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Biomedical subjects

W R Meyer

Publications and source records attributed to W R Meyer.

At least 37 records · Page 2Linked to original sources
PubMed1997

Hydrosalpinges adversely affect markers of endometrial receptivity.

While in-vitro fertilization (IVF) was initially developed in women with tubal factor infertility, recent clinical studies have suggested that the presence of hydrosalpinges lowers implantation and pregnancy rates. We postulated that these hydrosalpinges cause impaired endometrial receptivity. A total of 103 women with hydrosalpinges were prospectively evaluated, and compared with 55 infertile and 44 fertile controls. All women had endometrial biopsies during the window of implantation, analysed by conventional histological criteria, and also stained for three integrin markers of endometrial receptivity (alpha1beta1, alpha4beta1 and alpha vbeta3). Women with hydrosalpinges (cases) expressed significantly less of the alpha vbeta3 integrin compared with controls. There was no difference in expression of alpha1beta1 or alpha4beta1 among groups. A significantly greater number of cases had out of phase histology and missing alpha vbeta3 (type I defects) and absent integrin expression despite normal histological maturation (type II) defects, compared with controls. Of 20 women with impaired endometrial receptivity who were also biopsied after hydrosalpinx surgery, 70% demonstrated increased alpha vbeta3 expression. Seventy-seven percent of type I and 57% of type II defects were corrected postoperatively. Using markers of endometrial receptivity, this study demonstrates that inflammatory hydrosalpinges have an adverse effect on endometrial receptivity, which in some cases may be overcome by surgical treatment of the hydrosalpinx.

Adult↗
PubMed1997

Primary amenorrhea: evaluation with MR imaging.

PURPOSE: To determine the accuracy of magnetic resonance (MR) imaging in the evaluation of patients with a history of primary amenorrhea. MATERIALS AND METHODS: Twenty-nine patients with primary amenorrhea underwent T2-weighted MR imaging in the axial and sagittal planes. Contrast material-enhanced and unenhanced T1-weighted MR imaging was performed in selected cases. MR imaging findings were correlated with surgical findings in 23 patients and with clinical findings in six patients. RESULTS: Surgical correlation was available in 14 of 17 patients with female anatomic anomalies (Mayer-Rokitansky-Küster-Hauser syndrome [n = 9], transverse vaginal septum [n = 3], imperforate hymen [n = 1], cervical agenesis [n = 1]), which confirmed MR imaging findings. In nine of 12 patients with congenital disorders of sexual differentiation (testicular feminization [n = 5], true hermaphrodite [n = 2], gonadal dysgenesis [n = 2]) who underwent surgical correlation, 13 of 16 (81%) gonads were correctly localized with MR imaging. Overall, there was excellent correlation between the classification of patients with MR imaging versus classification with the combination of surgical and laboratory findings (K = 0.88). CONCLUSION: MR imaging is useful in the work-up of patients who present with primary amenorrhea both for accurate diagnosis of pathologic conditions and for surgical planning.

Adolescent↗
PubMed1996

Therapeutic cup insemination with cryopreserved donor sperm: prognostic value of cervical mucus score at insemination and the number of motile sperm in mucus at 24 hours.

OBJECTIVE: To examine the prognostic value of cervical mucus score at insemination and the number of motile sperm in mucus 24 hours after therapeutic cup insemination with cryopreserved donor sperm. DESIGN: Retrospective analysis. SETTING: Academic tertiary medical center. PATIENTS: One hundred thirty-eight women with confirmed bilateral tubal patency who received therapeutic cup inseminations with cryopreserved donor sperm between 1986 and 1993. INTERVENTIONS: All insemination cycles were monitored with serial daily urinary LH determinations with a single (n = 312) insemination or two inseminations (n = 212) performed on and/or 1 day after the day of LH surge detection. A single examiner assigned cervical mucus scores in all insemination cycles and recorded the number of motile sperm in mucus 24 hours after the first insemination in dual insemination cycles. MAIN OUTCOME MEASURE: Pregnancy rate during various cervical mucus and motile sperm scores. RESULTS: Ninety-one women conceived (66%) and seven of these achieved two pregnancies. The overall pregnancy rate per insemination cycle was 18.7%. Age and day of insemination were the only variables identified as having significant influence on cycle outcome. Pregnancy occurred with decreasing frequency as patient age increased and was nearly twice as likely after insemination on the day after the urinary LH surge as on the day of surge detection. CONCLUSIONS: Insemination the day after the urinary LH surge is superior to the day of surge detection. Cervical mucus score and the number of motile sperm in mucus 24 hours after therapeutic cup insemination with cryopreserved donor sperm do not correlate with cycle outcome.

