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Query: UMLS:C0344329 (collapse)
 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hysteroscopy and laparoscopy are relatively non-invasive methods routinely employed in the investigation of infertility. The danger of air embolism during these procedures was recognized early, and carbon dioxide was substituted for air since it is more readily soluble in blood. In this report we describe 3 cases of circulatory collapse and cardiac arrest in healthy young women during routine hysteroscopy (out of a total of 62 patients during the period 1989-1990) which were most probably caused by massive carbon dioxide embolism. Premedication was with oral diazepam 10 mg. Anesthesia was induced with 0.1 mg fentanyl, 2.5 mg droperidol and 100 mg methohexital (100 mg propofol in one case). Intubation was facilitated with 2 mg pancuronium and 50-100mg succinylcholine. Anesthesia was maintained with nitrous oxide 66% and halothane. Ventilation was controlled with a tidal volume of 10 ml per kilogram body weight at a rate of 10 per minute. Monitoring included ECG, automated non-invasive blood pressure, capnometry, pulse oximetry and body temperature. Anesthesia was uneventful prior to insufflation. In each case the signs and symptoms began approximately 5-8 minutes after the start of insufflation and consisted of an initial tachycardia rapidly followed by ventricular dysrhythmias, bradycardia and cardiac arrest. The end-tidal CO2 decreased during the tachycardic phase and prior to asystole. The patients were cyanotic with engorged jugular veins. Resuscitation with closed chest heart massage and intravenous epinephrine or orciprenaline was successful in every case. The typical "mill wheel phenomenon" of gas embolism was audible on auscultation after heart activity had returned, but disappeared after about 5 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Gas embolism with cardiac arrest during hysteroscopy. A case report on 3 patients]. 177 42

Twenty-four couples with unexplained infertility were studied in a spontaneous cycle followed by a clomiphene citrate (CC) cycle (150 mg, days 5-9). All spontaneous cycles were ovulatory, as defined by follicular collapse determined by transvaginal sonography. In CC cycles, 6/24 (25%) cycles demonstrated luteinized unruptured follicles (LUF). In 2/6 LUF cycles there was no apparent luteinizing hormone (LH) surge. LUF cycles had significantly elevated LH levels in the follicular phase compared to ovulatory CC cycles. There was no apparent difference in serum oestradiol. In CC cycles multifollicular development occurred in 87.5% of cycles, with significantly elevated serum oestradiol. Luteinizing hormone and follicle-stimulating hormone were elevated in the follicular phase compared to spontaneous cycles. This study suggests a high incidence of LUF when CC is administered to ovulatory patients, and its use in patients with ovulatory infertility is questioned.
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PMID:The effects of clomiphene citrate upon ovulation and endocrinology when administered to patients with unexplained infertility. 193 43

The clinical features and the intrafollicular environment of luteinized unruptured follicle (LUF) were investigated in 60 infertile women by means of ultrasonography. LUF was diagnosed in daily ultrasound scans in 52 (13.5%) of 384 apparently ovulatory cycles. High incidences of LUF cycle were observed in the patients with polycystic ovary (37.5%), endometriosis (24.7%) and a history of pelvic surgery (26.2%), whereas LUF cycles were rare in the patients who conceived (2.7%). Mean follicular diameter measured by transvaginal ultrasonography showed no difference between LUF and ovulatory cycles during the follicular phase, whereas during the luteal phase, a continual growth pattern without follicular collapse was observed in LUF cycles. The ultrasonic aspiration of the follicle was carried out in 21 LUF cycles on the luteal phase. In 19 cases, hormonal profiles for the aspirated follicular fluid coincided with the preoperative diagnosis, and in 6 of 19 cases (31.6%), the presence of entrapped oocytes, direct evidence of LUF, was demonstrated. The morphological observation revealed that the oocytes recovered from the LUF follicle were in the stage of postmaturity, and the fertilization test in which they were used resulted in abnormal fertilization. These results indicate that LUF is an important cause of infertility and that periovarian abnormality might contribute to the failure of follicular rupture and postmaturity.
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PMID:[Ultrasonographical study on luteinized unruptured follicle]. 221 20

Venous carbon dioxide embolism is a rare but potentially lethal complication of laparoscopy. The risk is increased when it is associated with hysteroscopy. A case is presented of a young women undergoing laparoscopy and hysteroscopy for infertility. Cardiovascular collapse and cardiac arrest, associated with a mill-wheel murmur, occurred during hysteroscopy at the time of a change of position. The patient had irreversible brain damage and died a week later. Early diagnosis and prevention of this serious complication are discussed.
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PMID:Carbon dioxide embolism during laparoscopy and hysteroscopy. 293 Oct 41

