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Zaidi AZ, Hawley I, Zaidi J. Intravenous leiomyomatosis-a case report. J OBSTET GYNAECOL 2020; 41:996-997. [PMID: 32293219 DOI: 10.1080/01443615.2020.1738362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A Z Zaidi
- St George's University of London, London, UK
| | - I Hawley
- Conquest Hospital, East Sussex Healthcare NHS Trust, East Sussex, UK
| | - J Zaidi
- Conquest Hospital, East Sussex Healthcare NHS Trust, East Sussex, UK
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Singh A, Kawaji K, Tung R, Addetia K, Nazir N, Narang A, Zaidi J, Baker GO, Lang R, Patel A. IMPLEMENTATION OF A WIDEBAND LATE GADOLINIUM ENHANCEMENT CARDIAC MAGNETIC RESONANCE PROTOCOL TO IMPROVE ASSESSMENT OF MYOCARDIAL SCAR IN PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATORS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34861-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mishra B, Singh AK, Zaidi J, Singh GK, Agrawal R, Kumar V. Presurgical nasoalveolar molding for correction of cleft lip nasal deformity: experience from northern India. Eplasty 2010; 10:e55. [PMID: 20694165 PMCID: PMC2916669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
CONTEXT The cleft lip type nasal deformity presents one of the most complex surgical challenges. The long-term postoperative results are still not satisfactory despite an emphasis on primary nasal correction. This is attributed to tissue memory and healing. Nasoalveolar molding is used effectively to reshape the nasal cartilage and to mold the maxillary arch before cleft lip repair. AIMS This study was undertaken to evaluate the role of presurgical nasoalveolar molding in correction of cleft lip nasal deformity for patients with unilateral and bilateral clefts of the lip. SETTINGS AND DESIGN Twenty-three cases of clefts of lip and palate with nasal deformity were subjected to present study from May 2004 to May 2006. These cases were initially treated on outpatient basis, and they were admitted at the time of operation. All of these patients were children of less than 1 year of age, belonging to north Indian population. MATERIAL AND METHODS Study consisted of patients of cleft lip and palate who were given presurgical nasoalveolar splints at early age. Lip repair was done after at least 2 months of molding. These patients along with control group (without presurgical nasoalveolar molding) were followed up for 1 year. Measurements were taken at different intervals in study over dental cast and on patients. Data obtained from comparison of 2 groups were analyzed using "MSTAT" analysis software (developed by Dr Russel Freed, Professor & Director, Crop & Soil Sciences Department, Michigan State University, East Lansing, Michigan). RESULTS In our study, we found that nostril height was more in patients of experimental group (P = .18), while nostril width and alar perimeter were not changed significantly. Children with nasoalveolar molding had significant lengthening of columella (P = .02). Patients of unilateral cleft lip had more reduction in alveolar gap (P = .08) than bilateral group (P = .15). CONCLUSIONS Nasoalveolar molding can be a useful adjunct for treatment of cleft lip nasal deformity. It is a cost-effective technique that can reduce the number of future surgeries such as alveolar bone grafting and secondary rhinoplasties.
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Affiliation(s)
| | | | | | - G. K. Singh
- Department of Orthodontics, Chhatrapati Shahuji Maharaj Medical University (Erst while King Georges Medical College), Lucknow, Uttar Pradesh, India
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Hameed A, El-Halwagy H, Mehta V, Donnellan I, McNeillis N, Zaidi J. Subphrenic abscess resulting in multi-organ failure after caesarean section. J OBSTET GYNAECOL 2010; 30:312-4. [PMID: 20373941 DOI: 10.3109/01443610903576266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Hameed
- Department of Obstetrics and Gynaecology Royal Sussex County Hospital, Brighton, UK.
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Abstract
The objective of this study was to evaluate the use of the term 'parity' in multiple pregnancies using a questionnaire survey. One hundred and fifty obstetricians and midwives in five maternity units in southeast Thames region of the London deanery were administered the questionnaire. One hundred and twenty-six questionnaires were returned (84% response rate). Only 21% described twin delivery as a single parous experience. The improper clinical application of the word parity was shown in both obstetricians and midwives. Standardisation of the definition to ensure accuracy and uniformity in record keeping is necessary.
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Affiliation(s)
- E I Opara
- Department of Obstetrics and Gynaecology, Conquest Hospital, St Leonards on Sea, East Sussex, UK.
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Opara E, Gile J, Zaidi J. Inferior vena cava filter thrombo-prophylaxis in high-risk twin pregnancy. Int J Gynaecol Obstet 2007; 98:62-3. [PMID: 17498716 DOI: 10.1016/j.ijgo.2006.11.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 11/14/2006] [Accepted: 11/15/2006] [Indexed: 11/16/2022]
Affiliation(s)
- E Opara
- Department of Obstetrics and Gynecology, Conquest Hospital, The Ridge, St Leonards On Sea, UK.
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Affiliation(s)
- J Zaidi
- Conquest Hospital, St Leonards-on-Sea, Sussex, UK
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Zaidi J, Jacobs H, Campbell S, Tan SL. Blood flow changes in the ovarian and uterine arteries in women with polycystic ovary syndrome who respond to clomiphene citrate: correlation with serum hormone concentrations. Ultrasound Obstet Gynecol 1998; 12:188-196. [PMID: 9793191 DOI: 10.1046/j.1469-0705.1998.12030188.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Our purpose was to study the hemodynamic changes in the uterine and intraovarian vessels in women with polycystic ovary syndrome (PCOS) and to relate the vascular changes to hormonal indices. METHODS Six women with a history of previous anovulatory cycles and/or oligomenorrhea and/or elevated serum luteinizing hormone concentrations in addition to polycystic ovaries underwent induction of ovulation with clomiphene citrate. Serial transvaginal ultrasonography was performed on menstrual cycle day 2, daily from the estimated day of ovulation minus 6, 6-hourly from the estimated day of ovulation minus 2 or when the mean follicular diameter was greater than 16 mm (whichever was earlier) until 6 h after follicular rupture, and once 7 days after follicular rupture. At each scan, uterine and intraovarian blood flow was assessed by transvaginal color Doppler ultrasound, and serum concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone were assessed by fluoroimmunoassay. RESULTS All six women demonstrated ultrasonographic features of ovulation. Follicular peak systolic blood flow velocity (Vmax) and ovarian stromal Vmax in the dominant ovary increased during the follicular phase of the menstrual cycle and reached a peak at 36 and 42 h after the onset of the LH surge of 30.7 +/- 4.6 cm/s and 37.0 +/- 3.9 cm/s, respectively. There was no significant change in the ovarian stromal Vmax of the non-dominant ovary. There was no significant change in the pulsatility index (PI) in either the follicular or the ovarian stromal vessels during the menstrual cycle. The changes in follicular Vmax correlated significantly with changes in serum concentrations of FSH, LH and progesterone. Uterine artery time-averaged maximum velocity (TAMX) declined to its lowest levels at LH surge minus 6 days, and thereafter increased. In contrast, the PI increased during the follicular phase of the cycle, reaching a peak at LH surge minus 4 days, and thereafter declined. The changes in uterine artery PI correlated inversely with serum estradiol and serum progesterone concentrations. CONCLUSIONS Women with PCOS have significant differences in intraovarian and uterine artery hemodynamics, both at the baseline ultrasound scan and during the clomiphene-induced menstrual cycle, compared with women with normal ovaries. The intraovarian and uterine artery vascular differences are likely to be due to a primary disorder within the polycystic ovary and their different hormonal status. Clomiphene citrate may have an effect on uterine artery blood flow.