Adult↗
PubMed1996

Laser treatment of recurrent vulvar angiokeratoma associated with Noonan syndrome.

BACKGROUND: Vulvar angiokeratoma is often confused with other, more common perineal lesions. Chronically elevated venous pressures may contribute to this rare disorder. Laser treatment may lend palliation for several years. CASE: A woman with the characteristic cardiac abnormalities of Noonan syndrome initially responded to Argon laser treatment of vulvar angiokeratoma. Excessive recurrent disease was treated satisfactorily with the Nd:YAG laser. CONCLUSION: Recurrent vulvar angiokeratoma in Noonan syndrome supports the premise that increased persistent central venous pressure may be involved in the disease process.

Adult↗
PubMed1995

Combined abdominal-perineal sonography to assist in diagnosis of transverse vaginal septum.

BACKGROUND: Transperineal sonography has been used to detect incompetent cervices, placenta previa, cervical pregnancy, and vaginal and cervical atresia. CASE: Transperineal sonography was used to investigate primary amenorrhea in a 14-year-old girl. A mid-transverse septum was found and confirmed surgically. CONCLUSION: Transperineal or translabial sonography assisted in the differentiation of primary amenorrhea, when adequate vaginal access was prohibited.

Abdomen↗
PubMed1995

Endovaginal Doppler ultrasound in ovarian torsion: a case series.

Four women with acute pelvic pain clinically suspected to be secondary to ovarian torsion were examined with gray-scale and Doppler ultrasound. All affected ovaries were enlarged (volumes 3.2-34 times the volumes of the ovaries on the unaffected sides). Three ovaries showed no internal flow, and one showed internal arterial flow. Ovary-conserving treatment was attempted in all four cases but the three ovaries which showed no evidence of internal flow eventually required removal. The fourth case, in which arterial flow was present on Doppler examination, was treated only with laparoscopic untwisting of the pedicle and did not require oophorectomy. The results of our study suggest that Doppler findings may distinguish ovaries which are beyond salvage and require removal from those which may be saved by prompt laparoscopic untwisting of the adnexa, but further studies with larger numbers of patients will be necessary.

Adnexa Uteri↗
PubMed1992

Aldose reductase inhibition prevents galactose-induced ovarian dysfunction in the Sprague-Dawley rat.

OBJECTIVE: Our objective was to determine whether impaired ovarian function induced by short-term creation of a galactosemic state in the rat might be prevented by the coadministration of an aldose reductase inhibitor. STUDY DESIGN: Prepubertal Sprague-Dawley rats were fed four different diets including (1) control, (2) 40% galactose, (3) 40% galactose and an aldose reductase inhibitor, and (4) an aldose reductase inhibitor with the control diet. Percentage germinal vesicle breakdown, postovulatory oocyte quantities, hormonal parameters, ovarian histologic evaluation, and ovarian galactitol concentrations were determined. RESULTS: The galactose-fed animals (group 2) had decreased germinal vesicle breakdown (47%) versus control (69%, p < 0.05). Galactose-exposed animals had significantly decreased quantities of postovulatory eggs (6.4 per animal) after menotropin ovarian stimulation in comparison with controls (14.1, p < 0.01). In rats exposed to high dietary levels of galactose (group 2) ovarian galactitol concentrations were significantly higher (protein 42.12 mumol/gm versus 0.0 for controls, p < 0.005). When galactose-fed animals received the aldose reductase inhibitor, ovarian accumulation of galactitol was significantly reduced and the observed detrimental effects on the oocyte were prevented. CONCLUSION: Galactitol accumulation or metabolic flux through aldose reductase in galactosemic rodents may be involved in the demonstrated ovarian dysfunction.

