Thomas S. Kosasa

THE PREVENTION OF POSTOPERATIVE PELVIC ADHESIONS FOLLOWING CONSERVATIVE OPERATIVE TREATMENT FOR HUMAN INFERTILITY

A combination of Decadreon (dexamethasone) and Phenergan (promethazine) was tested in this collaborative study of 240 infertility patients as a means of preventing postoperative adhesion formation after simple pelvic surgery. 24 patients were lost to follow-up. The overall pregnancy rate among the 240 patients was 51.7% (124): 49% with primary infertility and 58% with secondary infertility conceived after surgery. 90 full-term deliveries were recorded, 27 spontaneous abortions occurred, and 7 ectopic gestations were conceived. In all, 31 cases were reinspected for various reasons after the drug treatment postsurgery; 42% showed no adhesions, 23% showed minimal adhesions, and 35% had significant adhesions. Complications coincident with use of the combined medication were seen in 2.2% (11 of 240) patients. Though this study lacked controls, the authors feel thta the use of corticosteroids postoperatively after pelvic intervention may control the numbers of adhesions which form postoperatively.

Clinical use of a solid-phase radioimmunoassay specific for human chorionic gonadotropin

Abstract A rapid radioimmunoassay specific for human chorionic gonadotropin (hCG) has been developed. Elimination of cross-reactivity with luteinizing hormone (hLH) was obtained by utilizing an antiserum with a specificity for the beta subunit of hCG. A solid-phase system, in which the antibody was bound to CNBR-activated sepharose in a preliminary step, reduced the minimum incubation time of the assay to two hours. The assay has been found to be of particular value in those conditions where in the concentration of hCG as measured by previously described assays would be affected by circulating levels of hLH: i.e., early implantation, unruptured ectopic pregnancy, threatened abortion, and trophoblastic disease under chemotherapy.

The use of a radioimmunoassay specific for human chorionic gonadotropin in patients with molar pregnancy and gestational trophoblastic disease

Abstract Serum human chorionic gonadotropin (hCG) activity is compared in 14 patients under treatment for gestational trophoblastic disease (GTD) using both a radioimmunoassay (RIA) specific for hCG and a nonspecific rapid solid-phase RIA which measures both luteinizing hormone (hLH) and hCG. The results indicate that the nonspecific RIA is adequate for the diagnosis and management of patients with GTD when the hCG titer is above endogenous hLH levels, but a specific RIA is required to ensure complete remission and to detect early recurrence during follow-up.

A comparison between gonadotropin radioimmunoassays with the use of 48 hour and six-day incubation methods

A double-antibody radioimmunoassay for human follicle-stimulating hormone (FSH) and human luteinizing hormone (LH) which can be carried to completion in 48 hours was compared with the conventional six-day double-antibody radioimmunoassay. The bound-over total (B/T) dose response curves for the 48 hour assay were comparable in slope and dose range with the six-day assay and the four per cent average within-assay and the nine per cent between-assay coefficients of variation for the 48 hour assay were comparable with the variation observed in the conventional six-day assay. Maximum variation among identical serum samples assayed in both systems was 15.3 per cent so that quantitative results obtained with either assay system were comparable.

Microscopic appearance of the human fallopian tube following a reanastomosis procedure.

Microscopic evaluation of a human fallopian tube following end-to-end anastomosis over a polyethylene stent was performed 10 days after the initial surgical procedure. The stent was removed on the 3rd postoperative day. Examination of the excised tube revealed a patent lumen without any evidence of mucosal compromise. The submucosa adjacent to the anastomotic site revealed a mild polymorphonuclear leukocytic infiltration, although a marked inflammatory response was observed around the 5-0 chromic sutures used in the reanastomosis. This case and recent animal studies suggest that early removal of the stent does not appear to jeopardize the patency of the tube and may be preferable to removal after 3 to 4 months.

The effect of propylthiouracil on the hormone levels of early human gestation

Abstract Five patients who had arranged for termination of unwanted pregnancies were studied between the 6th and 10th week of gestation to determine the effect of propylthiouracil on thyroid function and its effect on the hormone levels of early pregnancy. In all 5 patients, the various parameters studied did not rise as is normally expected in early pregnancy. Two patients had spontaneous abortions after the end of the period of medication. The other 3 patients sought surgical termination at 12 weeks menstrual dates in another state. Whether the medication routine here outlined causes its effect by direct action on the thyroid output or on the trophoblast and/or the corpus luteum will require further investigation.