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Biomedical subjects

Z Blumenfeld

Publications and source records attributed to Z Blumenfeld.

At least 91 records · Page 5Linked to original sources
PubMed1992

Growth hormone (GH)-binding protein regulation by estrogen, progesterone, and gonadotropins in human: the effect of ovulation induction with menopausal gonadotropins, GH, and gestation.

The recently described serum GH-binding protein (GH-BP) may reflect the GH-receptor level. To assess the serum GH-BP levels under various physiological and supraphysiological levels of sex steroids, we have evaluated its concentration in 26 patients undergoing 34 cycles of ovulation induction with either human menopausal gonadotropins (hMG)/hCG or GH/hMG/hCG. The latter ovulation induction protocol was undertaken in "Clonidine negative" patients in a prospective, randomized, crossed-over manner, between GH/hMG/hCG or hMG/hCG. The increase in GH-BP levels in patients' sera undergoing ovulation induction directly correlated with peripheral estradiol (E2) (r = 0.577; P < 0.001), and with peripheral progesterone (P4) (r = 0.542; P < 0.001; n = 174) concentrations in hMG/hCG cycles, and also in GH/hMG/hCG cycles (r = 0.669, P < 0.001 for E2, and r = 0.722, P < 0.001 for P4, n = 84). GH-BP levels did not change significantly in response to 0.15 mg Clonidine ingestion. The baseline GH-BP levels significantly correlated with the body mass index of 47 patients (r = 0.547; P < 0.001). The insulin-like growth factor-I (IGF-I) concentrations increased in correlation with increasing E2 levels up to 5500 pmol/L but decreased thereafter, at very high E2 concentrations. In gestations generated by ovulation induction with hMG/hCG or GH/hMG/hCG, longitudinal measurements of GH-BP levels showed an initial sharp increase during early gestation, followed by a gradual decrease beginning around the end of the first trimester and continuing during the mid and late trimesters. In normal spontaneous pregnancies, GH-BP levels, measured from the fifth week until term, were negatively correlated with gestational age (r = -0.581; P < 0.001; n = 84). This pattern is highly suggestive of the possibility that GH-BP is coregulated not only with E2 and P4 but also with hCG, and possibly other gonadotropins as well. Indeed, in patients with "resistant ovaries", pharmacological amounts of hMG failed to increase E2 concentrations but moderately increased GH-BP levels. These data provide good indirect evidence for coregulation of the GH-BP with both sex steroids and gonadotropins. The mid and late trimesters decrease in GH-BP levels in spite of increasing sex steroids concentrations, may be attributed to the decreasing hCG concentrations, and/or to the increasing secretion of placental lactogen (PL) and placental GH with the advancing gestation.

Carrier Proteins↗
PubMed1992

Clubfeet associated with hydrocephalus: new evidence of gradual dynamic development in utero.

Clubfoot, a relatively frequent congenital malformation, may be associated with several genetic syndromes or other malformations, or may appear as an isolated idiopathic anomaly. We describe the intrauterine development of clubfeet subsequent and in parallel to fetal hydrocephalus formation, as followed by serial transvaginal sonographic scans at 11-16 weeks' gestation. The possibility of a causal relationship between the central nervous system malformation and the clubfeet is suggested. To the best of our knowledge, this is the first description of the dynamic, in vivo fetal development of hydrocephalus and clubfeet at 11-16 weeks' gestation.

Adult↗
PubMed1991

First- and early second-trimester oligohydramnios-a predictor of poor fetal outcome except in iatrogenic oligohydramnios post chorionic villus biopsy.

Whereas a well-known association exists between oligohydramnios and renal agenesis, renal dysplasia, urinary tract obstruction and intrauterine growth retardation in the second half of pregnancy, the causes and prognosis of early oligohydramnios are less known. Twelve cases of first- and early second-trimester oligohydramnios were detected out of 5000 fetal screenings for malformation detection. Two out of these 12 cases occurred in patients who had undergone chorionic villus sampling, two were associated with premature rupture of membranes, six were associated with fetal cardiac malformations and two cases were idiopathic. Whereas ten out of 12 cases ended in intrauterine fetal death, spontaneous or therapeutic abortions, in the two cases which developed after chorionic villus sampling the oligohydramnios was self-limiting and these two pregnancies ended in term deliveries of normal, healthy neonates. It may be concluded that oligohydramnios in the first half of gestation bears a poor fetal prognosis except in cases where it follows chorionic villus sampling.