Aldehyde Reductase↗
PubMed1992

Ectopic pregnancy: evaluation with endovaginal color flow imaging.

Endovaginal sonography and endovaginal color flow imaging were compared in 155 patients with clinical suspicion of ectopic pregnancy. Sixty-five patients (42%) had surgically confirmed ectopic pregnancies. Thirty-six of the pregnancies were diagnosed with endovaginal sonography alone, the criteria being an extrauterine sac or ectopic fetus (sensitivity, 54%). Sixty-two ectopic pregnancies were diagnosed with endovaginal color flow imaging (sensitivity, 95%) when an ectopic fetus or sac was seen or placental flow was identified in an adnexal mass separate from the ovary and uterus. The diagnosis of ectopic pregnancy was excluded with endovaginal sonography (specificity, 98%) and endovaginal color flow imaging (specificity, 98%) by finding an intrauterine gestation, nonvisualization of an adnexal mass, and absence of placental flow. Three false-positive and three false-negative diagnoses were made with endovaginal color flow imaging (positive predictive value, 97%). The addition of color Doppler flow imaging to endovaginal sonography allows increased sensitivity in the detection of ectopic pregnancy.

Adult↗
PubMed1991

Ovarian surgery on the rabbit. Effect of cortex closure on adhesion formation and ovarian function.

Surgical reapproximation of serosal surfaces in an attempt to reduce adhesiogenesis remains a controversial issue. For the reproductive gynecologist, this tenet is especially appropriate to the ovarian cortical surface. Using a rabbit model (n = 22), an ovarian unipolar cautery incision was created, and surgical closure versus nonclosure was evaluated. Closure with continuous 6-0 polyglactin resulted in a significant increase in the degree of ovarian adhesion envelopment versus nonclosure (1.8 +/- 0.2 vs. 0.9 +/- 0.2, P less than .01). Surgical closure also resulted in a significant increase in the vascularity of the adhesions (P less than .05). Despite the increase in adhesion formation, ovarian function, as determined by the mean number of corpora lutea, pregnancies and the nidation index, was not different in sutured ovaries, unsutured ovaries or nonsurgically treated controls.

Animals↗
PubMed1991

Laparoscopic clips. Evaluation of absorbable and titanium with regard to hemostasis and tissue reactivity.

Advanced laparoscopic techniques require laparoscopic means of providing hemostasis. We tested the hemostatic ability of laparoscopic surgical clips and their tissue reactivity as assessed by adhesion formation in an animal model. Twenty-six New Zealand white rabbits were randomized at laparotomy to one of three treatment groups: titanium surgical clips, absorbable surgical clips (both applied with a laparoscopic clip applicator) and chromic sutures of equal mass. Either the right fallopian tube was transected, with clips or sutures applied proximally and distally to control bleeding, or the clips or sutures were applied 5 mm apart and the tube transected. A clip or suture of the same material was placed on the midportion of the left fallopian tube. Necropsy was performed at 42 days, and each clip/suture site was scored for adhesions. All the materials were easily applied and effective in achieving hemostasis. The adhesion scores tended to be lower with the absorbable clips; however, there were no statistically significant differences between the groups. Laparoscopic clips are effective in providing hemostasis, are easily applied and cause no more adhesion formation than do conventional suture materials.

Animals↗
PubMed1991

New techniques in the diagnosis of ectopic pregnancy.

