Biomedical subjects
Publications and source records attributed to N Gleicher.
Pelvic abscesses may develop after retention of foreign bodies. A case is presented in which during drainage of a post cesarean section pelvic abscess a small piece of a latex glove was recovered. The formation of pelvic abscesses due to foreign bodies is discussed.
Ultrasonic volume evaluation of the endometrium was performed on 19 spontaneously ovulating and 48 ovulation-induced women and correlated to E2 and P values in peripheral blood. No statistical correlations were obtained between either hormone level and any of the sonographically obtained parameters except for E2 levels in reference to the anteroposterior diameter of the endometrium in stimulated cycles (R = 0.29; P less than 0.05). It is concluded that the sonographic evaluation of the endometrium does not contribute to the evaluation of either spontaneous or induced cycles.
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Previously sterilized women are generally considered protected against salpingitis. However, when we diagnosed salpingitis by laparoscopy in 48 patients during a 16-month period, we found four (8%) who had been previously sterilized. Therefore, contrary to generally stated belief, salpingitis may occur after interruption of tubal continuity.
Among 59 laparoscopically staged endometriosis patients, 28.8% tested positive for antinuclear antibody. Of 44 patients, 45.5% were lupus anticoagulant positive (greater than 1.3) and 20.5% were within a borderline range (1.2-1.3). Antinuclear antibody positivity was inversely related to stage of disease (P = .009); lupus anticoagulant positivity exhibited a similar trend, but did not reach statistical significance. Of 31 endometriosis patients, 64.5% exhibited immunoglobulin G (IgG) autoantibodies and 45.2% demonstrated IgM autoantibodies to at least one of 16 antigens investigated. Among IgG autoantibodies, those to phospholipids were most frequently detected, followed in order of frequency by antibodies to histones and nucleotides. The incidence of IgM autoantibodies was inverted, with antinucleotides appearing most frequently and antiphospholipids least frequently. A strong correlation was noted between the presence of lupus anticoagulant and antinuclear antibody with both IgG and IgM autoantibodies. These observations suggest that endometriosis is associated with abnormal polyclonal B cell activation, a classic characteristic of autoimmune disease. This contention is further supported in that immunoglobulin levels (particularly IgG) are elevated in patients with endometriosis, and more so in lupus anticoagulant-positive than lupus anticoagulant-negative endometriosis patients (P = .021).
It has been reported that bacteria may attach to motile spermatozoa, be carried through the cervix and uterus to the fallopian tubes, and cause acute salpingitis. In an attempt to mimic these conditions in vitro, we incubated Escherichia coli, Streptococcus faecalis, Pseudomonas aeruginosa, and Staphylococcus aureus with motile spermatozoa which then were allowed to migrate through a capillary filled with bovine cervical mucus. After satisfactory sperm migration through the mucus, the capillaries were broken and cultured at different distances from the original insemination site. Mucus fractions in proximity to bacterial inocula grew varying amounts of the pathogens. More distal fractions of mucus columns were generally culture-negative even though they contained motile sperm which had been exposed to bacteria. Migration of spermatozoa exposed to bacteria through bovine cervical mucus did not result in enhanced bacterial penetration.
Since the immune response in fetuses of mothers with systemic lupus erythematosus (SLE) is unknown, we investigated sera from six mothers and their paired offspring by enzyme-linked immunosorbent assay (ELISA) for the presence of a common anti-DNA idiotype (16/6 Id) and, as control, for the presence of an unrelated public idiotype of antibody to hepatitis B surface antigen (HBsAg). In addition, maternal as well as fetal sera were evaluated for the presence of antibodies to ssDNA, dsDNA, poly(I), poly (dT), RNA, cardiolipin, total histones and the presence of lupus anticoagulant. Clinically active SLE mothers showed in general increased IgG and, to a lesser extent, IgM autoantibody activity. Circulating lupus anticoagulant was detectable in clinically active mothers only. All offspring of clinically active SLE mothers showed increased IgG autoantibodies to a variety of antigens, while IgM antibodies were detected in only one fetus. In contrast, fetuses of clinically inactive mothers showed only minor IgG activity. Common anti-DNA-idiotype (16/6 Id) activity also correlated with disease activity in both maternal and fetal compartments. One clinically active mother was 16/6-negative; her offspring was, however, positive, indicating de novo production of the idiotype by the fetus. In contrast, a control anti-HBsAg idiotype was not detected in either maternal or fetal sera. It therefore appears that offspring of clinically active SLE mothers serologically reflect maternal disease activity. Furthermore, autoantibodies and common idiotype of autoantibodies can be found within the fetal compartment even in the absence of such antibodies in the maternal serum. Discrepancies between mothers and offspring in IgM-autoantibody levels and the presence of new idiotypes in fetuses are indicative of fetal de novo autoantibody production.