Journal Article↗
PubMed1991

Pseudoprognathism--an auxiliary ultrasonographic sign for transvaginal ultrasonographic diagnosis of cleft lip and palate in the early second trimester.

Cleft lip and palate have been diagnosed antenatally only in the late midtrimester or at later gestational ages, when it is too late for pregnancy termination. The diagnosis of fetal cleft lip was made in three low-risk nulligravid women at 14 to 16 weeks of gestation by systematic screening with a 6.5 MHz transvaginal transducer and was confirmed by postabortal examination.

Adult↗
PubMed1991

Cardiac involvement in patients with primary antiphospholipid syndrome.

To evaluate cardiac involvement in primary antiphospholipid syndrome, two-dimensional and Doppler echocardiographic studies were performed in 34 consecutive patients with this syndrome. All patients had an increased level of serum anticardiolipin antibodies with no evidence of malignancy or systemic lupus erythematosus. The clinical manifestations of primary antiphospholipid syndrome were arterial thrombosis in 14 patients, venous thrombosis in 6 and recurrent fetal loss in 14. Valvular lesions were observed on two-dimensional echocardiography in 11 patients (32%) (9 women and 2 men), aged 24 to 57 years (mean +/- 1 SD 36 +/- 10). Abnormal echocardiographic findings were observed in 9 (64%) of 14 patients with arterial thrombosis versus 1 (17%) of 6 patients with venous thrombosis and 1 (7%) of 14 patients with recurrent fetal loss. The most common echocardiographic abnormality was mitral leaflet thickening, found in five patients; this was associated with mitral regurgitation in three and with combined mild mitral stenosis and regurgitation in one patient. Localized subvalvular mitral thickening was observed in one patient and calcification of the anulus in another. Aortic valve thickening was observed in two patients, one of whom also had a moderate degree of aortic regurgitation. Vegetation-like lesions on the mitral or aortic valve were found in two patients. It is concluded that valvular lesions are commonly found in primary antiphospholipid syndrome, particularly when the syndrome is manifested by peripheral arterial thrombosis. The location and appearance of valvular lesions in this syndrome are heterogeneous. Most patients have no clinically significant valvular disease. Two-dimensional and Doppler echocardiographic studies are often informative in these patients.

Adult↗
PubMed1991

Transvaginal sonography in infertility and assisted reproduction.

This review on transvaginal sonographic uses in the diagnosis and treatment of infertility evolves from the plethora of data acquired due to the renewed technology of TVS. A combination of its advantages: 1) closer proximity to the pelvic organs and therefore clearer images as compared to abdominal ultrasound, 2) the avoidance of the necessity of full bladder made the TVS gain much popularity in obstetrics and gynecology. Its value is recognized not only by opening a door to early detection of common pathologies of pregnancy--ectopic gestation and fetal malformations, multiple fetuses, and spontaneous fetal reduction ("vanished twin"), but also made visualization of the enlarged fallopian tubes, uterine cervix and corpus and ovarian follicles an almost indispensible adjunct to modern gynecologic infertility workup. The value of TVS seems to increase tremendously not only as an indispensible diagnostic tool but also as a modern means of replacing laparotomy or laparoscopy for follicular aspiration and eggs retrieval for IVF/ET, GIFT and assisted reproduction, reduction of the number of multiple fetuses, and for treatment of most cases of ectopic pregnancy. Its value in the diagnosis and treatment of the infertile couple seems invaluable now and indispensible tomorrow.

Female↗
PubMed1991

Synergistic effect of growth hormone and gonadotropins in achieving conception in "clonidine-negative" patients with unexplained infertility.