Pulse and color Doppler studies have provided a potent method for the investigation of functional changes and pathologic conditions in the female pelvis, both in the gravid and nongravid state. Combined with transvaginal sonography, which optimizes the imaging capability, the transvaginal color Doppler ultrasonography provides a new major modality for reproductive flow studies that have hitherto been possible only in animal models because of the invasiveness of the technique. Apart from these potential applications of the technique for research purposes, however, transvaginal imaging and the Doppler technique have become major modalities in all patients suspected of ectopic pregnancy at our institution.

Fallopian Tubes↗
PubMed1990

Secondary hypogonadism in hemochromatosis.

Hemochromatosis is a rare disorder of iron storage. This report illustrates a case of hypogonadotropic-hypogonadism in a female with biopsy-proven hemochromatosis. Dynamic pituitary and gonadal testing revealed subnormal gonadotropin responses to gonadotropin-releasing hormone (GnRH) but normal ovarian reserve, as shown by normal follicular stimulation with hMG. Thus, abnormalities of ovulation and menstruation in patients with hemochromatosis are most likely because of inadequate pituitary responsiveness to GnRH.

Adult↗
PubMed1990

Unsuspected leiomyosarcoma: treatment with a gonadotropin-releasing hormone analogue.

We present a case of a 46-year-old woman evaluated for abnormal uterine bleeding and an enlarged uterus, with normal endometrial sampling. Three months of leuprolide acetate injections resulted in a nonenlarging uterus and resolution of iron deficiency anemia and menorrhagia. Intraoperative examination suggested leiomyosarcoma, which was confirmed by postoperative permanent histologic sections. Residual uterine sarcomatous disease was confirmed on reexploration. Similar cases will continue to raise arguments against conservative hormonal intervention in the perimenopausal woman with an enlarged uterus. As the gynecologist gains familiarity with the use of gonadotropin-releasing hormone analogue therapy in the treatment of myomatous uteri, the criteria for hysterectomy will become less rigid and the potential for delay in the diagnosis and treatment of sarcomatous disease will become more common. Physicians must be cognizant of this potential complication of conservative therapy of leiomyomata uteri.

Antineoplastic Agents↗
PubMed1990

Fetal intestinal obstruction: necessity for percutaneous umbilical blood sampling to assess the severity of Rh sensitization.

Investigation into the severity of hemolytic disease due to Rh isoimmunization may be complicated by concurrent amniotic fluid contamination with bile. We have presented a case in which a prenatal sonogram showed evidence of fetal intestinal obstruction, which was subsequently confirmed postpartum by exploratory laparotomy. Since intrauterine regurgitation of bile occurs with intestinal obstruction distal to the papilla of Vater, percutaneous umbilical blood sampling is necessary to discern the presence and severity of hemolytic disease as indicated by an abnormal spectrophotometric absorption pattern.

Adult↗
PubMed1990

Evidence of gonadal and gonadotropin antibodies in women with a suboptimal ovarian response to exogenous gonadotropin.

Failure to respond to human menopausal gonadotropin (hMG) with adequate ovarian stimulation is associated with a poor prognosis in subsequent cycles in women participating in an in vitro fertilization/embryo transfer program. Sera from 26 menstruating women (mean age 38 +/- 4.3 years) identified as "low responders" with either tubal or male factor infertility, mean baseline FSH values of 11 mIU/mL, and peak serum estradiol levels lower than 300 pg/mL were assessed for specific antibodies to human ovary and gonadotropins. Twenty-five infertile women with tubal or male factor infertility with a good response to hMG served as controls. Ninety-two percent of low responders had antibodies to FSH and 65% had antibodies to LH when assessed by enzyme-linked immunosorbent assay. Similarly, 77% of low responders had ovarian antibodies. No hepatic antibodies were found in the sera of low responders, indicating that the positivity was not a general interaction with cell components. None of the "good responders" had antibodies to gonadotropins or to ovarian or liver tissue. The significant differences in antibodies between the groups supports a possible immunologic cause for low ovarian stimulation response to gonadotropin.

Adult↗