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Affiliation(s)
- J Zaidi
- Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, Denmark Hill, London
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Kyei-Mensah AA, LinTan S, Zaidi J, Jacobs HS. Relationship of ovarian stromal volume to serum androgen concentrations in patients with polycystic ovary syndrome. Hum Reprod 1998; 13:1437-41. [PMID: 9688367 DOI: 10.1093/humrep/13.6.1437] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The aim of this study was to investigate of the relationship of ovarian stromal volume, measured using three-dimensional ultrasound, to serum androgen concentrations in patients with polycystic ovaries. Serum gonadotrophin, oestradiol and androgen concentrations and ovarian volume measurements were obtained in the early follicular phase from 100 women undergoing assisted conception treatment cycles. Group 1 contained 50 women with regular menstrual cycles and normal ovarian morphology, group 2 contained 24 women with regular menstrual cycles and polycystic ovaries seen on ultrasound scan and group 3 contained 26 women with polycystic ovary syndrome. Statistical analysis included analysis of variance, Scheffé's procedure and Pearson's correlation. Total ovarian volume (15.7-16.1 versus 11 ml, P < 0.05), stromal volume (14.5 versus 9.4 ml, P < 0.05) and thecal steroid concentrations were significantly greater in groups 2 and 3. Stromal volume was positively correlated with serum androstenedione concentrations (r = 0.45, P = 0.0019 in group 3) but was not correlated with any other endocrine parameter. It was concluded that polycystic ovaries are characterized by increased ovarian stroma with associated overproduction of theca-derived steroids, particularly androstenedione.
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Affiliation(s)
- A A Kyei-Mensah
- The London Women's Clinic, University College London Hospitals, UK
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Lees C, Jurkovic D, Zaidi J, Campbell S. Unexpected effect of a nitric oxide donor on uterine artery Doppler velocimetry in oligomenorrheic women with polycystic ovaries. Ultrasound Obstet Gynecol 1998; 11:129-132. [PMID: 9549840 DOI: 10.1046/j.1469-0705.1998.11020129.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We compared uterine artery vascular responses following administration of the nitric oxide donor glyceryl trinitrate to ten women with oligomenorrhea and ultrasound evidence of polycystic ovaries with those of nine women with a normal menstrual cycle and ultrasonically normal ovaries. Mean arterial blood pressure, pulse rate and uterine artery flow velocity waveforms were recorded before and 60-75 min after glyceryl trinitrate patch application. The pulsatility index and resistance index were calculated to describe changes in impedance to flow in the uterine artery. Peak systolic and time-averaged velocities were also measured. Pretreatment median arterial pressure was higher in women with polycystic ovaries (90 mmHg) compared to those with regular cycles (80 mmHg) (p < 0.05). No differences were found in pulse rate and uterine artery blood flow indices between the two groups. After glyceryl trinitrate patch administration, there was no change in blood pressure or pulse rate in either group. In women with polycystic ovaries, there was an increase in uterine artery resistance index (0.93 to 1.00; p < 0.05) and pulsatility index (3.77 to 4.99; p < 0.05) and a decrease in peak systolic (36.8 to 32.3 cm/s; p < 0.05) and time-averaged maximum (8.5 to 5.0 cm/s; p < 0.05) velocities. Uterine artery Doppler parameters remained unchanged in women with normal cycles. Uterine artery vascular responses to the nitric oxide donor glyceryl trinitrate are different in women with normal cycles compared to oligomenorrheic women with polycystic ovaries. This may be relevant to an understanding of the pathophysiology underlying the higher risk of cardiovascular morbidity and mortality associated with polycystic ovarian syndrome.
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Affiliation(s)
- C Lees
- Department of Obstetrics and Gynaecology, St. George's Hospital Medical School, London, UK
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Zaidi J, Barber J, Kyei-Mensah A, Bekir J, Campbell S, Tan SL. Relationship of ovarian stromal blood flow at the baseline ultrasound scan to subsequent follicular response in an in vitro fertilization program. Obstet Gynecol 1996; 88:779-84. [PMID: 8885913 DOI: 10.1016/0029-7844(96)00316-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess whether Doppler indices of intraovarian blood flow are related to the subsequent follicular response in an in vitro fertilization (IVF) program. METHODS One hundred five women underwent ultrasonographic assessment of ovarian morphology, transvaginal color Doppler measurement of intraovarian blood flow and immunoassay of serum FSH during the early follicular phase of an IVF cycle. The subsequent follicular response was related to the Doppler data. RESULTS Mean ovarian stromal peak systolic blood flow velocity was significantly correlated with the follicular response (P = .001), even after adjusting for the age of patient, type of ovary (polycystic or normal), total number of human menopausal gonadotropin ampules used, and serum FSH. Mean ovarian stromal pulsatility index was not related to the follicular response. Mean ovarian stromal peak systolic blood flow velocity was significantly lower (P = .007) in the poor-response group. The adjusted odds of a poor response increased significantly by an estimated 22% per cm/second decrease in velocity (P = .02). CONCLUSION Ovarian stromal blood flow at the baseline ultrasound scan is correlated with subsequent follicular response and may be a new indicator for predicting ovarian responsiveness in an IVF program.
