Search Results - (Author, Cooperation:M. Hull)

2018-03-29

BMJ Publishing

2044-6055

Medicine

Open access, Epidemiology, Epidemiology

2013-08-03

American Association for the Advancement of Science (AAAS)

0036-8075

1095-9203

Biology

Chemistry and Pharmacology

Computer Science

Medicine

Natural Sciences in General

Physics

Animals ; Biological Evolution ; *Climate Change/history ; *Ecosystem ; Greenhouse Effect ; History, Ancient ; *Oceans and Seas ; *Seawater ; Temperature ; Tidal Waves ; Vertebrates

2015-04-04

Nature Publishing Group (NPG)

0028-0836

1476-4687

Biology

Chemistry and Pharmacology

Medicine

Natural Sciences in General

Physics

Alzheimer Disease/*genetics ; Female ; Genetic Predisposition to Disease/*genetics ; Genetic Variation/*genetics ; Humans ; Male ; Phospholipase D/*genetics

2015-12-18

Nature Publishing Group (NPG)

0028-0836

1476-4687

Biology

Chemistry and Pharmacology

Medicine

Natural Sciences in General

Physics

Animals ; Biodiversity ; Biological Evolution ; Classification ; Conservation of Natural Resources ; Ecology/methods ; *Ecosystem ; *Extinction, Biological ; Fossils ; Population Density

2018-01-14

BMJ Publishing

2044-6055

Medicine

Open access

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Objective To determine the relative value of the woman's age, basal follicle stimulating hormone (FSH), basal luteinising hormone (LH) and menstrual cycle pattern (all denned prior to treatment) in predicting the ovarian response to gonadotrophin stimulation for in vitro fertilisation.Design Open, descriptive cohort study.Patients One hundred and seventy-one consecutive ovulatory women undergoing their first cycle of in vitro fertilisation with ovarian stimulation after pituitary desensitisation.Interventions Measurement of basal (early follicular phase) and down-regulated concentrations of serum FSH and LH, and calculation of age at treatment and of median length of menstrual cycles and range of variation prior to treatment.Main outcome measures Duration and amount of gonadotrophin stimulation to achieve follicular maturity, number of mature follicles, peak serum oestradiol concentration and number of mature oocytes, were compared between banded values of variables studied.Results Increasing basal FSH concentrations were significantly associated with reducing oestradiol levels, numbers of mature follicles and oocyte yield even when the FSH levels were still within the normal range though above average (6 to 8.9 i.u./l). There were similar but weaker associations with FSH levels after down-regulation. There were also significant differences between women over and under 40 years old in their oestradiol levels, numbers of follicles and of oocytes. Analysis of variance showed significant independent association of basal FSH with both oestradiol and numbers of oocytes, but not of age, menstrual pattern, or serum LH concentrations.Conclusion Serum FSH is more sensitive than the woman's age in determining her ovarian responsiveness to stimulation. LH concentrations and menstrual cycle patterns are unhelpful.

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Basal serum prolactin concentrations were compared with mid-luteal serum progesterone concentrations and prospectively studied conception rates up to 12 months in women with otherwise unexplained infertility including a normal menstrual cycle. There were altogether 188 women with mean prolactin levels up to 3075 mU/1: 47 with prolactin up to 200 mU/1, 100 with prolactin 201–400 mU/1,18 up to 600 mU/1, 16 up to 800 mU/1, and 7 greater than 800 mU/1. There were no significant differences in the mean progesterone values or chance of conception between any of the groups. The findings indicate that prolactin measurement is generally of no value in normally menstruating women, except possibly in the unusual event of evidence of persistent distinct luteal deficiency (not found in the present study).

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Summary. The effect of epidural analgesia on oxytocin release during the second stage of normal labour was studied by comparing 10 primigravidae who had epidurals with 10 control subjects who did not have epidurals. A significant increment in oxytocin between paired peripheral blood samples taken at the onset of full cervical dilatation and crowning of the fetal head was found in the control subjects but not in those with epidurals. Forceps delivery was required more often in the group with epidural analgesia and was associated with lower oxytocin levels at crowning. Since distension of the lower birth canal and stimulation of pelvic autonomic nerves leads to oxytocin release, and the need for forceps associated with epidurals can be reduced by oxytocin, these differences are attributed to the lumbar epidural block.

