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Biomedical subjects

S Alvarez

Publications and source records attributed to S Alvarez.

At least 109 records · Page 6Linked to original sources
PubMed1990

[Ovarian stimulation for in vitro fertilization using LHRH agonists: comparison of plasma and intra-follicular hormone profiles using "short" and "long" protocols].

Plasmatic estradiol (E2), progesterone (P) and LH were measured during the follicular phase of 343 cycles induced for in vitro fertilization (IVF) using a LHRH agonist in a "long protocol" (Group I) and 76 cycles in a "short protocol" (Group II). Moreover measurements in the plasma and follicular fluid (FF) of E2, P, LH, Delta-4-androstenedione (A), Testosterone (T) and prolactin (PRL) were performed on the day of oocyte retrieval (DO) in 46 women of the group I (111 FF) and 27 of the group II (67 FF). In the group I, plasma LH always remains below 3 mUl/ml, whatever the type of agonist (Buserelin or DTRP6-LHRH) and the type of stimulation (HMG or FSH) are used. On the other hand in the group II, mean plasma LH and P levels from D-5 to D-2 and those of FF LH, T and A on DO are significantly higher than in the group I. These changes are associated with a significant decrease of retrieved oocytes (5.8 versus 7.8 p less than 0.0001), pregnancy rate (15% versus 30%, p less than 0.01) and ongoing pregnancy rate (10% versus 22%, per oocyte retrieval, p less than 0.01). They suggest that the pituitary desensitization could be unsatisfactory with the short protocol use of agonist.

Adult↗
PubMed1990

[Outcome beyond the 1st trimester of 305 pregnancies conceived by fertilization in vitro].

The obstetrical outcome of 305 pregnancies obtained by in vitro fertilization were reviewed: out of 275 pregnancies following fresh embryo transfers, 205 (74.5%) were single, 64 (23.3%) double and 6 (2.2%) triple). We observed increased frequencies of high blood pressure linked to older maternal age, bleeding in the late pregnancy and breech presentation, which could be associated to abnormal insertion of umbilical cord and/or placenta. Multiple pregnancies, especially the triple ones, are of the highest risk (intra-uterine growth retardation, low birth weight). Nevertheless the total fetal mortality remains low in our experience. Data about 22 pregnancies following cryopreserved embryo transfer, 5 after oocyte donation and 3 therapeutic abortions are also given.

Adult↗
PubMed1990

Leukopenia secondary to mycobacterium leprae.

Hansen's disease (HD) is one of the major infectious diseases in the world with an estimated total of 12 million cases. Physicians in North America, however, rarely see HD or its manifestations. Hematological manifestations of HD have been reported but are not well appreciated. We report a patient with leukopenia while under treatment for active HD who demonstrated mycobacterial involvement of the bone marrow.

Bone Marrow Diseases↗
PubMed1989

[Treatment of ovarian polycystic syndrome in vitro. Physiopathogenetic considerations].

More than 60% of patients with polycystic ovary disease (PCO) cannot conceive after repeated ovulation inductions with Clomifene citrate although there is ovulation or more frequently follicle luteinization. Because of hyperstimulation, therapy with hMG has been superseded by low doses of purified FSH with variable results according to authors. It has been even claimed that there was no benefit to replace hMG with FSH. However, on the basis of the PCO physico-pathology, namely LH hypersecretion and androgen hyperproduction, it would be rational to associate the desensitization of the pituitary with LH-RH agonist and the ovary stimulation with variable doses of hMG or purified FSH. In the series where such therapy associating LH-RH agonists with purified FSH was applied, the results concerning suppression of LH and androgen secretion, and the occurrence of pregnancy were interesting. However, the risk of hyperstimulation still occurred. Thus, the first part concerns the critical review of these results while, in the second part, our experience in in vitro fecundation will be reported.

Androgens↗
PubMed1988

Programmed ovulation induction and oocyte retrieval for in vitro fertilization.

Forty-two patients underwent programmed ovulation induction for oocyte retrieval. They were treated in the preceding cycles with a progestagen, ethynodiol diacetate, at a dose of 2 mg twice daily. Two groups were defined based upon the stimulation protocol: Group A1 was stimulated with clomiphene citrate and human menopausal gonadotropin (hMG), and Group A2 with follicle-stimulating hormone (FSH) and hMG. They were compared to two randomized control groups of patients who received the same induction but were classically monitored. There was a high proportion of spontaneous ovulations in the programmed group (8/42) compared to the nonprogrammed group (0/42). There was a nonsignificant difference in the number of oocytes obtained or embryos replaced per cycle. Four pregnancies were obtained in the programmed group (24% per transfer), against 10 in the nonprogrammed patients (32% per transfer). The results of this method seem to be better using FSH for ovulation stimulation and a verification of the serum estradiol on the day of induction with human chorionic gonadotropin (hCG) and the following day (semiprogrammed method).

Adult↗
PubMed1988

Pregnancies after replacement of frozen-thawed embryos in a donation program.

