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PubMed1986

Serum bioactive follicle-stimulating hormone during the human menstrual cycle and in hyper- and hypogonadotropic states: application of a sensitive granulosa cell aromatase bioassay.

A sensitive in vitro assay based on the stimulation of estrogen production by cultured rat granulosa cells was recently developed for the measurement of biologically active FSH. This bioassay system is specific for FSH, highly sensitive, and capable of measuring basal FSH levels in rat serum. The granulosa cell aromatase bioassay was improved by the use of additives known to enhance FSH activity and by pretreatment of serum with 12% polyethylene glycol to remove inhibitory substances. We applied this method to the measurement of bioactive FSH levels in serum samples from human subjects. As determined in daily blood samples during ovulatory menstrual cycles in seven women, bioactive FSH levels exhibited a pattern closely resembling that of immunoreactive FSH. The mean bioactive serum FSH levels were 29.9, 20.5, 39.2, and 14.8 mIU/ml for the early follicular phase, late follicular phase, preovulatory surge, and luteal phase, respectively. The bio- to immunoratio (B:I) throughout the menstrual cycle ranged from 1.4-3.4, with a mean of 2.5. The ratios for early follicular phase, late follicular phase, preovulatory surge, and luteal phase were 2.7, 2.3, 1.4, and 2.6, respectively. The correlation coefficient (r) of the serum FSH values obtained by bioassay and RIA was 0.91. FSH bioactivity was also measured in patients in each of the following categories with the following mean values: oral contraceptive pill users (undetectable), hypothalamic amenorrhea (18.7 mIU/ml; B:I, 2.6), premature ovarian failure (163 mIU/ml; B:I, 1.7), and postmenopausal women (191 mIU/ml; B:I, 1.6). These findings suggest that measurement of immunoreactive FSH levels correctly reflects the biological activity of FSH in serum of cycling women and patients in certain hyper- and hypogonadotropic states. The granulosa cell aromatase bioassay represents a new tool for future assessments of biologically active FSH in physiological and pathophysiological conditions.

Adult↗
PubMedDate not supplied

Coronary artery disease in young women: risk factor analysis and long-term follow-up.

BACKGROUND: Heart disease in the leading cause of death in women of all ages in the United States, but data on coronary disease in young women remains sparse. OBJECTIVE: To identify and follow up a cohort of young women referred for the evaluation of coronary disease. METHODS: Retrospective review of the medical records. RESULTS: Thirty-two women younger than 31 years met the entry criteria. The average age was 28 +/- 2.4 years, 28% had insulin-dependent diabetes mellitus, 38% had hypertension, 6% had congenital heart disease, 38% had a family history of coronary artery disease, 72% were smokers, and 28% used oral contraceptives. Serum cholesterol levels were > 5.17 mmol/L (200 mg/dL) in 71%, and the mean cholesterol level was 6.70 +/- 2 mmol/L (259 +/- 78 mg/dL). Resting electrocardiographic results were abnormal in 28 women (88%), 22 of whom had evidence of transmural myocardial infarction. Follow-up averaged 9.8 +/- 6.4 years. Five patients died, all of whom had hypertension, and 4 of whom had diabetic nephropathy and required dialysis. CONCLUSIONS: Risk factors for coronary disease in young women include hypertension, hypercholesterolemia, diabetes mellitus, familial coronary disease, and smoking. Long-term prognosis is excellent for those without advanced diabetes mellitus and renal failure.

Adolescent↗
PubMed2002

Fifteen years analysis of complications following minilaparotomy female sterilization in Jos Nigeria.

A retrospective analysis of complications following female sterilization via minilaparotomy performed in Jos University Teaching Hospital between January 1985 and December 1999 was undertaken to determine the incidence, the type of complications and identify ways of improving the service. 2986 clients had female surgical contraceptions. Major surgical complications occurred in 0.87% of the clients. Minor complications were seen in 4.15% with wound sepsis contributing 3.75% to the rate. The crude failure rate was 0.23%. Re-anastomosis was the reason for the failures not surgical misapplication of devices nor fistulous opening as found elsewhere. There was no death in the series. Clients seeking surgical contraception should be counseled about the minimal major surgical and minor complications that could occur during the procedures. Our center will need to focus on infection prevention in female surgical contraception in order for the services to enjoy continuous acceptance by the clients.

Adult↗
PubMed1984

Carbon dioxide laser treatment of cervical warty atypias.

A total of 94 patients with cervical warty atypia have been treated, on an outpatient basis, using the carbon dioxide laser. The treatment was quickly and painlessly performed. Ten patients (10.6%) had a persisting warty atypia. These treatment failures were not related to age, parity, lesion size, or method of contraception.

