplasty appears to represent a useful and safe technique to achieve patency in selected cases of tubal interstitial obstruction. Reocclusion rates, long-term complication rates, and pregnancy rates after transcervical balloon tuboplasty remain to be established before the procedure should be considered a recommended alternative for either surgical tuboplasty or in vitro fertilization.

Adult↗
PubMed1988

Spontaneous recanalization of cornual tubal occlusion following a pregnancy achieved by in vitro fertilization.

A patient with bilateral tubal occlusion conceived by IVF and delivered a healthy infant vaginally. Four months postpartum, the patient again conceived spontaneously and carried to term. Recanalization of one fallopian tube was demonstrated on HSG performed after delivery of the second infant. Mechanical stretching and pregnancy-induced hormonal changes may explain spontaneous recanalization of obstructed fallopian tubes.

Adult↗
PubMed1988

Danazol but not gonadotropin-releasing hormone agonists suppresses autoantibodies in endometriosis.

The effect of treatment with danazol (n = 10) or gonadotropin-releasing hormone agonists (GnRH-a) (n = 10) on autoantibody (AA) production (IgG, IgM and, IgA to 6 phospholipids, 5 histones, and 4 polynucleotides) in endometriosis was evaluated blindly in a longitudinal, prospective, randomized study. Clinical improvement, ovarian suppression, and resolution of endometriosis were comparable in both groups. Approximately 50% of patients had significant AA abnormalities initially. During treatment with danazol but not GnRH-a, AA gradually decreased in concentration and in number/patient. Total immunoglobulin levels (IgG, IgM, and IgA) also decreased only in the danazol group. This study indicates that danazol, but not GnRH-a, lowers abnormal AA associated with endometriosis.

Adult↗
PubMed1988

Effects of short-term dietary restriction on survival of mammary ascites tumor-bearing rats.

We studied the effects of short-term dietary restriction on the survival of 3-4-month-old tumor-free and tumor-bearing Fisher rats. The diet-restricted food regimen consisted of alternate day ad libitum feeding followed by alternate day fasting. Diet-unrestricted control rats were fed ad libitum daily. Six tumor-free rats on the diet-restricted regimen compensated for the dietary restriction by an increase in food consumption during the alternate feeding days, and lost an average of only 2-3% of their weight in 13 days. Six tumor-free rats on a daily ad libitum feeding regimen gained an average of 6.8% in 15 days. The above dietary-restricted regimen was initiated 1 week before 24 rats were inoculated intraperitoneally with 15 million Mat 13762 ascites tumor cells. Sixteen of 24 (66.7%) diet-restricted tumor-bearing hosts and 5/24 (20.8%) diet-unrestricted tumor-bearing hosts survived at 9 days after tumor inoculation (p less than 0.005). Twelve of 24 (50%) diet-restricted tumor-bearing hosts, and 3 of 24 (12.5%) diet-unrestricted tumor-bearing hosts, survived at 10 days after tumor inoculation (p less than 0.025). Thus, the survival of tumor-bearing rats was enhanced by short-term relatively mild dietary restrictions. We suggest that relatively mild dietary restrictions should be included in clinical trials designed to inhibit cancer growth and enhance the survival of human cancer patients.

Animals↗
PubMed1988

Definition of normal autoantibody levels in an apparently healthy population.

Clinically asymptomatic women with laboratory abnormalities in autoantibody profiles have recently been shown to experience reproductive failure. The evaluation of autoantibody panels and the establishment of normal cutoff values in clinically apparently healthy populations has therefore achieved increasing importance. Investigation of 400 clinically asymptomatic patients (200 females and 200 males) for the presence of autoantibodies to six phospholipids, five histone subfractions, and four polynucleotides revealed a nonparametric distribution of autoantibodies primarily for antiphospholipids and antihistone antibodies. This observation suggests that widely used parametric methods for the determination of normal autoantibody levels are inadequate and will give an unreasonably high incidence of abnormal results. Consequently, rather than the widely used 95% confidence interval, we used the 99% confidence interval (based on medians) to determine the upper limit of normal for various autoantibodies. This resulted in the detection of four to 13 positive patients (out of 400) per antigen, for a positivity rate of 1-3%. A more rigid definition of normal and abnormal autoantibody levels is essential to pursue accurately diagnostic and therapeutic considerations concerning the newly evolving concept of subclinically abnormal autoimmunity.

Adult↗
PubMed1988

Incidence of Chlamydia trachomatis in peripartum fallopian tubes.

We investigated the presence of Chlamydia trachomatis in fallopian tubes of patients undergoing Pomeroy tubal ligation in the immediate postpartum period with culture on cycloheximide-pretreated McCoy cells and with immunofluorescence staining. Two of 20 women were culture positive in both tubes, representing 10% culture positivity. Both patients were multiparous and black and reported no previous history of either pelvic inflammatory or sexually transmitted disease. Neither developed intrapartum or postpartum fever or any other signs of infection. These findings indicate that C trachomatis can be present in tubes of symptom-free pregnant women and not cause infectious morbidity either prepartum, intrapartum or postpartum.

Adult↗
PubMed1988

Improved penetration of spermatozoa into uterine fluids of women with abnormal postcoital tests.

Cervical mucus-uterine fluid cross-penetration of husbands' and control sperm was assessed in 13 couples with poor or negative postcoital tests. Cervical mucus scoring and tray agglutination test identified six women with sperm-agglutinating antibodies and seven women with cervical dysmucorrhea. All males were normozoospermic, with penetration into control cervical mucus and control uterine fluids. Control sperm penetrated into cervical mucus and uterine fluids of three and five of the women with sperm-agglutinating antibodies and cervical dysmucorrhea, respectively. Penetration of husbands' spermatozoa into uterine fluids of patients with sperm-agglutinating antibodies was lower than that of control semen (P less than .05). Control and husbands' sperm penetration into uterine fluids of women with cervical dysmucorrhea were identical. In both groups, husbands' and control sperm penetrated uterine fluids more frequently than cervical mucus (75 versus 12%; P less than .001). On a six-month follow-up and midcycle intrauterine inseminations, six patients (46%) conceived. We conclude that uterine fluids of patients with sperm-agglutinating antibodies and cervical dysmucorrhea may provide a better milieu for spermatozoa than cervical mucus. This observation suggests a rationale for intrauterine inseminations to achieve pregnancy.

Antibodies↗
PubMed1987

Breech delivery: why the dilemma?

A critical review of selected studies of breech delivery is presented with special attention to the statistical analysis of outcome for low birth weight and term breech delivery. Analysis of the data fails to support the routine use of cesarean birth for all cases of breech delivery except for those with hyperextension of the head. The implication of these findings is discussed.

Breech Presentation↗