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Affiliation(s)
- J Zaidi
- London Women's Clinic, United Kingdom
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Kyei-Mensah A, Maconochie N, Zaidi J, Pittrof R, Campbell S, Tan SL. Transvaginal three-dimensional ultrasound: reproducibility of ovarian and endometrial volume measurements. Fertil Steril 1996; 66:718-22. [PMID: 8893673 DOI: 10.1016/s0015-0282(16)58624-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the reproducibility of ovarian and endometrial volume measurements obtained using transvaginal three-dimensional (3D) ultrasound (US). DESIGN Prospective clinical study. SETTING A tertiary referral center for assisted reproduction. PATIENTS Forty women undergoing ovarian stimulation for IVF-ET using the long protocol of GnRH agonist. INTERVENTION Three observers independently measured 20 stored ovarian scanned volumes and 20 endometrial volumes. Also, ovarian volume was calculated from three diameters obtained by two-dimensional (2D) US. MAIN OUTCOME MEASURE Analysis of variance, the paired Student's t-test, and calculation of intraclass and interclass correlation coefficients were used for statistical analysis. RESULTS Three-dimensional ovarian volume measurements were not significantly different from ovarian volume calculated from three diameters (7.98 versus 7.58 mL). The mean endometrial volume measurement was 3.56 mL. The intraobserver coefficient of variation for both ovarian and endometrial volume was 8%. The interobserver coefficient of variation was 9% for ovarian volume and 11% for endometrial volume. Intraclass and interclass correlation coefficients were 0.95 and 0.95 for ovarian volume and 0.90 and 0.82, respectively, for endometrial volume. CONCLUSION Transvaginal 3D US produces highly reproducible ovarian and endometrial volume measurements.
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Affiliation(s)
- A Kyei-Mensah
- London Women's Clinic, University College London Hospitals, King's College School of Medicine and Dentistry, United Kingdom
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Abstract
OBJECTIVE Our purpose was to study the hemodynamic changes in the uterine and intraovarian vessels during the normal menstrual cycle and to relate the vascular changes to hormonal index values. STUDY DESIGN Seven women who had bilateral tubal patency, a normal pelvis on laparoscopy, and regular ovulatory cycles underwent serial transvaginal ultrasonography on menstrual cycle day 2, daily from estimated day of ovulation-6, hourly from estimated day of ovulation-2, or when the mean follicular diameter was > 16 mm (whichever was earlier) until 6 hours after follicular rupture and once 7 days after follicular rupture. At each scan uterine and intraovarian blood flow was assessed with transvaginal color Doppler ultrasonography and serum concentrations of follicle-stimulating hormone, luteinizing hormone, estradiol, and progesterone assessed by fluoroimmunoassay. RESULTS In one case there was evidence of a luteinized unruptured follicle and the patient was therefore excluded from analysis. In the other six women there was spontaneous ovulation at a mean of 39 hours after the onset of the luteinizing hormone surge. On the side with the dominant follicle, follicular and ovarian stromal peak systolic blood flow velocity rose significantly during the menstrual cycle with no significant change in pulsatility index. The changes in blood flow velocity correlated significantly with changes in serum follicle-stimulating hormone, luteinizing hormone and progesterone concentrations. There were no significant changes in either blood flow velocity or pulsatility index in the contralateral ovary. Uterine artery time-averaged maximum velocity on the side of the developing ovarian follicle increased during the menstrual cycle with no significant change in the contralateral vessel. Uterine artery pulsatility index on the side of the developing follicle declined during the midluteal phase and was significantly lower than on the contralateral side. The changes in time-averaged maximum velocity correlated with the changes in serum estradiol and progesterone concentrations. CONCLUSION The vascular changes in the wall of the dominant ovarian follicle and ovarian stroma during the menstrual cycle are consistent with activity of angiogenic-like factors. The decline in uterine artery resistance during the midluteal phase may reflect optimal vascularity for implantation of the blastocyst.
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Affiliation(s)
- S L Tan
- Department of Obstetrics and Gynecology, King's College School of Medicine and Dentistry, London, United Kingdom
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Zaidi J, Tan SL. Advances in the use of ultrasound in infertility management. Curr Opin Obstet Gynecol 1996; 8:161-5. [PMID: 8818524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Over the past year a number of interesting studies using colour Doppler ultrasound have emerged in the field of infertility. Although they have increased our knowledge of physiological changes, prospective randomized studies are still awaited. The development of three-dimensional ultrasound systems is likely to provide improved spatial evaluation of pelvic organs and improve diagnosis of the polycystic ovary.
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Affiliation(s)
- J Zaidi
- Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, University of London, UK
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Awonuga AO, Pittrof RJ, Zaidi J, Dean N, Jacobs HS, Tan SL. Elective cryopreservation of all embryos in women at risk of developing ovarian hyperstimulation syndrome may not prevent the condition but reduces the live birth rate. J Assist Reprod Genet 1996; 13:401-6. [PMID: 8739056 DOI: 10.1007/bf02066172] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Our goal was to evaluate the use of elective cryopreservation of all embryos to prevent the development of ovarian hyperstimulation syndrome in patients at risk while undergoing in vitro fertilization treatment. DESIGN We analyzed 117 treatment cycles in which the serum E2 concentration on the day of hCG administration was > 10,000 pM and in whom > or = 15 oocytes were retrieved at ultrasound-directed follicle aspiration. The incidence of ovarian hyperstimulation syndrome, pregnancy, and live birth in 65 patients who had elective cryopreservation of all embryos and 52 patients who had fresh embryo transfer were compared. Independent t test and chi-square test (with Yates' correction) was used as appropriate. RESULTS The clinical pregnancy (35 vs 17%; P < 0.03) and the live birth (27 vs 12%; P < 0.05) rates in patients receiving fresh embryo transfer was significantly higher than in those who had elective cryopreservation of all embryos. The incidence of moderate and severe ovarian hyperstimulation syndrome was similar in both groups (3.8 and 6.2%). CONCLUSIONS Elective cryopreservation of all embryos does not reliably protect against the development of ovarian hyperstimulation syndrome but may reduce the clinical pregnancy and live birth rate.
