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Biomedical subjects

N M Fisk

Publications and source records attributed to N M Fisk.

At least 217 records · Page 12Linked to original sources
PubMed1989

Transvaginal ultrasonic assessment of endometrial growth in spontaneous and hyperstimulated menstrual cycles.

Endometrial thickness and reflectivity were assessed by transvaginal ultrasound in both spontaneous and hyperstimulated menstrual cycles. Two groups of women with ovulatory cycles were examined; women in group 1 had unexplained infertility and women in group 2 were having artificial insemination by donor because of reduced spermatogenesis; a third group (group 3) comprised women with tubal infertility undergoing hyperstimulation for in-vitro fertilization. There was no difference in endometrial thickness or reflectivity between the three groups. A basic pattern of endometrial appearance common to all cycles was found, consisting of hypoechoic, isoechoic and hyperechoic images, occurring in the early follicular, late follicular and luteal phases, respectively. In all three groups a positive correlation was found between proliferative phase plasma oestradiol concentration and endometrial thickness. Group 1 r = 0.403, P less than 0.01; group 2 r = 0.439, P less than 0.01; and group 3 r = 0.617, P less than 0.01. There was a progressive increase in endometrial growth throughout the normal cycle until a plateau was reached 5 days after the LH surge. This pattern was also seen without acceleration of the process in hyperstimulated cycles, despite supranormal levels of oestrogen. Assessment of endometrial thickness is not a useful variable in monitoring hyperstimulated cycles. No aberrations of endometrial growth or pattern were observed in the women with unexplained infertility.

Clomiphene↗
PubMed1989

Fetal macrocytosis in association with chromosomal abnormalities.

Mean red cell volume (MCV) was determined in 264 fetuses between 15-41 weeks. After exclusion of anemic, hypoxic, and chromosomally abnormal fetuses, the MCV in 208 umbilical venous samples was shown to decrease with gestation (r = 0.64; P less than .001), and a normal range was constructed by linear regression analysis. An elevated MCV was found in both fetuses with triploidy, in four of five with monosomy X, and in four of ten with trisomies 18 or 21. The MCV was similarly raised in four of five fetuses with gross anomalies in whom cytogenetic cultures had failed. Significant correlations were found in chromosomally abnormal fetuses between the elevation in MCV and both the nucleated red cell (r = 0.69; P less than .01) and reticulocyte counts (r = 0.57; P less than .05). There was a similar correlation with nucleated red cells in 16 severely anemic fetuses with Rh disease, 12 of whom had a raised MCV. Elevation in MCV was unrelated to hypoxia. Macrocytosis had a sensitivity of 71% and a specificity of 95% in the second trimester for predicting an abnormal karyotype in nonanemic fetuses (kappa index 0.60). Fetal MCV may provide clinically useful information while one awaits culture results. We suggest that karyotyping be considered in fetuses undergoing blood sampling for other indications in whom the MCV is raised.

Anemia↗
PubMed1988

The fetal intrahepatic umbilical vein as an alternative to cord needling for prenatal diagnosis and therapy.

Seventy-one fetal blood samplings (FBS) were attempted from the intrahepatic portion of the umbilical vein (IHV) at 18-34 weeks; 54 were attempted primarily and 17 secondarily after a failed attempt at the placental cord insertion. Fetal blood was obtained in 89 per cent of the cases. Intravascular transfusion (IVT) was attempted on 31 occasions and successful in 24 (77 per cent). In all cases of failed sampling or transfusion via the IHV, prenatal diagnosis and/or therapy was accomplished using alternative procedures. On only one occasion was the procedure postponed. There were no losses or neonatal morbidity attributable to the procedure. FBS from the IHV may be considered as an alternative approach to sampling the placental cord insertion. It is recommended in cases where the approach to the placental cord insertion is difficult or hazardous.

Blood Specimen Collection↗
PubMed1988

CA 125 in peritoneal fluid and serum of patients with endometriosis.

Serum and peritoneal fluid collected from 48 patients at laparoscopy was assayed for CA 125. Geometric mean serum CA 125 was similar in 21 patients with predominantly early stage endometriosis (13.4 U/ml; confidence intervals (C.I.) 10.8-16.7) and 27 patients without endometriosis (12.9 U/ml; C.I. 9.7-17.2). Mean peritoneal fluid CA 125 was higher in the endometriosis patients (mean 44.4 U/ml; C.I. 34.5-57.2) than controls (35.7 U/ml; C.I. 30.0-42.2), but the difference was not significant. Peritoneal fluid volume was increased in endometriosis patients (p = 0.013), and only after correction for peritoneal fluid volume did total antigenic concentration in aspirated peritoneal fluid show significant elevation (p = 0.0015) in endometriosis patients (mean 340 U/ml; C.I. 212-547) compared with controls (125 U/ml; C.I. 85-184). These results suggest that although CA 125 may be expressed in peritoneal fluid in endometriosis, it is unlikely to be of use as a marker of disease activity in peritoneal fluid obtained by culdocentesis.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1988

Fetal outcome in obstetric cholestasis.