Eighteen patients with primary (n = 8) or secondary (n = 10) ovarian failure were enrolled in a donation program. In 15 cases, the oocytes were donated anonymously; in 3 cases, they were donated by the sister of the recipient. All the recipients had cyclic steroid replacement therapy that included estrogens and progesterone administered by the transdermal and tranvaginal routes, respectively. The embryos obtained were cryopreserved and replaced with no attempt at synchronization between donor and recipient. Steroid hormonal patterns were within the range for the normal menstrual cycle and endometrial biopsies taken on day 21 or 22 of the treatment cycles were independently assessed as being representative of day 21 +/- 2. Four of 12 transfers were successful (31%): 1 patient aborted at 6 weeks, and the three others were delivered, one normally and two by cesarian sections. The authors' practice suggests the following: (1) steroid supplementation by transdermal and transvaginal routes is effective, (2) synchronization between donor and recipient is no longer required with the use of frozen-thawed embryos, and (3) the "temporal window" is large since all the replacements were done on day 14 of the cycle.

Administration, Intravaginal↗
PubMed1988

Nosocomial infections in long-term facilities.

We studied the incidence and prevalence of hospital-acquired infections in our intermediate-care units and the Nursing Home Care Unit at the Veterans Administration Medical Center, Johnson City, TN over a 4-year period (1980 through 1983). The global infection rate was 3.86 per 1,000 patient care days. The lower respiratory tract was the most common site of infection, followed by urinary tract infections, skin infections, bacteremia, wound infections, and infections at other sites. The prevalence study conducted by monthly visits over a 1-year period showed similar results. All of our patients were elderly males with multiple underlying diseases and poor performance status. The high incidence of nosocomial infections in chronic-care facilities relates to the poor functional assessment of the patients, which may increase the susceptibility of these patients to develop infections, mainly lower respiratory and cutaneous infections.

Aged↗
PubMed1988

Cryopreservation of human embryos and oocytes.

The success rate of human embryo cryopreservation depends on technical and embryonic parameters. First of all, the cryoprotectant can affect embryo survival as we found by comparing two freeze-thaw procedures using propanediol (PROH) (1.5 mol) alone or with sucrose (0.1 mol). Embryo survival was significantly enhanced with sucrose (62 versus 32%). Embryo quality is another major parameter involved in the success of freezing; the rates of positive survival were found to be 67% for morphologically normal embryos versus 49% for embryos with fragments (P less than 0.001). The efficiency of embryo cryopreservation in an IVF programme could be estimated in 1986: a woman with extra embryos, stored after transfer of 3-4 fresh embryos (16% of all cycles), can expect a 22% pregnancy rate per transfer of fresh embryos and a 32% pregnancy rate per collection after transfer of the stored eggs. A comparative study of the cryopreservability of immature or mature oocytes was performed in humans. Human oocytes have a low survival rate (36%) whatever the cryopreservation protocol or the initial maturation stage. Immature human oocytes could survive freezing and thawing, mature and be fertilized in vitro, but with a very low efficiency.

Embryo Transfer↗
PubMed1988

Prognostic value of pre-ovulatory serum progesterone, LH and oestradiol-17 beta levels in stimulated cycles for in-vitro fertilization.

The prognostic value of a decrease in oestradiol-17 beta (E2) on the day after HCG injection in stimulated cycles has been related to a premature increase in plasma progesterone (P) on the day before HCG injection. This retrospective study was carried out on 363 patients who were divided into four groups. Patients in group A were given clomiphene citrate plus human menopausal gonadotrophin (HMG) to stimulate follicle growth, and they were subdivided into subgroups A1 and A2 who showed an increase or a decrease in E2 levels after HCG injection. The changes in E2 were greater than 10% of the levels on the previous day. Patients in group B were stimulated by HMG and were similarly subdivided into subgroups B1 and B2 according to their E2 levels. The number of oocytes recovered and the incidence of pregnancy was significantly higher in A2 as compared with A1, and higher but not significantly so in B2 versus B1. Moreover, in subgroups A1 and B1 the day before the decrease of E2 was marked by a significant rise in LH before the HCG injection. We suggest that oocyte recovery is deferred in these cases.

Adult↗
PubMed1988

Results of IVF in the treatment of polycystic ovary disease.

Sixteen patients with polycystic ovarian syndrome (PCO) were treated by in-vitro fertilization (IVF), 11 suffered from definitive tubal infertility and five had previously undergone multiple unsuccessful attempts at ovulation induction after conventional therapy. They were randomly allocated into two groups: A1 (six patients) treated with 'pure FSH' and A2 (10 patients) whose ovarian stimulation was performed by a combination of LHRH agonist and pure FSH. More oocytes were recovered in group A1 (7.5 +/- 2.2) and group A2 (10.3 +/- 5.8) than in a control group (B) but this difference was not significant. There was no difference between groups A and B in the number of immature oocytes, the oocyte fertilization rate (60%) and the number of embryos replaced per patient (2.8). Four pregnancies were achieved in the six patients in group A1, 5/9 in group A2 and 3/6 in group B. One severe hyperstimulation was recorded in group A1 but this patient developed a pregnancy which was normal at term. This small study suggests that IVF may be a solution to the treatment of PCO resistant to clomiphene citrate and HMG treatment and that the combination of pure FSH with an analogue of LHRH (in a short protocol of 15 days) does not seem to have an advantage over FSH stimulation alone and does not reduce the frequency of hyperstimulation.