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Abstract
Toxic epidermal necrolysis (TEN) is a rare disease resulting in bullous necrosis of the epidermis with partial-thickness loss of skin and mucous membranes. Previous reports of TEN have not focused on respiratory complications. During a 6-year period, 12 patients with biopsy-proven TEN were referred to a regional burn unit at the Wellesley Hospital, Toronto. Five patients required mechanical ventilatory support, and nine showed roentgenographic evidence of respiratory complications that had developed. Intensive therapy in a critical care burn unit resulted in a 75% survival rate. The four nonsurvivors had severe preexisting multisystem disease. Four survivors were observed prospectively, with 3 monthly pulmonary function testings performed. The four survivors tested, even if they did not require mechanical ventilatory support, showed evidence of respiratory involvement. Three patients demonstrated a persistent reduction in carbon monoxide diffusing capacity of up to 35% to 40% below normal. From our case series we suggest that TEN, although primarily a dermatologic condition, may result in life-threatening acute respiratory decompensation requiring ventilatory support and long-term pulmonary function abnormalities. Patients with TEN should be closely monitored for pulmonary complications.
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Affiliation(s)
- R A McIvor
- Division of Respirology, University of Toronto, Ontario, Canada
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Zaidi J, Campbell S. Letter. Colour Doppler imaging and polycystic ovary syndrome. Hum Reprod 1996; 11:916. [PMID: 8671357 DOI: 10.1093/oxfordjournals.humrep.a019283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- J Zaidi
- Academic Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, Denmark Hill, London SE5 8RX, UK
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Abstract
The US diagnostic criteria of the PCO have been refined with each successive advance in US technology. Diagnostic accuracy has evolved from a mere appreciation of overall ovarian size to the recognition of characteristic follicular patterns of distribution and subtle textural changes in the ovarian stroma. The most consistent features are the presence of multiple small follicles arranged around, or scattered through, a dense echogenic ovarian stroma, although recognition of the latter is highly subjective. Sophisticated innovations such as 3D US, together with colour and pulsed Doppler US, should improve the objectivity of observations and allow quantitative analysis of the ovarian stroma, which is known to be the source of the characteristic hyperandrogenaemia in PCOS. Valid comparative studies of women with normal and polycystic ovaries should now be feasible and will hopefully bring us closer to understanding the pathogenesis of this fascinating condition.
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Awonuga AO, Dean N, Zaidi J, Pittrof RU, Bekir JS, Tan SL. Outcome of frozen embryo replacement cycles following elective cryopreservation of all embryos in women at risk of developing ovarian hyperstimulation syndrome. J Assist Reprod Genet 1996; 13:293-7. [PMID: 8777342 DOI: 10.1007/bf02070141] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
AIM Our aim was to compare the outcome in subsequent frozen embryo replacement cycles in four groups of patients who had elective cryopreservation of all their embryos because they were considered to be at increased risk of developing severe ovarian hyperstimulation syndrome. DESIGN Sixty-two (91%) of 68 IVF cycles (68 patients) in which elective cryopreservation of all embryos was performed were analyzed. All patients continued on the GnRH agonist, buserelin, after oocyte recovery until the onset of vaginal bleeding. Frozen embryo replacement occurred in a hormone replacement cycle that started either on day 3 of the withdrawal bleed (group I; N = 15) or after serum estradiol levels had fallen to < 100 pmol/L (group II; N = 16). The other patients commenced a frozen embryo replacement cycle several months later in either a hormone replacement (group III; N = 15) or a natural (group IV; N = 16) cycle. RESULTS Two patients developed severe ovarian hyperstimulation syndrome. There were no significant differences among the four groups regarding demographic variables, the dose of hMG used, and the clinical outcome. There was a higher but not significantly different clinical pregnancy rate in group I (26.7%), compared to group II (12.5%), group III (13.3%), and group IV (18.8%). CONCLUSIONS Several options exist for the timing and protocol used for frozen embryo replacement in patients who had elective cryopreservation for the prevention of ovarian hyperstimulation syndrome, none of which was found to be clearly superior in this observational report.
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Zaidi J, Collins W, Campbell S, Pittrof R, Tan SL. Blood flow changes in the intraovarian arteries during the periovulatory period: relationship to the time of day. Ultrasound Obstet Gynecol 1996; 7:135-140. [PMID: 8776239 DOI: 10.1046/j.1469-0705.1996.07020135.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Intraovarian blood flow was assessed by transvaginal color and pulsed Doppler ultrasound prospectively in six women during the periovulatory period. All patients had regular ovulatory menstrual cycles and a mid-luteal serum progesterone level consistent with spontaneous ovulation in the preceding cycle. Each patient underwent serial transvaginal ultrasound examination and Doppler assessment of blood flow in the ovarian stroma and in the wall of the dominant follicle or corpus luteum. When the mean follicular diameter was > 16 mm or day -2 from the estimated day of ovulation was reached, patients were scanned at 6-h intervals at 06.00, 12.00, 18.00 and 24.00 until follicular rupture, to investigate the presence of circadian rhythms. The pulsatility index (PI) and the maximum peak systolic blood flow velocity (Vmax) were calculated as Doppler indices of impedance to blood flow and velocity, respectively. A venous blood sample was taken at each visit for subsequent hormonal analysis. There was no significant circadian fluctuation in either mean follicular Vmax or mean follicular PI before or after the luteinizing hormone (LH) surge. Similarly, mean Vmax and mean PI in the non-dominant ovarian stroma did not show any significant fluctuation over the same periods. The mean PI in the dominant ovarian stroma showed daily fluctuations with the highest values occurring most commonly at 06.00 and the nadir in the afternoon and late evening. This fluctuation was the reverse of the circadian variation previously demonstrated in the uterine artery. However, in contrast to the uterine artery, comparison between the mean PI values in the dominant ovarian stroma at 06.00 and 18.00 only approached significance after the LH surge. The dominant ovarian stroma Vmax tended to rise during the day, although the differences between 06.00 and 18.00 were also not significant. Although there are fluctuations in Doppler blood flow indices in the dominant ovarian stroma, further studies are necessary to demonstrate whether this represents a significant circadian rhythm.
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Affiliation(s)
- J Zaidi
- Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, London, UK
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Kyei-Mensah A, Zaidi J, Pittrof R, Shaker A, Campbell S, Tan SL. Transvaginal three-dimensional ultrasound: accuracy of follicular volume measurements. Fertil Steril 1996; 65:371-6. [PMID: 8566265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To evaluate the accuracy of three-dimensional (3-D) ultrasound (US) follicular volume measurements. DESIGN Prospective clinical study. SETTING A tertiary referral center for assisted reproduction. PATIENTS Twenty-five patients undergoing ovarian stimulation for IVF-ET using the long protocol of GnRH agonist. INTERVENTION Transvaginal two-dimensional (2-D) and 3-D ovarian scan performed immediately before US-directed follicle aspiration. MAIN OUTCOME MEASURES The volume of follicular fluid aspirated was compared with the corresponding volume of the follicle measured by 3-D US and with the conventional 2-D US volume measurement calculated using the formula pi/6 (D1 x D2 x D3). Limits of agreement and 95% confidence intervals were calculated and systematic bias between the methods was analyzed. RESULTS The limits of agreement between the volume of follicular aspirate and follicular volume determined by US were +0.96 to -0.43 mL for 3-D measurements and +3.47 to -2.42 mL for 2-D measurements. CONCLUSIONS The true volume of ovarian follicles, within the clinically useful range for IVF-ET cycles, is measured more accurately by a 3-D US system than by 2-D US techniques.
