Biomedical subjects
Publications and source records attributed to S A Carson.
These data suggest that EP can be diagnosed and safely treated medically with MTX using the scheme outlined with no laparoscopy. Laparoscopic removal can be reserved for those patients with large unruptured EP (greater than 3.0 cm; cardiac activity) or the individual who requires laparoscopy for diagnosis.
Genetic diagnosis and therapy is well established in the antenatal period. The advancement of uterine and in vitro fertilization allow access to the early blastocyst. Simultaneously, laboratory techniques are being miniaturized to be sufficiently sensitive and specific for diagnosis with only a few cells. Thus genetic diagnosis and therapy may be extended from the antenatal patient to the antegravid patient. This article discusses the techniques of uterine lavage and in vitro fertilization as well as the diagnostic possibilities that this early embryonic period offers.
Endometriosis, even in mild cases, decreases monthly fecundity. Immunologic disorders have been suggested as the mechanism. In light of possible increases in serum autoimmune antibodies, increased peritoneal macrophages, and increased sperm phagocytosis associated with this disease, we postulated that peritoneal fluid antisperm antibodies would be increased and might be the cause of increased sperm phagocytosis and its associated infertility. Peritoneal fluid, from 18 patients with endometriosis and 10 infertile controls, was tested with the antisperm antibody immunobead test validated for peritoneal fluid. One of 18 patients with endometriosis and none of 10 controls had antisperm antibodies present. Therefore, increased sperm phagocytosis is unlikely a result of peritoneal antisperm antibodies in endometriosis patients.
Operative hysteroscopy may result in profound hyperglycemia and hyponatremia when crystaloids containing glucose are used as a distention medium. Four patients undergoing operative hysteroscopy developed hyperglycemia in proportion to increasing operative time. None of five monitored patients undergoing diagnostic hysteroscopy developed clinically significant hyperglycemia.
In the medical management of ectopic pregnancy, human chorionic somatomammotropin (hCS) proved to be a more sensitive indicator of continued trophoblastic activity than either beta-human chorionic gonadotropin (beta-hCG) or progesterone (P). In the authors' series of 21 women treated with methotrexate for ectopic pregnancies, only two ruptured. In both cases, hCS levels continued to rise during and after methotrexate treatment. Concomitantly, beta-hCG and P decreased in both of these patients. The authors thus interpret increasing hCS as a reflection of continued syncytiotrophoblast growth, signalling impending rupture. Furthermore, patients with levels of hCS less than 10 ng/ml may require neither medical nor surgical therapy.
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Sera from 214 infertile patients were assayed for antisperm antibodies using the IBT, GAT, and SIT. The new IBT methodology was compared with the more classical tests. Although SIT and GAT did not correlate to any particular antibody class, both were negative if IgA was present alone. The immunoglobulin class presented a preferential sperm region binding site: IgG to the head and tail, IgM to tail tip only, IgA to head and tail. Furthermore, these immunoglobulins from the serum of male patients bound differently to sperm than immunoglobulins from female serum. Finally, we were able to calculate the relative sensitivity, specificity, and predictive values for these tests.
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The binding characteristics of epidermal growth factor (EGF) receptors were studied in cell membrane preparations from adult male (n = 14) and female (n = 13) rat livers. Results indicate a significant lower (about 65%) number of EGF receptors in female preparations. The possibility that the decrease in EGF receptors was only a reflection of an excess free EGF in female preparations was ruled out by means of acid extraction, ultrafiltration, and measurement of EGF in the acid extracts. In view of the known role of EGF in cell differentiation, it may be important to recognize that the number of its receptors, at least in liver preparations, is markedly different between sexes.
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A study of 53 individuals failed to reveal an association between any HLA antigen and endometriosis. Division of the sample into those having a relative affected with endometriosis (N = 11) and those not having such a relative (N = 42) similarly failed to reveal significant associations.