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Plasma unconjugated oestriol (E3) concentrations were determined by radio-immunoassay in 10 normal subjects in late pregnancy, throughout a normal day and night, and after a 50 g oral glucose load. There was a circadian pattern in E2 concentration characterized by an abrupt increase of 15 per cent at night. There was no significant rhythm during the day or night, taken separately. However there was a 10 to 11 per cent reduction in E3 concentrations soon after some meals and after a glucose load, possibly due to expansion of the plasma volume. Excluding the effect of meals, the fluctuation of E3 concentrations in individuals (median of the coefficients of variation) was 11 5 per cent in the day. Overall, it was 13·2 per cent in the day, 12·1 per cent at night and 15·9 per cent over the whole period studied. Since the variation in plasma unconjugated E3 concentrations through 24 hours was no greater than random fluctuations or day-to-day variation there is no need to restrict the time of blood sampling in clinical practice.

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Results of treatment of 52 patients with amenorrhoea associated with hyper-prolactinaemia are presented. All patients had a detailed radiological examination of the pituitary fossa, including lateral tomography in every patient and air encephalography in those in whom a pituitary tumour was suspected. There were 17 patients with untreated pituitary tumours, 5 patients with previously treated pituitary tumours and persisting hyperprolactinaemia, and 30 patients with normal pituitary radiology. Patients with pituitary tumours were treated either by transsphenoidal or transfrontal surgical extirpation of the tumour, followed, if necessary, by external irradiation and/or bromocriptine. Four patients were treated with external irradiation as primary therapy, and three patients who did not wish to conceive were treated with bromocriptine as primary therapy. Patients with normal radiological appearances were treated with bromocriptine as primary treatment. Ovulatory menstrual cycles developed in 42 patients and there were 19 pregnancies. Those ovulating but not conceiving had adequate non-endocrine factors to account for the disparity. Failure of response was seen in 10 patients and was due to inadequate fall of prolactin in response to surgery (2 patients), external irradiation (3 patients) and bromocriptine (1 patient), and gonadotrophin deficiency which developed after surgery in 3 patients but was present pre-operatively in 1. The relative merits of treatment by surgery, external irradiation and bromocriptine are discussed and a policy of treatment outlined.

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Summary. The feasibility of studying ovarian arterial blood flow has been demonstrated, using an ultrasonic method combining real-time imaging and pulsed Doppler (the ‘duplex’ method). Results using a percutaneous full-bladder technique were validated by comparison with use of an ultrasound probe applied directly to the arteries at laparotomy. The ovarian arteries demonstrated qualitatively and quantitatively distinct flow patterns compared with the internal and external iliac arteries. From recorded waveforms a pulsatility index (PI) reflecting vascular impedance was calculated. The PI was found to be lower, indicating increased blood flow, in the artery supplying the ovary carrying the dominant follicle or corpus luteum. Serial studies suggest that this change occurs at an early stage of the menstrual cycle. possibly before the dominant follicle can be recognized by its size or increased hormone production. Uterine arterial flow was also detectable, more accurately abdominally than vaginally, and the changes typical of late pregnancy were already found to be present, though to a lesser degree, in the first trimester.

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Summary. Time-specific conception rates were studied prospectively after a carefully validated post-coital test (PCT) in a consecutive series of 80 ovulatory women without any pelvic or seminal cause for their previous infertility. The PCT was performed on endocervical mucus collected 6–18 h after intercourse. The definition of a negative result, indicated by the absence of forward-moving sperm, depended on the finding being repeated in a second cycle and on the presence each time of fully developed mucus, indicated simply by its abundance, ductility and clarity. The time to conception was inversely related to the number of motile sperm seen. Simpler analysis showed a fivefold greater chance of conception associated with a positive compared with a negative PCT; after 2 years the cumulative conception rates were 84 and 16% respectively.

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

The relation between maternal plasma unconjugated oestriol (E3) concentrations and uterine activity was investigated by very frequent, carefully timed determinations of E, during synchronously recorded uterine contractions in six normal subjects. There was an initial rise (10 to 50 per cent above the mean) in E3 levels reaching a peak coincident with the contraction peak (range 20 seconds before to 15 seconds after) followed by a fall of similar magnitude below the mean reaching a nadir about 80 seconds (range 60 to 105 seconds) after the contraction peak. Although the pattern of E3 fluctuation was most marked in labour the overall degree of variation was no greater than at other times. Cystine aminopeptidase (CAP) concentrations in the same serum samples showed no significant correlation with uterine contractions. The reasons for, and practical applications of, the E3 results are discussed.

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Amenorrhoea due to loss of weight was diagnosed in 39 of 170 consecutively investigated patients with amenorrhoea: 24 patients had anorexia nervosa but in the remainder this diagnosis could not be made with certainty. The only difference detected between the two groups was in their lowest weights. Endocrine tests revealed subnormal oestrogen production, low serum LH levels and a failure to ovulate in response to clomiphene. All patients were encouraged to put on weight and 14 resumed ovulatory menstrual cycles. In these patients the mean weight at resumption of ovulation exceeded the mean weight at presentation by 3·6 kg; in contrast, in the patients who remained amenorrhoeic, there was no significant increase of weight by the time of the last visit. Of 8 patients who complained of infertility, 5 ovulated and conceived. Thus dietary treatment of patients with amenorrhoea and loss of weight may replace gonadotrophin therapy for induction of ovulation in a significant proportion of patients with anovulatory infertility.

