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Biomedical subjects

N Gleicher

Publications and source records attributed to N Gleicher.

At least 145 records · Page 8Linked to original sources
PubMed1986

Pregnancy and autoimmunity.

Clinical immunology, already a subspecialty within internal medicine, is achieving increasing importance within the field of reproductive medicine. The recent recognition that subclinical autoimmune processes may be causally related to repeated early-pregnancy loss has allowed for the conceptional connection between the fields of infertility and obstetrics. While the immunology of infertility has been in mainstream clinical practice for years, clinical application of immunologic knowledge in obstetrics has somewhat lagged behind. The review presented here is an attempt to summarize recently recognized immune processes which affect pregnancy. Pregnancy seems particularly susceptible to immunologic interference during the very early and very late stages of gestation. During early pregnancy subclinical autoimmune processes seem capable of causing both pregnancy loss as well as congenital fetal abnormalities such as congenital heart block. Very acutely occurring immune processes in late pregnancy can endanger both maternal and fetal life and need therefore to be clinically recognized as such. The considerable progress in the clinical immunology of pregnancy made over the last few years needs to be continued by defining the clinically observed processes immunologically and biochemically in more detail. The thus obtained knowledge will not only benefit the clinical management of immunologically affected pregnancy, but will also enhance the general understanding of many far wider-reaching immunological processes. After all, pregnancy represents an unique model of nature.

Abortion, Habitual↗
PubMed1986

Pitfalls in sonographic imaging of the incompetent uterine cervix.

Artifacts interfering with sonographic imaging of the uterine cervix in pregnancy are described. Increasing the amount of fluid in the urinary bladder closes the cervix and alters the configuration of the lower uterine segment, while increased intra-uterine pressure results in reciprocal changes. Angulation of the transducer and manual pressure thereon distort sonographic findings. It is concluded that, contrary to recent reports in the literature, sonography cannot reliably demonstrate changes in cervical compliance during pregnancy. Vaginal examination remains the ultimate diagnostic modality for the diagnosis of the incompetent cervix, while sonography may be used as an adjunct only.

Cervix Uteri↗
PubMed1986

Effect of ejaculation frequency on sperm quality.

Sixty-four normozoospermic and 19 oligozoospermic males underwent sperm analyses of two successive specimens obtained at 1-, 2-, and 3-day intervals. The first specimen was produced after 3 days of abstinence. Sperm volume of normozoospermic males declined from 2.3 +/- 1.0 to 1.6 +/- 1.0 ml, 2.6 +/- 1.0 to 2.0 +/- 0.9 ml, and 2.1 +/- 0.9 to 1.9 +/- 1.0 ml at 1-, 2-, and 3-day intervals, respectively. Similarly, oligozoospermic males showed declines from 2.3 +/- 1.2 to 1.7 +/- 1.5 and 2.3 +/- 1.1 to 1.8 +/- 1.2 and an increase from 1.2 +/- 1.2 to 1.5 +/- 0.7 ml, respectively. Sperm counts of normozoospermic males declined from 65 +/- 54 to 55 +/- 34, 83 +/- 57 to 69 +/- 47, and 97 +/- 51 to 81 +/- 46 million spermatozoa/ml at 1-, 2-, and 3-day intervals, respectively. Oligozoospermic males showed declines from 5.1 +/- 5.4 to 3.8 +/- 4.1 and 8.2 +/- 8.6 to 7.2 +/- 5.2 and an increase from 3.8 +/- 0.6 to 5.7 +/- 2.1 million spermatozoal/ml at 1-, 2-, and 3-day intervals, respectively. Sperm motility of normozoospermic males varied from 41 +/- 20 to 38 +/- 18, 55 +/- 14 to 56 1/3 pm 14, and 52 +/- 15 to 52 +/- 20% at 1-, 2-, and 3-day intervals, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Ejaculation↗
PubMed1986

Prenatal sonographic diagnosis of Hirschsprung's disease.

The prenatal sonographic presentation of Hirschsprung's disease is described. This report strongly suggests that bowel distention in Hirschsprung's disease may begin in the late third trimester of intrauterine life. The importance of early diagnosis and treatment cannot be overemphasized. Sonography may greatly contribute to the early diagnosis of Hirschsprung's disease.

Adult↗
PubMed1986

The predictive value of hCG beta subunit levels in pregnancies achieved by in vitro fertilization and embryo transfer: an international collaborative study.

Serial human chorionic gonadotropin (hCG) beta subunit measurements of 300 pregnancies achieved by in vitro fertilization (IVF) were obtained by 15 IVF centers worldwide. Hormonal curves were established for 164 normal singleton pregnancies, 25 normal multiple gestations, 60 chemical pregnancies, 41 first-trimester spontaneous abortions, and 10 ectopic pregnancies. In comparison to the normal singleton pregnancy curve, chemical pregnancies and spontaneous abortions showed statistically lower hCG levels. hCG levels of ectopic pregnancies, compared with normal singleton gestations, were lower from days 7 to 14. It is concluded that beta-hCG determinations of in vitro fertilized pregnancies allow pregnancy diagnosis as early as 7 to 9 days after embryo transfer (ET) and will permit early discrimination between normal and abnormal IVF pregnancies. A single beta-hCG determination on day 9 after ET may discriminate chemical, ectopic pregnancy or impending miscarriage from a normal gestation. An hCG determination on day 17 will predict early normal development of an IVF pregnancy.