No formal genetic studies of incomplete müllerian fusion anomalies have been conducted previously, despite several reports of familial aggregates. Accordingly, the authors sought to determine the frequency with which symptomatic müllerian fusion anomalies occurred in relatives of a small but genetically unbiased sample of 24 probands. Only one of 37 (2.7%) female sibs over age 16 appeared to have a symptomatic uterine anomaly; none of 24 mothers, none of 45 maternal aunts, and none of 50 paternal aunts appeared affected. Such a low frequency of affected relatives is more consistent with polygenic/multifactorial etiology than with other genetic etiologies.
Epidermal growth factor promotes growth in many cell types. The role of epidermal growth factor during gestation and fetal development is unknown. This study investigates the presence and binding characteristics of epidermal growth factor receptors in placentas throughout gestation. Cell membrane preparations were obtained from first-, second-, and third-trimester placentas and hydatidiform moles. Specific epidermal growth factor receptors were observed as early as 6 weeks of gestation. Throughout gestation, Scatchard analysis of epidermal growth factor binding was curvilinear, and dissociation studies were consistent with site-to-site interaction with negative cooperativity. Affinity constants at high (Ke = 9.9 +/- 0.79 X 10(9) L/mol) and low (Kf = 3.0 +/- 0.25 X 10(9) L/mol) receptor occupancy were unchanged throughout normal gestation. However, the number of receptors per milligram of protein significantly increased with advancing normal gestation (correlation coefficient, r = 0.81). In hydatidiform moles, the number of receptors was reduced when compared to that of normal tissue of similar gestational age. Our study provides a quantitative basis for further evaluation of epidermal growth factor as a possible factor in embryogenesis and fetal development.
Familial aggregates of incomplete Müllerian fusion have been reported, but the role of genetic factors has not been elucidated. In the last several years, we have fortuitously encountered three families in which several members were affected with Müllerian fusion anomalies. In two families, several members had incomplete Müllerian fusion as traditionally described. In the third family, several members had the hand-foot-genital syndrome, a rare autosomal dominant disorder characterized not only by Müllerian fusion defects but also by skeletal (hand and foot) malformations. The etiologic heterogeneity of Müllerian fusion defects is considered.
The genetics of Müllerian aplasia (absent fallopian tubes, absent or rudimentary uterine corpus and cervix, absent upper vagina) has never been investigated systematically. Some investigators believe the disorder is inherited in female-limited autosomal dominant fashion, males transmitting the mutant gene but, of course, not manifesting the trait. To investigate this possibility, we obtained pedigrees in 23 probands with Müllerian aplasia. None had an affected relative. The absence of affected individuals among 30 postpubertal sisters, 31 paternal aunts, and 40 maternal aunts makes it unlikely that a sex-limited autosomal dominant gene is a common cause of Müllerian aplasia in our population. Dominant genes might exist in other populations, and fresh dominant mutations cannot be excluded. However, polygenic/multifactorial inheritance is perhaps more plausible.
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A case of an ovarian endometrioid cystadenofibroma with epithelial atypia and Meigs' syndrome is described. The patient had a large pleural effusion that resolved rapidly after extirpation of the tumor. The S-phase fraction, measured by in vitro incorporation of tritiated thymidine, was extremely low, suggesting that this unusual tumor has a limited growth potential despite its atypical features. Ultrastructurally, the epithelial component has few features described in other ovarian endometrioid tumors. The cells have deeply clefted nuclei and numerous secondary cytolysosomes, features more commonly seen in Brenner tumors; the morphologic similarities may reflect a low epithelial turnover rate. Despite a review of the literature and an analysis of the case, the authors were unable to determine the pathogenetic mechanism of Meigs' syndrome.
Relapsing polychondritis is a disease characterized by progressive inflammation of cartilagenous structures including those of the glottis, trachea, or central bronchi. We performed detailed physiologic and radiologic studies of the respiratory tract in five patients with respiratory involvement due to relapsing polychondritis. We found that the maximal expiratory and inspiratory flow-volume loop and airway resistance together can provide useful clues as to the presence, site, and fixed or dynamic nature of the upper airway obstruction in these patients. However, in patients with fixed upper airway obstruction or compound lesions, computer tomography of the respiratory tract, cinetracheography, or laryngotracheograms at different lung volumes were required to identify the site of the obstruction and to clarify the dynamic nature of the obstruction.