Biomedical subjects
R Ansbacher
Publications and source records attributed to R Ansbacher.
Uterine anomalies and future pregnancies.
In the preceding pages, the various uterine anomalies with their major clinical symptoms, etiology, classification, association with urinary tract abnormalities, and reproductive outcome with or without surgery are described. The various surgical techniques for surgical correction of uterine anomalies, indications for surgery, and surgical complications are outlined. With the proper selection of patients with repetitive miscarriages due to uterine anomalies, prognosis for future childbearing is excellent, and term viable infants should replace the high fetal loss these women previously experienced.
Early therapy for the incompetent cervix in patients with habitual abortion.
From a thorough evaluation of 66 couples with habitual abortion (HA), 42 were found to have a widened uterine isthmus at hysterosalpingography (HSG) as their only abnormality. First trimester cervical effacement occurred in 90% of these patients. A combination of medical (progesterone [P]), and surgical (McDonald cerclage) begun during the first trimester resulted in successful term pregnancy in 35 of the 36 HA patients (97%) who were treated. The results of this study suggest that (1) functional cervical incompetence may play a major role in HA; (2) a widened uterine isthmus at HSG and first trimester cervical effacement are clinical signs that may define this group of HA; (3) early recognition and therapy for the incompetent cervix can interrupt the progression of events leading to the loss of an otherwise normally developing fetus; and (4) increased perinatal morbidity demands continuous antepartum assessment of fetoplacental integrity in these patients.
Genetic defects.
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Humoral sperm antibodies: a 10-year follow-up of vas-ligated men.
Fourteen men were studied over a period of 10 years before and after bilateral was ligation. Seven men (50%) continued to have demonstrable circulating sperm-agglutinating antibodies, and one man had persistent sperm-immobilizing antibodies at a low titer of 1:2. None of the 10 ejaculates submitted contained spermatozoa or antibody activity, although two of the seminal plasma specimens immediately immobilized donor spermatozoa upon contact. There were no adverse medical reactions or conditions noted in these men during the course of the study.
Sperm antibodies and infertility.
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Rape: evaluation and treatment in a military hospital.
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Adhesion sites of neural tumor cells: biochemical composition.
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Adhesion sites of murine fibroblasts on cold insoluble globulin-adsorbed substrata.
The attachment and detachment behavior of three mouse fibroblast cell lines adhering to plastic tissue culture substrata coated with the serum protein cold-insoluble globulin (CIg) resembles that seen on the usual serum-coated substrata. The transformed cell line SVT2 spreads more extensively on the CIg-coated than on the serum-coated substratum, while the nontransformed Balb/c 3T3 line and concanavalin A-selected "revertant" of SVT2 are equally well spread on both substrata. In all three cases, immunofluorescence microscopy using antibodies to CIg suggests that the cells are more tightly apposed to the CIg-coated substratum than to the serum-coated substratum. Substrate-attached material (SAM), which contains cell-substratum adhesion sites and which is left after EGTA-mediated detachment of cells, is enriched for cell surface fibronectin and glycosaminoglycans (GAG). When cells are seeded onto CIg-coated substrata rather than serum-coated substrata, there is an increased deposition of GAG but a comparable deposition of cellular proteins. The protein distribution of the two types of SAM are identical as analyzed by sodium dodecyl sulfate/polyacrylamide gel electrophoresis, including fibronectin content. This indicates that substratum-bound CIg cannot functionally substitute for cell surface fibronectin in these adhesion sites. Analysis of the GAG deposited on CIg-coated substrata reveals that hyaluronate and the chondroitins are increased to a much greater extent than heparan sulfate; however, the ratio of hyaluronate to the various chondroitin species is invariant. These data provide further evidence that hyaluronate and the chondroitins are deposited in adhesion sites in well-defined stoichiometric proportions, possibly as supramolecular complexes, and that CIg may mediate adhesion of cells in the serum layer by binding to GAG-containing proteoglycans.
Glycosaminoglycans that bind cold-insoluble globulin in cell-substratum adhesion sites of murine fibroblasts.