Based on preliminary reports by others and by us of a potentiating effect of growth hormone (GH) on human menopausal gonadotropin (hMG)-induced ovulation, a study using a randomized, prospective, cross-over protocol between GH + hMG/human chorionic gonadotropin (hCG) and hMG/hCG was undertaken. The study included patients with long-standing (2-11 years) unexplained infertility with a negative or reduced GH response to clonidine (up to 150 micrograms of clonidine orally). The first cycle was randomly assigned between GH/hMG/hCG (study cycle) and hMG/hCG alone (control cycle), and after an interval cycle the patient's treatment was crossed over. All patients who completed the study had previously undergone 1-20 attempts at ovulation induction for in vitro fertilization (IVF) and 5-40 cycles of ovulation induction for in vivo fertilization at three different medical centers. Three patients conceived on the combined GH/hMG cycle, with diminution in the hMG consumption needed for ovulation induction in the study cycles. Another patient with long-standing mechanical infertility underwent 11 abortive attempts at ovulation induction with hMG for IVF but has never achieved egg retrieval. On the GH/hMG/hCG ovulation induction cycle, three mature ova were retrieved as opposed to no response and cancellation of the "hMG only" cycle. Another patient with 11 years of primary infertility who had undergone 21 previous attempts at ovulation induction and had reached follicular aspiration in only three of those cycles conceived spontaneously on the first cycle after the GH/hMG/hCG IVF/ET cycle. All four pregnancies that have been achieved by now in seven GH/hMG-treated patients ended in cesarean deliveries of four normal male neonates. No correlation was found between the follicular fluid levels of insulin-like growth factor I (IGF-I) and the fertilization rate in vitro. The peripheral IGF-I levels were significantly higher during the follicular phase of the study cycles than during the respective stage of the control cycles or the luteal phase of either cycle. A study of serum GH-binding protein (GH-BP) levels revealed gradual increases in the late follicular phase, in the luteal phase, and in early pregnancy. On the basis of this study and in keeping with earlier reports, we conclude that the addition of GH to hMG/hCG may serve as a contributory adjunct in selected patients. However, in contrast to others who could not find a correlation between the response to acute tests for GH release and the ovarian response to combined treatment, we conclude that the clonidine test can play a discriminatory role in identifying patients who may benefit from this innovative combination.

Adult↗
PubMed1991

Hemorrhagic ovarian cyst detection by transvaginal sonography: the great imitator.

The sonograms of 102 hemorrhagic ovarian cysts (HOC) were reviewed to ascertain the full spectrum of sonographic findings as visualized by transvaginal sonography (TVS). The diagnoses, in 11 cases, were proven by surgery and the rest have undergone conservative follow-up until resolution (clinically and sonographically). The accurate diagnosis of HOCs by transabdominal sonography is quite difficult. The appearance of these cysts as visualized by TVS is described. We advise TVS as a better means for identification of HOCs, thus decreasing the rate of diagnostic invasive procedures.

Adolescent↗
PubMed1991

Anticardiolipin antibodies in patients with recurrent pregnancy wastage: treatment and uterine blood flow.

The interest in autoimmune pregnancy loss has increased recently with the discovery of the association between the presence of antibodies to phospholipids and cardiolipin and habitual abortion. To evaluate the prevalence of anticardiolipin antibodies in patients with recurrent fetal loss and the effect of low-dose aspirin and corticosteroid treatment, we examined 67 women for anticardiolipin antibodies with an enzyme-linked immunosorbent assay. Increased levels of anticardiolipin antibodies were found in 34 of these women (50.7%) and in none of 12 normal pregnant controls. Seventeen of these 34 patients conceived and were treated with aspirin, 100 mg/day, and fluocortolone, 10 mg/day. Twelve gravidas reached term, all delivering live infants with good Apgar scores and normal birth weights. Three others delivered prematurely, two of them because of premature rupture of membranes and the other because of severe fetal growth retardation. This latter woman delivered at 31 weeks, and the 1000-g infant died neonatally. The neonatal survival rate was 82% in the treated patients, versus 18% in the same group of subjects in their previous, untreated gestations. The umbilical artery resistance index of the treated subjects was not different from that of anticardiolipin-negative hypertensive women who did not receive aspirin and corticosteroid therapy. However, the uterine artery resistance index was significantly lower in the hypertensive treated group than in the untreated group. Whether this difference reflected a beneficial effect of low-dose aspirin and corticosteroid therapy on pregnancy outcome and survival rate remains to be evaluated.