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Zaidi J, Pittrof R, Shaker A, Kyei-Mensah A, Campbell S, Tan SL. Assessment of uterine artery blood flow on the day of human chorionic gonadotropin administration by transvaginal color Doppler ultrasound in an in vitro fertilization program. Fertil Steril 1996; 65:377-81. [PMID: 8566266 DOI: 10.1016/s0015-0282(16)58103-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess whether measurement of uterine artery blood flow impedance (the pulsatility index) as determined by transvaginal color Doppler ultrasound on the day of hCG administration in patients undergoing IVF can predict pregnancy and implantation rates. DESIGN Prospective observational study of women undergoing IVF. SETTING A tertiary referral center for assisted reproduction. PATIENTS One hundred thirty-five patients undergoing 139 IVF cycles. INTERVENTION Transvaginal color Doppler assessment of uterine artery pulsatility index on the day of administration of hCG. MAIN OUTCOME MEASURES Mean pulsatility index of the left and right uterine arteries, pregnancy rate, and embryo implantation rate. RESULTS The patients were grouped into pregnant and nonpregnant groups and according to whether the pulsatility index was low (1.00 to 1.99), medium (2.00 to 2.99), or high (> or = 3.00). The pregnancy rates were 13.8%, 34.7%, and 14.3% for the low, medium, and high pulsatility index groups, respectively, and were not significantly different. The implantation rates for the same groups were 10.7%, 16.3%, and 5.4%, respectively. The implantation rate for all the patients with pulsatility index < 3.00 (and especially 2.00 to 2.99) was significantly higher than the high pulsatility index group. CONCLUSIONS The study suggests that the measurement of uterine artery pulsatility index on the day of hCG predicts subsequent implantation rates. It may allow the administration of hCG to be deferred until uterine artery pulsatility index falls to < 3.00, which may result in improved implantation rates.
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Affiliation(s)
- J Zaidi
- Academic Department of Obstetrics and Gynecology, King's College School of Medicine and Dentistry, University of London, United Kingdom
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Shaker AG, Pittrof R, Zaidi J, Bekir J, Kyei-Mensah A, Tan SL. Administration of progestogens to hasten pituitary desensitization after the use of gonadotropin-releasing hormone agonist in in vitro fertilization--a prospective randomized study. Fertil Steril 1995; 64:791-5. [PMID: 7672152 DOI: 10.1016/s0015-0282(16)57856-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess the effect of administration of adjuvant IM progestogen to patients undergoing IVF who were not pituitary desensitized after 14 days of GnRH agonist (GnRH-a) administration. DESIGN Prospective randomized study. SETTING A tertiary referral center for assisted conception. PATIENTS Forty-nine patients undergoing 51 IVF treatment cycles. INTERVENTION Patients in whom the endometrial thickness was > 5 mm or who had an ovarian cyst > 15 mm after 14 days of GnRH-a administration were recruited if the serum E2 concentration was > 27.24 pg/mL (> 100 pmol/L). Patients in group 1 (n = 22) received a single IM injection of 100 mg P whereas patients in group 2 (n = 29) did not. Patients in both groups continued to receive SC GnRH-a 500 micrograms/d and had serum E2 levels measured every 3 days until the concentrations were < or = 100 pmol/L. MAIN OUTCOME MEASURES The number of days of GnRH-a administration from recruitment until serum E2 concentration measured < or = 100 pmol/L, number of cycles with withdrawal bleeding, number of days from recruitment to withdrawal bleeding, total dose of hMG used, number of follicles > 14 mm, number of oocytes, number of embryos, and pregnancy rates per cycle commenced and per ET. RESULTS There were no significant differences in all the above parameters except in the mean number of days from recruitment to onset of withdrawal bleeding, which were 5.33 +/- 0.7 (mean +/- SEM) and 8.62 +/- 1.26 days in groups 1 and 2, respectively. The pregnancy rate per ET was higher in group 1 (38.88%) when compared with group 2 (19.04%). However, this difference was not statistically significant. CONCLUSIONS Adjuvant administration of a single IM injection of progestogen hastens the onset of withdrawal bleeding in patients who are not pituitary desensitized after 2 weeks of administration of SC GnRH-a. It does not appear to affect the length of time the serum E2 concentrations take to reach basal levels or to alter the ovarian responsiveness to exogenous gonadotropins.