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Summary. Artificial insemination with husband's semen into the cervical canal and uterine cavity (high AIH) was assessed by a randomized controlled prospective study in 46 couples whose infertility was due to failure of sperm mucus penetration, as defined by negative postcoital tests, after excluding all interfering female factors and men with sperm density 〈1 × 106/ml. Seminal analysis was abnormal in 18 of the 46 men and sperm antibodies in semen were detected in 19 of the remaining 28 with normal seminal analysis. Overall, the cumulative conception rate after 6 months with AIH was 4·7 (SE 3·8)% and without treatment was 6·6 (SE 3·9)%. The results were unaffected by the findings on seminal analysis or by the presence or absence of sperm antibodies in semen. AIH appeared to be of no benefit.

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Summary. In an attempt to reduce pain after laparoscopy, a drain was left for 6 h in the peritoneal cavity through the umbilical incision to take advantage of visceral peristaltic and voluntary muscle movements to expel residual gas. In a randomized study 25 treated patients were compared with 28 controls. Use of the drain was found to approximately halve the frequency of pain throughout the first 2 postoperative days. The severity of pain was also significantly reduced in the first 6 h and after mobilization at home the next day when pain is usually at its worst.

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

In 246 women with amenorrhoea we compared the result of the progestogen challenge test (menstrual response to oral medroxyprogesterone acetate 5 mg daily for 5 days) (225 patients) with the serum oestradiol-17β (E2) concentration (154 patients) and with clinical assessment of the oestrogen state of the lower genital tract (183 patients) and related them to the response to clomiphene (188 patients). Ovulation in response to clomiphene was defined essentially by a mid-luteal serum progesterone concentration of at least 25 nmol/l. E2 values were only useful when they fell below 150 pmol/l; they then indicated that ovulation was very unlikely to occur after clomiphene (2 per cent). Clinical assessment was also only useful in predicting failure to ovulate with clomiphene. However, the progestogen challenge test gave good prediction of ovulatory as well as anovulatory responses to clomiphene. After absent or scanty bleeding following progestogen, only 4 per cent of our patients ovulated, and repeated treatment with clomiphene did not increase the ovulatory rate. After a normal menstrual response to progestogen, 39 per cent ovulated in their first cycle with clomiphene using only 50 mg daily, this proportion rising to 55 per cent if 100 mg was used, and to 75 per cent after treatment for three cycles.

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Summary. Oestrogen and androgen states have been studied in relation to ovarian morphology defined by ultrasonography in 65 women with oligo-amenorrhoea. Of the 48 women with polycystic ovaries (PCO), 44 (92%) had a withdrawal bleed following progestogen challenge (indicating oestrogenization) compared with just three (18%) of the 17 with non-PCO (P 〈 0.001). Median serum concentrations of oestradiol and oestrone were statistically significantly higher in the PCO group but the ranges overlapped widely. Of the four women with PCO but oestrogen deficiency, two were hirsute and had evidence of a severe form of the disorder. The other two were not hirsute and appeared to have hypo-thalamic dysfunction associated with weight loss overriding the disorder due to pre-existing PCO. Compared with the non-PCO group, the PCO subgroup without hirsutism (n = 31) had statistically significantly higher median values of LH, testosterone, androstendione, and dehydro-epiandrosterone sulphate concentrations, and free androgen index. Concentrations of androgen, but not LH, were significantly higher still in the PCO subgroup with hirsutism (n = 17).

Electronic Resource

1471-0528

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Summary. In an attempt to reduce pain after laparoscopy, presumed to be due to persistence of CO2 in the peritoneal cavity especially under the diaphragm, women were kept 30° head down for 30 min immediately after operation. By random selection 67 treated patients were compared with 64 kept flat, postoperative symptoms being recorded at fixed times for 3 days. Although tilting was found to be of no significant benefit there were two useful findings. In both groups there was a significant fall in the frequency of upper abdominal pain during the first postoperative night from about 53% to about 25%, followed by a rise after returning home on the first postoperative day to about 60% and only a slow fall in the next 2 days. The severity of pain followed the same pattern. Patients should be warned to expect increased pain on ambulation after leaving hospital. Also, there was doubling in lower abdominal pain during the first 6 h associated with the use of Falope rings for sterilization, compared with either Hulka clip sterilization or only diagnostic laparoscopy.

Electronic Resource