Abortion, Habitual↗
PubMed1991

First- and second-trimester diagnosis of fetal ocular defects and associated anomalies: report of eight cases.

Ocular cataract, hypertelorism, hypotelorism, anophthalmos, and microphthalmos are rare malformations commonly associated with other fetal anomalies. Previously, ocular malformations were detected only after mid-gestation. Transvaginal sonography allows the detection of many structural fetal anomalies. We describe the case reports of eight ocular anomalies among 1600 fetal screenings by transvaginal sonography at 12-18 weeks' gestation. Severe cataract was correctly diagnosed by transvaginal sonography. However, transvaginal sonography failed to detect moderate cataract in a case of repeat cataract in a subsequent gestation. Anophthalmia may sometimes be secondary to a degenerative process in middle and late pregnancy. In five of the eight described cases, the eye malformations were associated with defects of the central nervous system.

Adult↗
PubMed1990

[Gestation and spontaneous delivery in hydrocephalus with ventriculoperitoneal shunt].

The number of hydrocephalic patients reaching the reproductive age has increased in recent years due to improvement in the therapeutic armamentarium and the increased use of unidirectional ventriculo-peritoneal or ventriculo-atrial shunts for drainage of cerebrospinal fluid. 15 pregnancies in 14 patients with hydrocephalus and draining shunts have been reported. A patient with hyperprolactinemia and ventriculo-peritoneal shunt for hydrocephalus, who conceived after treatment and delivered spontaneously, is presented. It is concluded that gestation does not change the rate of complications and that most of these women conceive and deliver spontaneously.

Cerebrospinal Fluid Shunts↗
PubMed1990

Early determination of fetal sex using transvaginal sonography: technique and pitfalls.

Transvaginal sonography (TVS) enables sex determination at an early stage of pregnancy. The morphologic features of fetal external genitalia at 13 weeks to 16 weeks, menstrual age, are different from those seen later in pregnancy; therefore an attempt to determine fetal gender at this early stage by the same criteria as those used later is hazardous, especially for determining the male sex. The main diagnostic criteria for male gender determination by TVS are the "dome" sign representing the sonographic visualization of the fetal scrotum, the cranially directed phallus, and the longitudinal raphe at the base of the penis. The diagnostic criteria for female gender are the 2 or 4 parallel lines representing the labial folds and the caudally directed phallus (clitoris). The length of the fetal phallus at this early stage is not diagnostic and may be the main pitfall to the unexperienced sonographer. Between weeks 13 and 14 sex diagnosis was possible in 130/171 pregnancies (76%) in our first 2 years and 188/235 (80%) in our last 2 years of experience. Between weeks 15 and 16 sex diagnosis was possible in 122/139 pregnancies (88%) during our first 2 years and 96.7% (528/546) during the last 2 years of experience. The accuracy rate for fetal male gender identification increased from 91.7% during the first 2 years of TVS experience to 99.7% during the last 2 years of TVS experience, and the accuracy rate for female gender identification, increased from 93.3% to 100%, respectively, applying the above criteria and based on acquired experience of early fetal sex identification by TVS early in gestation. Early and precise determination of fetal sex is possible and might avoid invasive procedures such as amniocentesis.

Female↗
PubMed1990

First and early second-trimester diagnosis of fetal urinary tract anomalies using transvaginal sonography.