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Zaidi J, Campbell S, Pittrof R, Tan SL. Endometrial thickness, morphology, vascular penetration and velocimetry in predicting implantation in an in vitro fertilization program. Ultrasound Obstet Gynecol 1995; 6:191-198. [PMID: 8521069 DOI: 10.1046/j.1469-0705.1995.06030191.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A total of 96 women undergoing in vitro fertilization (IVF) treatment were studied on the day of human chorionic gonadotropin (hCG) administration by transvaginal ultrasonography with color and pulsed Doppler ultrasound. We assessed endometrial thickness, endometrial morphology, presence or absence of subendometrial or intraendometrial color flow, intraendometrial vascular penetration and subendometrial blood flow velocimetry on the day of hCG administration and related the results to pregnancy rates. The overall pregnancy rate was 32.3% (31/96) and there was no significant difference between the pregnant and non-pregnant groups with regard to endometrial thickness, subendometrial peak systolic blood flow velocity (Vmax) or subendometrial pulsatility index (PI). The pregnancy rates based on endometrial morphology were not significantly different, being 17.6% (3/17), 33.3% (2/6) and 35.6% (26/73) for types A (hyperechoic), B (isoechoic) and C (triple-line) endometria, respectively. In eight (8.3%) patients, subendometrial color flow and intraendometrial vascularization were not detected. This absence of blood flow was associated with failure of implantation (p < 0.05). The pregnancy rates related to the zones of vascular penetration into the subendometrial and endometrial regions were: 26.7% (4/15) for Zone 1 (subendometrial zone), 36.4% (16/44) for Zone 2 (outer hyperechogenic zone) and 37.9% (11/29) for Zone 3 (inner hypoechogenic zone), and were not significantly different. Of cycles with type A endometrium, 23.5% (4/17) had absent subendometrial color, which was greater than the frequency of absent color in the type C endometrium (4.1%, p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Zaidi
- Academic Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, University of London, UK
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Zaidi J, Campbell S, Pittrof R, Kyei-Mensah A, Shaker A, Jacobs HS, Tan SL. Ovarian stromal blood flow in women with polycystic ovaries--a possible new marker for diagnosis? Hum Reprod 1995; 10:1992-6. [PMID: 8567828 DOI: 10.1093/oxfordjournals.humrep.a136222] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Blood flow changes in the ovarian stroma of women embarking on in-vitro fertilization treatment were assessed on day 2 or 3 of the menstrual cycle using colour and pulsed Doppler ultrasound. Women were divided into three groups: group 1, 63 women with regular, ovulatory menstrual cycles and normal ovaries on ultrasound scan; group 2, 13 women similar to group 1 but with polycystic ovaries (PCO) on ultrasound scan; and group 3, 12 women with biochemical evidence of previous anovulatory cycles and/or oligomenorrhoea and/or elevated serum luteinizing hormone concentrations (> 10 IU/l) in the early follicular phase together with PCO on ultrasound scan. A subjective assessment of the intensity and quantity of coloured areas in the ovarian stroma appeared to be greater in both groups 2 and 3 compared with group 1. Mean (SEM) ovarian stromal peak systolic blood flow velocity (Vmax) was 16.88 (1.79) and 16.89 (2.36) cm/s in groups 2 and 3 respectively. These velocities were significantly greater than the mean (SEM) ovarian stromal Vmax of group 1; 8.74 (0.68) cm/s (P < 0.001). Mean (SEM) ovarian stromal time averaged maximum velocity (TAMX) was 10.55 (0.91) and 10.89 (1.80) cm/s in groups 2 and 3 respectively, both significantly greater than mean ovarian stromal TAMX of group 1, (P < 0.001). There was no significant difference in pulsatility index (PI) between the three groups. There thus appears to be significantly greater ovarian stromal blood flow velocity in women with polycystic ovaries as detected by colour and pulsed Doppler ultrasound. Increased ovarian stromal blood velocity may be a new parameter to assist in the ultrasound diagnosis of PCO.(ABSTRACT TRUNCATED AT 250 WORDS)
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26
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Zaidi J, Jurkovic D, Campbell S, Pittrof R, McGregor A, Tan SL. Description of circadian rhythm in uterine artery blood flow during the peri-ovulatory period. Hum Reprod 1995; 10:1642-6. [PMID: 8582954 DOI: 10.1093/oxfordjournals.humrep.a136148] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Uterine artery blood flow was assessed by transvaginal colour and pulsed Doppler ultrasound prospectively in six women during the peri-ovulatory period. All patients had regular ovulatory menstrual cycles and a mid-luteal serum progesterone consistent with spontaneous ovulation in the preceding cycle. Each patient underwent serial transvaginal ultrasound examination and Doppler assessment of blood flow in the uterine arteries. When the mean follicular diameter was > 16 mm or day -2 from the estimated day of ovulation was reached, patients were scanned at 6 hourly intervals at 0600, 1200, 1800 and 2400 h until follicular rupture. The pulsatility index (PI) and time averaged maximum velocity (TAMX) were calculated as Doppler indices of impedance to blood flow and velocity respectively. A venous blood sample was taken at each visit for subsequent hormonal analysis. The mean uterine artery PI showed a marked daily fluctuation with a nadir occurring most commonly at 0600 h. A comparison between the mean PI values at 0600 and 1800 h showed significantly lower results at 0600 h in both dominant (P < 0.05) and nondominant (P < 0.02) uterine arteries. Furthermore, mean uterine artery TAMX showed daily fluctuations with peak values most commonly occurring at 0600 h with the nadir occurring during the afternoon and late evening. There was no temporal relationship between the fluctuations in PI and changes in luteinizing hormone, follicle stimulating hormone, oestradiol or progesterone concentrations. These observations suggest that there is a circadian rhythm in uterine artery blood flow during the peri-ovulatory period which appears to be independent from the hormonal changes.
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Affiliation(s)
- J Zaidi
- Academic Department of Obstetrics and Gynaecology, King's College Hospital School of Medicine and Dentistry, Denmark Hill, London, UK
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Zaidi J, Jurkovic D, Campbell S, Okokon E, Tan SL. Circadian variation in uterine artery blood flow indices during the follicular phase of the menstrual cycle. Ultrasound Obstet Gynecol 1995; 5:406-410. [PMID: 7552803 DOI: 10.1046/j.1469-0705.1995.05060406.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
We investigated for the presence of circadian variation in uterine artery blood flow indices during the late follicular phase of the menstrual cycle. Twenty women with regular menstrual cycles underwent transvaginal color Doppler assessment of blood flow in the uterine arteries on two occasions precisely 12 h apart on the same day in the follicular phase. Ultrasound examinations were performed between 06.00 and 10.00 and repeated between 18.00 and 22.00. Indices of uterine artery blood flow included the pulsatility index (PI) and the time-averaged maximum velocity (TAMX). The changes in PI and TAMX were related to variations in serum concentrations of estradiol and luteinizing hormone (LH). We noted a significantly higher PI and lower TAMX in the evening compared to the morning values, p < 0.001 and p = 0.01, respectively. There was no significant change in estradiol or LH concentrations between morning and evening (p > 0.05). There appears to be a circadian rhythm in uterine artery blood flow occurring independently of these hormonal parameters. The circadian changes in PI and TAMX may be larger than the previously described effects of hormones on these parameters. The accurate interpretation of uterine artery blood flow indices should take these time-related fluctuations into account.
