Biomedical subjects
Publications and source records attributed to V Insler.
Observation of women who underwent cerclage of the uterine cervix in pregnancy indicated that during the first 24 hours after operation a marked increase of the uterine size takes place. Since this feature came rather as a surprise, seventy one cases were studied carefully.
Synthetic gonadotropin-releasing hormone (GnRH) in the form of nasal drops was self-administered by five amenorrheic patients in an attempt to assess its therapeutic value in anovulatory infertility. After follicular maturation had been induced with human menopausal gonadotropins (HMG), a total daily dose of 7.5 mg of GnRH in the form of nasal drops was self-administered at 2-hour intervals for 6 hours on 3 consecutive days. In four patients, plasma luteinizing hormone (LH) levels were significantly elevated over a period of at least 8 hours. In three of these patients, in addition, there was a definite upward shift in the basal body temperature (BBT) curve, and uterine bleeding occurred 6 to 9 days after the first dose of GnRH. In the fourth patient, ovulation was induced as indicated by a biphasic BBT curve, a plasma progesterone level of 13 ng/ml, and a luteal phase of 15 days. In the remaining patient, there was a borderline LH response and no clinical response. It is concluded that GnRH, in the form of nasal drops, is effective in eliciting and maintaining elevated plasma LH levels in patients in whom follicular maturation has been induced with HMG. By obtaining ovulatory LH levels, such a regimen can lead to ovulation. In addition intranasal self-administration of GnRH is convenient and may provide an alternative route of administration for long-term therapy with this hormone.
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Ninety-seven postmature pregnancies were monitored by amnioscopy or amniocentesis (to determine presence or absence of meconium), oxytocin challenge tests (OCT), 24-hour urinary oestriol estimations and fetal movement counts. The colour of the amniotic fluid and the result of the OCT predicted almost all cases of fetal distress in labour and infants with low Apgar scores. Oestriol estimations and fetal movement counts predicted fetal distress only when combined with other positive tests. Of 50 patients with no abnormal test results, 49 had uneventful labours. The Caesarean section rate was not above average and all babies were liveborn.
Sixty-two patients with spontaneous abortion and 58 with missed abortion were all promptly treated with curettage. The reproductive performance and the subsequent fertility of both groups during a five year period before and after the abortion were compared. To our suprise, no significant differences were found between the two groups.
A possible relationship between the antibacterial activity of amniotic fluid and its peroxidase content was examined. Antibacterial activity, assessed by counting colonies of S. aureus following 24 hour incubation, was present in 76% of the samples studied. It was not related to gestational age. Peroxidase activity, assessed by the O-dianisidine method, was not found in any of the amniotic fluid samples examined.
309 couples with infertility of 1 to 11 years duration in whom pregnancies occurred during examination or treatment were evaluated. The couples were classified into diagnostic groups according to the main cause of their infertility; anovulatory, mechanical, male, cervical, unexplained, combined. Pregnancies were divided into treatment-related and nontreatment-related. Analysis of results revealed that whereas in infertile patients with a defined cause of infertility, the treatment-related pregnancy rate was 73.1%, in the unexplained infertility group the incidence of treatment-related pregnancies was only 6.6%. We concluded that a meticulous fertility survey should be carried out in each infertile couple in order to detect a specific cause impeding fertility, but if such a cause cannot be found, reassuring of patients and decreasing their anxiety is more effective in inducing pregnancy than nonspecific therapy.
A new method is presented for differentiating amniotic fluid from cervical mucus, based on differences in the respective carbohydrate concentrations present in these fluids. Glucose and fructose are present in high concentrations in cervical mucus during pregnancy, average values being 240 and 30.4 mg/100 ml, respectively. Their concentrations in amniotic fluid, however, are low, averaging 39 and 3.3 mg/ml, respectively. Examination of 215 women between 36 and 42 weeks' gestation, using either glucose or fructose values, revealed a high degree of discrimination between amniotic fluid and cervical mucus. The best results, however, were obtained by employing the calculated linear sum 3.32 log glucose plus log fructose for each sample. Inaccuracy rates were low in comparison to those of other diagnostic methods, such as pH values, ferning, and Nile blue sulfate staining. A further advantage of the method is that it remains fairly accurate even when the time interval between rupture of the membranes and the investigation exceeds 24 hours.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Synthetic gonadotropin-releasing hormone (GnRH) in the form of nasal drops was self-administered by five amenorrheic patients in an attempt to assess its therapeutic value in anovulatory infertility. After follicular maturation had been induced with human menopausal gonadotropins (HMG), a total daily dose of 7.5 mg of GnRH in the form of nasal drops was self-administered at 2-hour intervals for 6 hours on 3 consecutive days. In four patients, plasma luteinizing hormone (LH) levels were significantly elevated over a period of at least 8 hours. In three of these patients, in addition, there was a definite upward shift in the basal body temperature (BBT) curve, and uterine bleeding occurred 6 to 9 days after the first dose of GnRH. In the fourth patient, ovulation was induced as indicated by a biphasic BBT curve, a plasma progesterone level of 13 ng/ml, and a luteal phase of 15 days. In the remaining patient, there was a borderline LH response and no clinical response. It is concluded that GnRH, in the form of nasal drops, is effective in eliciting and maintaining elevated plasma LH levels in patients in whom follicular maturation has been induced with HMG. By obtaining ovulatory LH levels, such a regimen can lead to ovulation. In addition, intranasal self-administration of GnRH is convenient and may provide an alternative route of administration for long-term therapy with this hormone.