Adolescent↗
PubMed2004

Primary ovarian pregnancy after postpartum bilateral tubal ligation: a case report.

BACKGROUND: Primary ovarian pregnancy constitutes <1% of ectopic gestations. Likewise, bilateral tubal ligation failure is uncommon, occurring in approximately 1% of tubal sterilization procedures. Should pregnancy occur after bilateral tubal ligation, of every 3 such pregnancies, 1 will be an ectopic. The incidence of ovarian pregnancy after tubal ligation has not been reported, but must be extremely rare. CASE: A 30-year-old, breast-feeding, white woman 6 months postpartum, with bilateral tubal ligation after delivery, developed acute right lower quadrant pain while excercising. Evaluation in the emergency room revealed rebound tenderness in the lower right abdomen, a positive beta-hCG level and ultrasound findings suspicious for a right ectopic pregnancy. Exploratory laparotomy revealed hemoperitoneum, previously ligated but otherwise-normal-appearing fallopian tubes, and a ruptured and bleeding right ovary. The pelvis was otherwise normal. Histology of the right ovarian wedge resection showed chorionic villi consistent with ovarian pregnancy. Both fallopian tubes were religated, and a review of the original tubal ligation histology confirmed tubal lumen in both segments. CONCLUSION: While ectopic pregnancy is a known but rare risk of failed tubal sterilization, pregnancy involving the fallopian tube is usually reported after tubal ligation failure. The rarely seen primary ovarian pregnancy is usually associated with intrauterine contraceptive devices or occurs in patients with pelvic inflammatory disease. Ovarian pregnancies are associated with massive hemoperitoneum in women unaware that they are pregnant.

Adult↗
PubMed2004

[Notifications to the Netherlands Pharmacovigilance Foundation Lareb of the expulsion of a vaginal contraceptive ring (NuvaRing) and of pregnancy during the use of it].

Netherlands Pharmacovigilance Foundation Lareb expulsion of the vaginal contraceptive ring NuvaRing was reported 8 times between February 2003 and April 2004. Moreover, in two of these reports pregnancy was reported. In that same period, Lareb received 10 more reports of pregnancy during the use of the ring, in which expulsion was not mentioned explicitly. Additional information on these cases was collected by questionnaire. Expulsion of the ring is described in the product information. The ring should then be placed back within 3 h. However, the Lareb reports show that expulsion of the ring is not always noticed by the user. In those cases the contraceptive efficacy of this method is questionable. The physician should be alert to pre-existing risk factors that increase the chance of expulsion of the ring, and should provide extra detailed advice about the right way of placing the ring, the risk of expulsion and the importance of replacing it in time.

Consumer Product Safety↗
PubMed1990

Problems in the long-term renal allograft recipient.

Despite great improvement in patient and graft survival, the long-term morbidity and mortality in renal transplant recipients are still significant. Cardiovascular disease accounts for much of the mortality in long-term survivors; screening before the transplant procedure and adequate control of hypertension should help improve patient survival. Many of the gastrointestinal complications are due to overimmunosuppression and sepsis. Adequate management must include withdrawal of all immunosuppressive medications in order to save the patient's life. Liver disease is usually of viral origin; patients with chronic active hepatitis or cirrhosis should remain on dialysis. Chronic rejection is the major cause of graft loss in long-term survivors; it is unresponsive to antirejection treatment and its progression may be mediated by nonimmunologic mechanisms. Correctable problems such as renal artery stenosis and ureteral obstruction should be ruled out before a late deterioration in graft function is disregarded as chronic rejection. Post-transplant diabetes, osteonecrosis, cataracts, and nephrotoxicity are directly related to the various immunosuppressive drugs currently used. The lowest dose compatible with graft acceptance should help reduce the incidence of these nonfatal but significant complications. Recurrence of disease is a common histologic finding in many transplant recipients but, except for a few diseases such as HUS, FSGS, and oxalosis, it usually does not lead to graft failure. Successful transplantation restores fertility in many uremic patients. Adequate counseling on contraception is imperative in order to avoid unwanted pregnancies and to delay parenthood for at least 1 year. Current immunosuppressive agents are not teratogenic, no dose adjustments are necessary, and an ill-advised decrease in medication may precipitate a rejection episode. Premature delivery is the major problem in these patients and can be avoided by maintaining adequate graft function and controlling hypertension and infections. It is evident from this review that most of the long-term morbidity and mortality seen in renal allograft recipients are due to overimmunosuppression with sepsis or to side effects of the individual drugs, steroids being a common denominator in almost all cases. New immunosuppressive protocols must aim not only to improve patient and graft survival but also to avoid the many complications that limit the full rehabilitation of these patients.

Graft Survival↗