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Affiliation(s)
- J Zaidi
- Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, University of London, UK
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28
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Steer CV, Williams J, Zaidi J, Campbell S, Tan SL. Intra-observer, interobserver, interultrasound transducer and intercycle variation in colour Doppler assessment of uterine artery impedance. Hum Reprod 1995; 10:479-81. [PMID: 7769083 DOI: 10.1093/oxfordjournals.humrep.a135966] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In this study we assessed the variability of measuring uterine artery pulsatility index by colour Doppler ultrasound using different ultrasound transducers (abdominal 3 MHz, abdominal 5 MHz, endovaginal 5 MHz with and without a full bladder). We then assessed the intra-observer coefficient of variation for the different transducers and interobserver variability for two observers using the endovaginal probe. The intercycle variability and effects of a full bladder on uterine artery blood flow were also assessed. The uterine vessels were most easily identified using the endovaginal transducer. The most reproducible results were obtained using the endovaginal probe. The coefficients of variation obtained for the vaginal route were intra-observer 4.1%, interobserver 11.8% and intercycle 16.5%. The blood flow indices were significantly different between the endovaginal and both transabdominal 5 and 3 MHz probes (P = 0.0027 and 0.0005 respectively). There was no significant effect of a full bladder on pulsatility index. This study suggests that transvaginal colour Doppler ultrasound is reproducible and the results obtained from clinical use would be reliable.
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Zaidi J, Jurkovic D, Campbell S, Collins W, McGregor A, Tan SL. Luteinized unruptured follicle: morphology, endocrine function and blood flow changes during the menstrual cycle. Hum Reprod 1995; 10:44-9. [PMID: 7745069 DOI: 10.1093/humrep/10.1.44] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A case of spontaneous luteinized unruptured follicle syndrome is presented with full documentation of hormonal, morphological and haemodynamic changes. Changes in uterine blood flow were also noted. Growth of the leading follicle was slow during the follicular phase of the cycle. After the luteinizing hormone (LH) surge, growth of the follicle was more rapid. Concurrently, the follicle developed internal echogenicity with ultrasonic evidence of separation of the granulosa cell layer. The follicle was no longer visible 144 and 132 h after the LH rise and peak respectively. There was no primary progesterone rise associated with either the LH rise or peak, but a secondary progesterone rise occurred 42 h after the onset of the LH surge. Peri-follicular blood flow velocity was detected for the first time on cycle day 5 and appeared to rise after the onset of the LH surge. Peri-follicular blood flow velocity appeared to reduce after the LH surge to values associated with the follicular phase. These observations are consistent with an association of a primary granulosa cell defect with luteinized unruptured follicle syndrome which would account for the initial slow follicular growth, absent primary progesterone rise and reduction in blood flow in the wall of the follicle after the LH surge.
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Affiliation(s)
- J Zaidi
- Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, London, UK
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30
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Abstract
Resistance index (RI) and pulsatility index (PI) in the uterine and spiral arteries, uterine artery peak systolic velocity and intervillous blood flow were recorded by transvaginal colour Doppler imaging in 30 missed abortions and 30 normal pregnancies matched for menstrual age. Pathological examination was performed in both groups within 24 h of Doppler investigation. The mean uterine PI was significantly (P < 0.01) higher in missed abortions compared to normal controls, whereas the mean uterine RI and peak systolic velocity and spiral RI and PI did not differ. A continuous intervillous flow was found in 16 out of 23 (69.6%) of the complicated pregnancies before 12 weeks of gestation whereas it was not found in controls. In the missed abortion cases, the trophoblastic shell was fragmented or absent in 53% and trophoblastic infiltration and physiological changes in the spiral arteries were reduced or absent in 43 and 63%, respectively. These findings were not related to normal or abnormal Doppler indices. Extended dislocation of the trophoblastic shell and a massive infiltration of the intervillous space and placental bed by maternal blood was also found in cases presenting with a continuous intervillous blood flow before 12 weeks of gestation. These findings suggest that abnormal flow velocity waveforms in early pregnancies complicated by embryonic death are related to deficient placentation and dislocation of the trophoblastic shell that follows embryonic demise. The premature entry of maternal blood into the intervillous space disrupts the materno-embryonic interface and is probably the final mechanism causing abortion.
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Affiliation(s)
- E Jauniaux
- Early Human Development Unit, Academic Department of Obstetrics and Gynaecology, King's College Hospital, Denmark Hill, London, UK
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Abstract
OBJECTIVE Our purpose was to investigate the biochemical composition of the coelomic fluid in first-trimester anembryonic pregnancies. STUDY DESIGN Coelomic and maternal serum were obtained from 17 anembryonic pregnancies and 17 apparently normal pregnancies between 7 and 12 weeks of gestation that were matched for gestational age. Electrolytes, total proteins, urea, creatinine, lactate, and human chorionic gonadotropin concentrations and pH were measured. RESULTS Significantly higher pH (p < 0.005) and bicarbonate levels (p < 0.001) and significantly lower total protein (p < 0.05), phosphate (p < 0.005), and human chorionic gonadotropin (p < 0.001) levels were found in coelomic fluid from anembryonic pregnancies compared with normal pregnancies. No difference was found for chloride, sodium, potassium, urea, creatinine, and lactate between the study and control groups. CONCLUSIONS The fluid collected in anembryonic pregnancies is of exocoelomic origin and its biochemical characteristics reflect a failure of most placental biological mechanisms such as metabolic function, transport function, and endocrine activity.
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Affiliation(s)
- E Jauniaux
- Department of Obstetrics and Gynecology, King's College School of Medicine and Dentistry, University of London, United Kingdom
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Pang YP, Zaidi J, Kozikowski AP, Cusack B, Richelson E. Rational design of novel neurotensin mimetics: discovery of a pharmacologically unprecedented agent exhibiting concentration-dependent dual effects as antagonist and full agonist. J Comput Aided Mol Des 1994; 8:433-40. [PMID: 7815094 DOI: 10.1007/bf00125377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report the rational design of novel neurotensin mimetics through use of the Multiple Template Approach. This approach is based on our notion that a flexible peptide can be replaced by a partially flexible molecule, identified through testing a comparatively small number of molecules possessing a different intrinsic availability of conformations of the native peptide. The Multiple Template Approach has culminated in the discovery of a pharmacologically unprecedented agent, which behaves as a neurotensin antagonist at low concentration and as a full neurotensin agonist at high concentration.