The effect of physiologic common free fatty acids (FFAs) on Mat 1376b ascites tumor cells in vitro and in vivo in F344 rats was investigated. Unsaturated fatty acids, such as palmitoleic (16:1), oleic (18:1), linoleic (18:2), linolenic (18:3), and arachidonic (20:4) acids, were significantly more effective killers of tumor cells in vitro than the corresponding saturated fatty acids of the same carbon length, including palmitic (16:0), stearic (18:0), and arachidic (20:0) acids. The saturated 16-carbon fatty acid (palmitic acid) was more toxic to tumor cells in vitro than the saturated 18-carbon (stearic) and 20-carbon (arachidic) acids. Injections of linoleic (18:2)-linolenic (18:3) acid combinations into rats inoculated with the tumor significantly enhanced the survival of the tumor-bearing animals. These results suggest that natural FFAs may under certain conditions be utilized as effective anticancer agents.
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Five in a series of ten patients with laparoscopically demonstrated salpingitis had cultures positive for Chlamydia trachomatis obtained from tubal and peritoneal surfaces. Spermatozoa were observed in the peritoneal fluid of three of these patients, and two had cultures positive for C trachomatis. C trachomatis was attached to spermatozoa recovered from the peritoneal cavity in both patients. This observation suggests that spermatozoa may serve as vectors for C trachomatis and spread this pathogen to the peritoneal surfaces of the uterus and fallopian tubes.
The most commonly used method to measure urinary protein involves a 24-hour urine collection. In a study of 54 specimens, we found excellent correlation between the protein content of a 24-hour urine collection and the protein/creatinine ratio of a single urine sample (r = 0.9936; P less than .0001). We conclude that the protein/creatinine ratio of a single urine specimen represents a highly accurate method to assess renal function in the pregnant patient, and seems clearly more practical than the 24-hour urine collection.
Total immunoglobulins, C3 and C4 complement, and autoantibodies to phospholipid antigens, histones, histone subfractions, and nucleotides were measured in serum and follicular fluids of 26 patients undergoing in vitro fertilization. Immunoglobulins and complement fractions appeared in statistically lower concentrations in follicular fluid than in serum. This gradient was clearly larger for immunoglobulin M (IgM) than for IgG, IgA, C3, or C4. Ten patients who were autoantibody positive to one or more of the evaluated antigens demonstrated statistically higher total IgG and IgM levels and lower C3 and C4 than 16 autoantibody negative patients. With regard to follicular fluid, positive patients had significantly elevated IgM levels in comparison with negative control patients, and significantly decreased C3 and C4 concentrations. Patients who were autoantibody positive in serum also exhibited uniformly abnormal follicular fluid autoantibodies. Positive patients had significantly higher IgG antiphospholipid antibodies in follicular fluid than controls, and demonstrated a similar trend for IgM and IgA antiphospholipid antibodies. Positive patients demonstrated no significant differences from negative patients in number of in vitro fertilization attempts, number of oocytes retrieved, fertilization rate, cleavage rate, and number of abnormal (granular) oocytes. However, positive patients experienced a lower pregnancy rate (5.4%) than negative patients (26.1%), although the difference did not reach statistical significance (P = .07). This observation strongly suggests that the presence of abnormal autoantibodies in the female may reduce the chance of pregnancy for in vitro fertilization patients. A similar effect of abnormal autoantibodies can then also be expected in attempts at spontaneous conception.