Abortion, Spontaneous↗
PubMed1986

Does cyclic human chorionic gonadotropin secretion indicate embryo loss in in vitro fertilization?

The human chorionic gonadotropin (hCG) beta subunit curve of normal singleton in vitro fertilization (IVF) pregnancies shows cyclic peaks during the first 56 days after embryo transfer (ET). This phenomenon is not demonstrable in normal spontaneous conceptions. The hCG curves of 151 singleton IVF pregnancies achieved by transfer of two, three, and four embryos therefore were compared statistically with the hCG curves of singleton IVF pregnancies achieved by transfer of only one embryo. The hCG levels of singleton IVF pregnancies achieved by transfer of more than one embryo had statistically higher hCG levels at 7 and 8, 19 and 20, and 37 and 38 days after ET. In a separate evaluation it was observed that declines in hCG levels of normal singleton IVF pregnancies preceded four of five first-trimester abortion incidence peaks of singleton IVF pregnancies. The observed cyclic hCG secretion may be indicative of early embryo deaths. This observation supports the contention that multiple ET results in significantly more multiple implantations than previously appreciated. Thus embryo survival in utero may represent another major contributory factor to success or failure of IVF.

Chorionic Gonadotropin↗
PubMed1986

Intrauterine inseminations with washed human spermatozoa.

The success of intrauterine inseminations with washed human spermatozoa was evaluated in four groups of patients. The first two groups were couples in whom either the man or the woman had detectable circulating sperm-agglutinating antibodies. The third group included couples where the woman exhibited hostile or absent cervical mucus, whereas the fourth group represented couples with oligozoospermic males. The couples underwent 3.7 +/- 2.1 insemination cycles, with a 30% overall pregnancy rate for all four groups. Intrauterine inseminations of women with hostile cervical mucus yielded a 68% conception rate. Couples with either male or female serum sperm-agglutinating antibodies showed 25% and 40% pregnancy rates, respectively. However, none of the couples with oligozoospermic males achieved pregnancy. Intrauterine inseminations with washed human spermatozoa thus represent a satisfactory method of achieving pregnancy in women with hostile cervical mucus and in couples with circulating sperm agglutinating antibodies. Couples in whom oligozoospermia has been identified as the principal cause of infertility do not seem to benefit from this therapy.

Adult↗
PubMed1986

Transcervical balloon tuboplasty.

TBT is a new technique that by use of a balloon catheter technique in a fashion similar to that of balloon angioplasty allows reestablishment of tubal patency in selected cases of tubal occlusion. The case presented here describes the first transcervical dilatation and recanalization of a proximally occluded fallopian tube in a patient with infertility.

Adult↗
PubMed1986

A new stirrable catheter for gamete intrafallopian tube transfer (GIFT).

Cannulation of the fimbriated end of the fallopian tube during gamete intrafallopian tube transfer (GIFT) may be at times extremely difficult and even require minilaparotomy. An ideal laparoscopic GIFT catheter should be flexible and stirrable, have a small diameter, and yet be sturdy enough to enable its manipulation. Such a catheter was developed in collaboration with Cook Ob/Gyne, a Division of Cook Inc., Indiana, with primary emphasis on easy laparoscopic manipulation. Its use in eight attempts of GIFT resulted in three pregnancies (37%).

Catheterization↗
PubMed1985

IgM gammopathy and the lupus anticoagulant syndrome in habitual aborters.

Recent reports strongly suggest an association between a laboratory picture of autoimmunity in the absence of clinical signs and symptoms and the recurrence of spontaneous pregnancy loss. This association seems particularly strong when circulating lupus anticoagulant is present and has therefore been called the circulating lupus anticoagulant syndrome. We present four patients with this syndrome who in addition to the asymptomatic autoimmune laboratory picture were also found to exhibit a distinct IgM gammopathy. In view of earlier reports that implicated IgM in poor pregnancy outcome, particularly in association with systemic lupus erythematosus, it is suggested that all patients with circulating lupus anticoagulant syndrome be evaluated for an IgM gammopathy. A fraction of IgM may be detrimental to development and growth of the normal fetal placental unit and may thus be implicated in repeated early pregnancy loss.

Abortion, Habitual↗
PubMed1985

Fetal heart rate in maternal hypoglycemic coma.

In pregnancies complicated by diabetes mellitus fetal heart rate (FHR) monitoring is widely utilized to detect early fetal compromise. Never, however, was the fetal heart rate monitored during a maternal hypoglycemic coma. Such a case is here presented.

Adult↗