Urinary tract anomalies are common. Prenatal diagnosis is important and enables either special obstetric management or termination of pregnancy and probably in the future, intrauterine intervention. Transvaginal sonography (TVS) allows visualization of the normal and anomalous fetal urinary tract at an early stage. One thousand nine hundred and forty women were examined via TVS at an early stage of pregnancy between 10 and 16 weeks from the last menstrual period (LMP) and 35 anomalies (1.8 per cent) were clearly identified: 29 cases of low urinary tract obstruction, 2 cases of multicystic dysplastic kidney, 2 cases of polycystic kidney (infantile type), 1 case of double collecting system, and 1 case of horseshoe kidney. Potter syndrome could be ruled out in three patients who had delivered fetuses suffering from this anomaly in previous pregnancies. The concise and early identification of anomalies makes TVS an important aid in the hands of the obstetrician, ultrasonographer, and neonatologist.

Abnormalities, Multiple↗
PubMed1989

First-trimester and early second-trimester diagnosis of nuchal cystic hygroma by transvaginal sonography: diverse prognosis of the septated from the nonseptated lesion.

Fetal cystic hygroma is a congenital malformation of the lymphatic system appearing as a single or multiloculated fluid-filled cavity, most often in the nuchal region. The malformation is believed to arise from failure of the lymphatic system to communicate with the venous nuchal system. Sometimes the lesion progresses to fetal hydrops, causing fetal death. To further delineate the cause and natural history of this disorder, we have prospectively studied eight cases of cystic hygroma of the neck, detected at gestational ages of 9 to 15 weeks by transvaginal sonography. Three of the eight fetuses survived (37.5%) and were normal at birth. Either hydrops fetalis or intrauterine fetal death occurred in the other five fetuses. In one of these five, therapeutic abortion was induced because of trisomy 21. In another fetus of these five, trisomy 18 was diagnosed by amniocentesis. This pregnancy ended in intrauterine fetal death. The ultrasonic evaluation of the cystic hygromas revealed that those that were reabsorbed in the three ultimately normal viable fetuses were nonseptated cysts, whereas all the four cystic hygromas ending in fetal death or associated with aneuploidy were septated, multilocular hygromas. In another fetus with nonseptated hygroma, nonimmune hydrops developed, which resulted in premature delivery and early neonatal death.

Down Syndrome↗
PubMed1989

Pretreatment of sperm with human follicular fluid for borderline male infertility.

To test the usefulness of human follicular fluid (FF) in treating male infertility, we incubated washed sperm specimens from 31 couples undergoing intrauterine insemination (IUI), for male and/or unexplained infertility, with either FF or Ham's F-10 medium (Gibco, Grand Island, NY), in alternating cycles in a randomized manner. Semen specimens from 28 men were incubated with either medium or FF. Incubations with FF have increased sperm penetration assay (SPA) scores from 24.8 +/- 17.3 to 34.3 +/- 13.6 (P less than 0.01). Incubation with heat-inactivized FF also has increased SPA scores, although to a lesser extent than noninactivized FF. Seventeen pregnancies occurred in the 31 couples treated by IUI (54.8%), 16 of them in FF-treated cycles (51.6%) and one in "control" IUI cycles (3.2%, P less than 0.01). All pregnancies occurred within four treatment cycles. Thus, IUI after sperm wash and preincubation with FF may be suggested for four to six cycles to couples with male factor and/or unexplained infertility who are reluctant to resort to artificial insemination by donor or adoption, before attempting the more costly and complex in vitro fertilization-embryo transfer procedure.

Body Fluids↗
PubMed1989

The potentiating effect of growth hormone on follicle stimulation with human menopausal gonadotropin in a panhypopituitary patient.

A hypogonadotropic patient with primary pituitary insufficiency who has been previously treated for four cycles with hMG/hCG for ovulation induction is described. The hMG consumption was 76 to 96 ampules/cycle. Addition of GH (16 to 24 units/cycle) to hMG treatment was associated with a significant diminution in hMG consumption (35 to 36 ampules/cycle). The patient conceived on the second cycle of combined hMG/GH/hCG treatment. The possible role of GH as an adjunct to gonadotropin treatment is discussed, as well as the possible mechanisms of GH effects on the ovary.

Adult↗