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Affiliation(s)
- Y P Pang
- Mayo Foundation for Medical Education and Research, Jacksonville, FL 32224
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Jauniaux E, Jurkovic D, Gulbis B, Collins WP, Zaidi J, Campbell S. Investigation of the acid-base balance of coelomic and amniotic fluids in early human pregnancy. Am J Obstet Gynecol 1994; 170:1365-9. [PMID: 8178867 DOI: 10.1016/s0002-9378(94)70157-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of our study was to analyze and compare the acid-base status of coelomic and amniotic fluids in early human pregnancy. STUDY DESIGN Coelomic fluid, amniotic fluid, and maternal serum were obtained from 55 normal pregnancies between 7 and 14 weeks of gestation and assayed for pH, PCO2, bicarbonate, chloride, phosphate, total protein, glucose, and lactate concentrations. RESULTS The coelomic fluid had a significantly lower pH and base excess and contained significantly lower glucose, total protein, and bicarbonate concentrations and higher PCO2, lactate, and phosphate levels than did maternal serum. In the amniotic fluid significantly higher pH, base excess, and lactate and bicarbonate levels and lower concentrations of chloride and phosphate were found compared with the coelomic fluid. Little variation was observed in the coelomic and amniotic fluid composition before 11 weeks of gestation. A significant increase in PCO2, total protein, and chloride levels and a decrease in pH, base excess, and bicarbonate concentrations were observed in the amniotic fluid between 11 and 14 weeks compared with 7 to 10 weeks. CONCLUSIONS The coelomic fluid composition was indicative of an anaerobic metabolic acidosis probably related to the accumulation of acid compounds from placental metabolism. During the same period of gestation the composition of the amniotic fluid demonstrated a metabolic alkalosis that probably arises from the accumulation of basic substances through the unkeratinized embryonic skin and from the metabolism of organic anions in the embryonic tissues. The changes in the amniotic composition and acid-base balance at the end of the first trimester may correspond to the switch from the mesonephros to the metanephros and result from the excretion in the amniotic fluid of acid metabolic fetal bioproducts through the maturing kidneys.
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Affiliation(s)
- E Jauniaux
- Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, University of London, United Kingdom
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Abstract
Pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and serious maternal morbidity or mortality. A case is presented of such a pregnancy associated with a high maternal serum alpha feto-protein presenting as an acute emergency at 29 weeks' gestation resulting in fetal salvage.
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Affiliation(s)
- J Zaidi
- Department of Obstetrics & Gynaecology, Greenwich District Hospital, London, United Kingdom
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Cusack B, Richelson E, Pang YP, Zaidi J, Kozikowski AP. Pharmacological studies on novel neurotensin mimetics: discovery of a pharmacologically unique agent exhibiting concentration-dependent dual effects as antagonist and agonist. Mol Pharmacol 1993; 44:1036-40. [PMID: 8246906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We report the development of two novel neurotensin mimetics (mimics 1 and 2). These compounds were rationally designed and synthesized according to the multiple template approach. We present results of experiments designed to define their pharmacological profiles. In radioligand binding assays with murine neuroblastoma clone N1E-115, we determined the equilibrium dissociation constants for these compounds at the neurotensin receptor. The Kd values for mimic 1 and mimic 2 were 3.3 microM and 1.9 microM, respectively. Functionally, both mimetics antagonized the neurotensin-stimulated production of cGMP, with Kd values in the low micromolar range. Interestingly, mimic 2 displayed a dualistic pharmacological profile, which was concentration dependent. At doses in the 10-100 microM range, mimic 2 became a full agonist, stimulating cGMP production in N1E-115 cells with an EC50 value of 19 microM. Furthermore, mimic 1 did not antagonize the cGMP response elicited by mimic 2. When the neurotensin receptor was desensitized with a neurotensin receptor agonist, mimic 2 failed to stimulate significant cGMP production. We propose that mimic 2 binds to a higher affinity site when acting as an antagonist and binds to a lower affinity and different site when acting as an agonist. Thus, mimic 2 would appear to represent a unique pharmacological tool to characterize the neurotensin receptor and its diverse binding sites in N1E-115 cells.
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Affiliation(s)
- B Cusack
- Neuropsychopharmacology Research, Mayo Foundation for Medical Education and Research, Jacksonville, Florida 32224
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Peters W, Zaidi J, Douglas L. Toxic epidermal necrolysis: a burn-centre challenge. CMAJ 1991; 144:1477-80. [PMID: 2032200 PMCID: PMC1335679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To describe the clinical features and outcome of patients with toxic epidermal necrolysis. DESIGN Case series. SETTING Ross Tilley Burn Centre, Wellesley Hospital, Toronto. PATIENTS Ten patients (seven women) with toxic epidermal necrolysis referred to the centre from 1984 to 1990. INTERVENTION Biobrane (Winthrop Pharmaceuticals, New York) was applied to all raw surfaces after the epidermis had been completely separated. It was not removed until the epidermis had regenerated. MAIN RESULTS The age of the patients varied from 27 to 90 (mean 45) years. The proportion of body surface area involved was 20% to 95% (mean 58.5%). Nine of the patients had received steroids and antibiotics prophylactically before being referred to the burn centre; the steroids were immediately tapered and the antibiotics withdrawn unless there was a specific infection. Urinary tract infection developed in seven patients, respiratory failure in six and systemic sepsis in six. All of the patients ultimately required antibiotics for treatment of systemic infections. Two patients died; both had severe illness before the onset of the toxic epidermal necrolysis. Biobrane provided a marked reduction in pain, eliminated the need for further dressings and allowed early, aggressive physiotherapy. The wounds healed completely within 14 to 21 days, with no significant scarring or need for skin grafting. CONCLUSIONS The use of a temporary skin substitute is recommended for the treatment of toxic epidermal necrolysis. There is no indication for prophylactic steroid or antibiotic therapy; indeed, such therapy is probably contraindicated.
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Affiliation(s)
- W Peters
- Ross Tilley Burn Centre, Wellesley Hospital, Toronto, Ont
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37
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el-Mufti M, Rakas FS, Glessa A, Abdulhadi A, Ekgam S, Fraitis F, Zaidi J. Ceftriaxone versus clavulanate-potentiated amoxycillin for prophylaxis against post-operative sepsis in biliary surgery: a prospective randomized study in 200 patients. Curr Med Res Opin 1989; 11:354-9. [PMID: 2707048 DOI: 10.1185/03007998909110135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A prospective study was carried out in 200 consecutive patients undergoing biliary surgery to compare the prophylactic effectiveness of ceftriaxone and clavulanate-potentiated (CP-) amoxycillin. Patients were assigned in a randomized fashion to two groups and received ceftriaxone (2 g intravenously pre-operatively), or CP-amoxycillin (1200 mg, to be repeated for 2 more doses in the case of patients undergoing procedures other than elective cholecystectomy). Post-operative wound infection occurred in 4% of patients in each group. Administration of ceftriaxone was associated with a lower incidence of post-operative pyrexia and chest infection as well as with a shorter hospital stay.
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Affiliation(s)
- M el-Mufti
- Department of General Surgery, University Teaching Hospital, Benghazi, Libya
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