Glycosaminoglycans (GAGs) and glycoprotein-derived glycopeptide from mouse BALB/c3T3 and simian virus 40-transformed 3T3 whole cells or their adhesion sites, which are left bound to the serum-coated tissue culture substratum after detachment of cells mediated by [ethylenebis-(oxyethylenenitrilo]tetraacetic acid (EGTA), were analyzed for specific binding to Sepharose columns derivatized with cold-insoluble globulin (CIg). CIg is the serum-contained form of fibronectin and is required for the adhesion of these fibroblasts to the substratum. Of the various GAGs present in these fractions of either cell type, only the highly N-sulfated sequences of heparan sulfate and a small subset of dermatan sulfate bind to CIg-Sepharose. There was no detectable binding of glycopeptide, undersulfated heparan sulfate, the various chondroitin species, or hyaluronate. Adhesion sites from newly attaching cells were greatly enriched in CIg-binding heparan sulfate when compared to long-term-growth adhesion sites or EGTA-detached cells. Various properties of binding were determined. The reference standard standard GAGs heparin (or heparan sulfate) and dermatan sulfate were able to displace bound radiolabeled adhesion site GAG from the column, whereas the other GAGs had no effect. CIg has been shown to be the only adhesion-promoting activity in the serum layer of this culture system. Because these fibroblast adhesion sites do not contain collagen, which could potentially mediate adhesion to the substratum-bound CIg, these data support other evidence that multivalent heparan sulfate proteoglycans mediate substratum adhesion of these cells by coordinate binding to fibronectin on the cell surface and CIg on the substratum.
Animal surgery: an adjunct to training in obstetrics and gynecology.
A resident in obstetrics and gynecology obtains adequate experience in basic gynecologic surgery during a 3-year training program, but the technical skill acquired in surgery of the bowel, bladder, ureters, and pelvic vessels is limited by the clinical material available. A program is described in which 3 animal models (dog, rabbit, cat) were used to expand the surgical skills of gynecology residents. The increased surgical competence and professional stimulation provided the residents by this program are shown to be both cost- and time-effective.
Inhibition of premature labor by terbutaline.
Terbutaline was administered to 50 women, all diagnosed as being in labor prior to 36 weeks' gestation. In 47, uterine activity was initially arrested with intravenous therapy. The infusion rate required to arrest uterine activity ranged from 10 to 80 microgram/min and 21 of the 50 patients (42%) required more than one intravenous infusion. The average prolongation of gestation was 3.7 weeks in those successfully treated. Twenty-four delivered within 48 hours after the terbutaline was discontinued. Treatment failures occurred in 11 (22%). Not a single infant died of the respiratory distress syndrome. Side effects were mild and well tolerated.
Artificial insemination with frozen spermatozoa.
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Bacterial endocarditis due to Listeria monocytogenes in a pregnant diabetic.
A case of bacterial endocarditis due to Listeria monocytogenes in a pregnant, Class D diabetic patient is presented. The importance of obtaining proper cultures and instituting appropriate antibiotic therapy promptly is emphasized. A favorable outcome was achieved in spite of the combined risk to the fetus of maternal diabetes and listeria endocarditis.
Hypertestosteronism treatment in hirsute women.
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Evaluation of conventional diagnostic tests for detection of recurrent carcinoma of the cervix.
The use of routine diagnostic tests to evaluate patients periodically after treatment for carcinoma of the cervix has been reviewed. Of 169 patients treated at Brooke Army Medical Center for carcinoma of the cervix, 73 were evaluated after their treatment by a group of six diagnostic tests referred to collectively as an oncologic survey. The survey consisted of an intravenous pyelogram (IVP), chest roentgenogram, barium enema, cystoscopy, proctoscopy, and bone scan. Although 16 patients developed recurrent tumor, the oncologic survey detected only three recurrences that had not already been suspected by physical examination. Only the IVP and chest roentgenogram were of sufficient benefit to suggest their routine use for the detection of recurrent cancer. The other tests included in the oncologic survey were not beneficial when used routinely and should be reserved to evaluate patients otherwise suspected of recurrent cancer.
Prophylactic antibiotics for women undergoing vaginal hysterectomy.
A triple-blind prospective study of women undergoing vaginal hysterectomy was conducted to compare cefazolin, cephaloridine and no antibiotic, Both cefazolin and cephaloridine were given preoperatively, whereas only cephaloridine was given postoperatively. One gram of cefazolin given intramuscularly on call to the operation room was found to be a safe and effective antibiotic for prophylaxis against febrile morbidity. The proper utilization of prophylactic antibiotics seems to be in the immediate preoperative period. The use of antibiotics after the first day of surgery is unnecessary.
Serum immunoglobulin levels in vasectomized men: preliminary report.
Seventy-five men undergoing vasectomy were tested by radial immunodiffusion assay prevasectomy and at 6 weeks and 3, 6, and 12 months postvasectomy for possible changes in serum immunoglobulin (Ig) levels. No significant changes occurred when the results were analyzed on a group basis per time period. However, when each individual's prevasectomy Ig level was considered as his norm, significant changes appeared to occur in serum IgG levels at 6 weeks, 6 months, and 12 months postvasectomy; in serum IgM levels at 6 weeks; but not, to date, in serum IgA levels. Seasonal, environmental, and infectious factors do not seem to be associated with the changes found. No significant seminal Ig changes have been demonstrated. Consideration of these findings and implications for possible immunopathology are briefly discussed.