Obstetric cholestasis has been associated with a high incidence of stillbirth and perinatal complications. Between 1975 and 1984, 83 pregnancies were complicated by cholestasis. Meconium staining occurred in 45%, spontaneous preterm labour in 44%, and intrapartum fetal distress in 22%. Of 86 infants two were stillborn and one died soon after birth. Perinatal mortality fell from 107 in a previous series from this hospital (1965-1974) to 35/1000 in this series. Cardiotocography, estimations of oestriol, liver function tests and ultrasonic assessment of amniotic fluid volume failed to predict fetal compromise, whereas amniocentesis revealed meconium in 8 of 26 pregnancies. Early intervention was indicated in 49 pregnancies, 12 because of fetal compromise. This study suggests that intensive fetal surveillance, including amniocentesis for meconium, and induction of labour at term or with a mature lecithin/sphyngomyelin ratio, may reduce the stillbirth rate in this 'high-risk' condition.

Cholestasis↗
PubMed1988

Maternal features of obstetric cholestasis: 20 years experience at King George V Hospital.

Between 1965 and 1984, 139 pregnancies in 125 women were complicated by obstetric cholestasis (OC). Prevalence increased from 0.1% in the first 10-year period to 0.2% in the second (p less than 0.001), following recognition of the adverse fetal risks of this condition. Perinatal data from both series, 1965-1974 and 1975-1984 have previously been published. Mothers in the latter series were more likely to be of Anglosaxon than Mediterranean origin (p less than 0.001) and did not have underlying haemolytic conditions. Diagnostic criteria changed considerably over the 20 years, such that liver biopsy was no longer needed, gastroenterological consultation was sought less frequently (p less than 0.001) and newer diagnostic criteria of increased bile acids with negative hepatitis serology were increasingly employed. Biochemical data were broadly similar in the 2 groups. An understanding of the clinical and laboratory features of this disease facilitates early diagnosis, which is imperative if intensive fetal surveillance is to reduce the high stillbirth rate in OC.

Alanine Transaminase↗
PubMed1988

Changes in fetal acid base status during intravascular transfusion.

Umbilical venous pH, PCO2, PO2, and base excess was measured immediately before and after 72 intravascular transfusions in 34 fetuses with erythroblastosis fetalis. In 67 uncomplicated transfusions, infused adult blood led to a mean (95% confidence intervals) fall in pH (0.037, CI 0.029 to 0.044) and base excess (2.03, CI 1.61 to 2.45) and a mean rise in PCO2 (0.24 kPa, CI 0.13 to 0.35). These changes correlated significantly with the increase in fetal haemoglobin and packed cell volume. Five transfusions were associated with complications within six hours: intrauterine death in two, fetal-distress necessitating delivery in two, and preterm labour in one. Two had pre-existing acidosis, whereas two of the three with normal blood gas and acid base measurements before transfusion had acute changes that were outside the normal ranges that had been established in uncomplicated transfusions.

Acid-Base Equilibrium↗
PubMed1988

Modifications to selective conservative management in preterm premature rupture of the membranes.

Selective conservation in preterm premature rupture of the membranes (PPROM) reduces risks of infection and pulmonary hypoplasia associated with expectant management by delivering those at greatest risk, while permitting continuation of pregnancy in the remainder. Although patient selection has traditionally been a clinical decision, more accurate criteria are now available. The role of biochemical, biophysical and microbiological predictors of chorioamnionitis and fetal pulmonary status in PPROM is reviewed, and the resultant modifications to selective conservative management discussed.

Bacterial Infections↗
PubMed1988

Hysterosalpingographic diagnosis of a single cervical ectopic ureter.

Single ectopic ureters terminating in the female genital tract are rare congenital anomalies caused by an abnormally lateral origin of the ureteric bud from the mesonephric duct in the three- to four-week embryo. The ureter remains intimately involved with mesonephric duct remnants, which acquire a communication with müllerian structures. Hysterosalpingography in a continent infertile patient outlined a single cervical ureter from a hypoplastic kidney draining into Gartner's duct remnants. No previous case of single cervical ectopic ureter has been reported without a müllerian anomaly, nor has a single cervical ureter been demonstrated on hysterosalpingography.

Adult↗