Chesley's classic long-term follow up study of eclamptic women clearly demonstrated the prognostic significance of parity in the differential diagnosis of various hypertensive diseases of pregnancy. Multiparous patients with eclampsia were different on long-term follow-up from primiparous eclamptic women. A logical conclusion from this observation is that multiparous and primiparous patient groups should be analyzed separately whenever hypertensive diseases of pregnancy are evaluated. This study is therefore an attempt to define the clinical profile of hypertension during pregnancy on the basis of parity alone. The prenatal and hospital records of 99 successive pregnant patients identified as hypertensive during a 1-year period at Mount Sinai Hospital Medical Center served as the study population. A group of 25 primiparous and 25 multiparous patients, all with uncomplicated pregnancies and normal deliveries in sequence during a 1-month period, served as normal nonhypertensive control groups. Various pregnancy parameters were statistically evaluated for study and control groups. Significant differences were found between hypertensive primiparous and multiparous patients in mean weight increase (p less than 0.05), gestational age at first increase in blood pressure (p less than 0.007), and time from first increase in blood pressure until delivery (p less than 0.008). The difference in birth weight was not significant between hypertensive groups. In contrast, among the control groups, multiparous patients had significantly larger offspring than primiparous patients (p less than 0.01). Weights of normal primiparous control women were almost identical to those of primiparous hypertensive women (3252.8 +/- 511.8 versus 3203.26 +/- 679.5 gm). Birth weights of offspring from multiparous hypertensive women, while not significantly different from those of primiparous hypertensive women, were significantly lower than those of multiparous control subjects (3093.94 +/- 898.7 versus 3593 +/- 305.6; p less than 0.01). No significant differences in a variety of laboratory findings, reflexes, edema, or mode of delivery were observed between the various groups. The clinical and laboratory presentation of hypertension in pregnancy may be similar between primiparous and multiparous patients. Nevertheless, clear differences do exist in both maternal presentation and impact of maternal disease on fetal growth and development. These differences strongly suggest a different pathophysiology as the underlying cause of hypertensive disease in primiparous and multiparous pregnant women.(ABSTRACT TRUNCATED AT 400 WORDS)
Transplantation of the uterus may be an optimal solution in young hysterectomized patients, in women with agenesis of the uterus or in severe uterine anomalies. In the human model, attempted tubal and ovarian homografts have usually failed. Eighteen rabbits underwent unilateral non-vascular uterine transplantation. Four rabbits underwent total unilateral uterine autograft. Three uteri showed severe inflammation and necrosis 72 h, 1 week and 1 month postoperatively. Thereafter, the operative technique was modified to avoid contamination from the vagina and four rabbits underwent supravaginal unilateral non-vascular autograft. Three uteri had preserved endometrial and myometrial structure on relaparotomy. The following four rabbits underwent homotransplantation of the uterus and showed acute rejection of the transplant. Under cyclosporine therapy three homotransplanted rabbits developed pelvic abscesses while three other rabbits showed preserved myometrial and endometrial structures.
To evaluate a potential bias between methods of birth control used and prescribed by physicians, we surveyed sexually active female physicians in regards to their own methods of birth control. When the contraceptive practices of female physicians are compared to those of the general population, no difference in use of various contraceptive methods is found. Among female obstetrician-gynecologists, however, the intrauterine device continues to be a disproportionally popular method of contraception. It is concluded that no gender bias exists in prescribing patterns of contraceptives since contraceptive use in female physicians is identical to that of the general populations.
The effects of a serial dilution of linoleic acid on human spermatozoa in whole semen was tested on 21 semen samples obtained from 11 normal volunteers. The minimal concentration of linoleic acid required to stop the movement of at least 75% of the moving sperm ranged from 1 to greater than 100 mg/dl. Fifteen of 21 (71%) of the semen samples were inhibited by added free fatty acids (FFA) concentrations that were less than or close to the physiologic concentration ranges of FFA in blood plasma (1 to 30 mg/dl). The immobilized sperm often formed aggregates similar to those formed by the action of autoantibodies against sperm cells. Preliminary studies conducted on a variety of other FFA have indicated that oleic acid (18/1) was less toxic than linoleic acid (18/2) and that linolenic acid (18/3) was more toxic than linoleic acid. The saturated FFA palmitic acid (16/0) and stearic acid (18/0) at concentrations up to 100 mg/dl showed little or no toxicity to sperm cells. It is suggested that FFA toxicity be included among physiologic factors that affect the motility and spontaneous aggregation of sperm cells.
Mean gestational sac volumes of 9 singleton pregnancies induced by human menopausal gonadotropin (hMG) measured by ultrasound were compared with mean gestational sac volumes obtained from 37 normal singleton pregnancies, 6 to 8 weeks from the last menstrual period. HMG-induced gestational sacs were smaller at 6 and 7 weeks of gestation, compared with normal pregnancies. Despite the initial lag in gestational sac volume, hMG-induced pregnancies subsequently demonstrated appropriate fetal growth as measured by crown-rump length measurements between 8 and 12 weeks. These pregnancies also demonstrated normal fetal growth patterns in the second and third trimesters of pregnancy, as assessed by clinical evaluation and ultrasound. These preliminary data suggest that early growth development in hMG-induced pregnancies may be different from that in spontaneously occurring pregnancies.