Adult↗
PubMed1988

Comparison between long and short protocols of LHRH agonist in the treatment of polycystic ovary disease by in-vitro fertilization.

Two groups of patients with polycystic ovary disease were treated with analogues of LHRH to compare long and short protocols of pituitary desensitization. In group 1 (n = 15), decapeptyl was administered for 30 days associated with stimulation by pure FSH. In group 2 (n = 12) Buserelin was given for 15 days with the same ovarian stimulation. Patients were randomly assigned to the two groups. Six patients in each group had received treatment, for at least 4 months, to induce ovulation with clomiphene citrate or HMG and failed to conceive, despite the absence of a tubal factor. The best results were obtained using the long protocol. Androgen concentrations, particularly delta 4-androstenedione, were significantly lower on the day of oocyte retrieval in group 1 than in group 2 (2.52 +/- 0.73 ng/ml versus 4.44 +/- 2.62, respectively (P less than 0.02). Polycystic follicular formation was less pronounced in group 1 and no clinical hyperstimulations occurred in this group. The pregnancy rate was comparable in the two groups (six ongoing pregnancies in 21 cycles in the 15 patients in group 1 versus three pregnancies in 12 cycles in the 12 patients in group 2).

Adult↗
PubMed1988

In vitro interactions of amikacin and beta-lactam antibiotics against amikacin-resistant gram-negative bacilli.

We tested 42 strains of amikacin-resistant gram-negative bacilli with amikacin in combination with six beta-lactam antibiotics using the checkerboard and time-kill curve techniques. Synergism was demonstrated with time-killing curve in 43-68% of the strains tested. Ceftazidime plus amikacin was the most active combination by the checkerboard technique, while amikacin-cefoperazone was the most active combination by the time-killing curve technique against Pseudomonas aeruginosa. Discrepancies were found between the results of the two methods used.

Amikacin↗
PubMed1988

Systemic augmentation of the immune response in mice by feeding fermented milks with Lactobacillus casei and Lactobacillus acidophilus.

This study investigates the effect of feeding fermented milks with Lactobacillus casei, Lactobacillus acidophilus and a mixture of both micro-organisms on the specific and non-specific host defence mechanisms in Swiss mice. Animals fed with fermented milk for 8 days (100 micrograms/day) showed an increase in both phagocytic and lymphocytic activity. This activation of the immune system began on the 3rd day, reached a maximum on the 5th, and decreased slightly on the 8th day of feeding. In the 8-day treated mice, boosted with a single dose (100 micrograms) on the 11th day, the immune response increased further. The feeding with fermented milk produced neither hepatomegaly nor splenomegaly. These results suggest that L. casei and L. acidophilus, associated with intestinal mucosae, can influence the level of activation of the immune system. The possible clinical application of fermented milks as immunopotentiators is also discussed.

Animals↗
PubMed1988

Disseminated blastomycosis in a pregnant woman successfully treated with amphotericin-B. A case report.

An 18-year-old woman developed disseminated blastomycosis in the 30th week of pregnancy. She was treated with amphotericin-B. Simultaneous maternal-infant blood levels at birth were 1.9 and 1.3 micrograms/mL, respectively. The amphotericin-B level in the amniotic fluid was 0.3 microgram/mL at delivery. The infant was normal and without ill effects from either the blastomycosis or the amphotericin-B. The skin lesions and pulmonary infiltrates in the mother improved rapidly, without unexpected side effects from the therapy. The limited experience with amphotericin-B indicates that it is both well tolerated and effective in this clinical situation.

Adolescent↗
PubMed1987

Pulmonary tuberculosis in elderly men.

The clinical manifestations, predisposing factors, and diagnostic approach to 29 young men and 35 elderly men with pulmonary tuberculosis admitted to a Veterans Administration hospital were compared. Elderly men had a higher number of underlying conditions such as atherosclerosis, previous gastrectomy, and malignancy, whereas alcoholism was more prevalent in the younger group. The classic symptoms and signs of tuberculosis were noted in a significantly higher proportion of the younger group: fever (62 percent versus 31 percent), weight loss (76 percent versus 34 percent), night sweats (48 percent versus 6 percent), sputum production (76 percent versus 48 percent), and hemoptysis (40 percent versus 17 percent) (p less than 0.05). Abnormal mentation was more common in the elderly group (31 percent versus 10 percent) (p less than 0.05). Radiographic findings were similar in both groups. Mortality related to tuberculosis was 20 percent in elderly men versus 3 percent in the younger men (p less than 0.05). Tuberculosis is frequently not considered in the differential diagnosis when elderly patients present with multiple medical problems and nonspecific complaints. Since there are differences in the clinical presentation and the outcome of pulmonary tuberculosis in elderly patients, a high index of suspicion for the disease should be maintained.

Adult↗