We have studied 100 women with regular menstrual cycles and infertility and tried to assess how frequently an 'inadequate' luteal phase (defined by low-peak progesterone levels) follows 'normal' ovulation. Normal follicular growth on serial ultrasound scan and follicular disappearance or collapse within 48 hours of the recorded LH peak were taken together as convincing evidence of ovulation. Eighty-three of 115 cycles were judged to be ovulatory and 32 to be anovulatory. A peak mid-luteal phase maximum serum progesterone (Po) level of 32 nmol/L (10 ng/ml) was taken arbitrarily as the cut-off level of discrimination between 'adequate' and 'inadequate' corpus luteum function. Serum progesterone was undetectable (less than 2.5 nmol/L) throughout in 2 cycles while the maximum was above 32 nmol/L in 102 and detectable but less than 32 nmol/L in 11. Of the latter only 1 was ovulatory. We conclude that cycles with low luteal phase Po levels represent luteinization without ovulation.
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PMID:Inadequate luteal phase usually indicates ovulatory dysfunction: observations from serial hormone and ultrasound monitoring of 115 cycles. 314 May 78

The rapid analysis of luteinizing hormone (LH) in urine would provide a useful clinical tool in the diagnosis and treatment of infertility in women. Urinary LH levels were measured in midday and evening specimens collected during 75 normal and stimulated menstrual cycles (55 women) using a rapid, visual, semiquantitative enzyme immunoassay dipstick test (OvuSTICK) and compared with basal body temperature (BBT) records, visualization of follicular collapse by daily ultrasonography, and serum hormone levels. In all 75 cycles studied, an LH surge (or its absence) in urine was associated with a biphasic (or monophasic) BBT record and/or serum progesterone. In addition, when serum and urine samples were obtained simultaneously, the day of the LH surge (or its absence) in the urine and serum correlated 100%. Discrepancies between ovulation as diagnosed by ultrasound and the LH surge in urine and/or serum in several patients suggested that individual factor(s) may affect the interpretation of ultrasound imaging. It appears that a simple, rapid, clinically reliable colorimetric method such as the OvuSTICK urinary LH test is an important parameter for predicting the time of ovulation.
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PMID:Evaluation of the OvuSTICK urinary luteinizing hormone kit in normal and stimulated menstrual cycles. 351 22

Fifty ml of a 0.2% iodine solution were instilled into the uteri of six mares selected for culling. Biopsy specimens were taken for microscopic examination before the commencement of the experiment and at various times over the course of a year after the single instillation. Severe oedema and haemorrhage was present in the lamina propria of all the post-instillation biopsy specimens. The epithelium showed vacuolisation and necrosis, as well as focal areas of epithelial loss. In some cases hyperplasia or metaplasia was seen. Cell infiltration was characterized by the presence of neutrophils, eosinophils and mild lymphocyte infiltration around the blood vessels. Leukostasis was present around the blood vessels in some specimens. Blood vessel changes were characterized in the early stages by oedema of the tunica media of the medium-sized arteries and later by arteriosclerosis with the complete obliteration of the lumen of the particular vessels in some cases. The endometrial glands showed hyperplasia and mitotic figures were more often seen in these glands than normal. The most pronounced lesion in the later stage of the experiment was fibrosis of the lamina propria with the resultant collapse of the stratum compactum and contraction of the stratum spongiosum. The severe fibrosis of the endometrium is the most probable reason for infertility in mares treated with iodine.
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PMID:[The detrimental effect of iodine as an intra-uterine instillation in mares]. 357 55

Sperm of 20 men aged 20-44 years was analyzed for motility and tail deformities in a Makler chamber and for axoneme abnormalities by transmission electron microscopy. In the quantitative analyses, 12.5 +/- 5.5% deformed tails at the light microscopic level and 24.4 +/- 7.7% abnormal axonemes in the principal piece. This high incidence of abnormalities in the sperm of fertile men indicated that micrographs of abnormal axonemes alone could not be used to imply the pathogenesis of infertility or sperm immotility without statistical comparison with a control group. Axoneme abnormalities were subdivided into three types. There was an asymmetry of abnormal axoneme types along the length of the sperm tail. Based on this asymmetry and on images of longitudinally sectioned sperm, the different types of abnormal axonemes most likely represented a single process of doublet microtubule detachment and foldback. Correlation of electron and light microscopy suggested that axoneme foldback progressed to focal tail defects and subsequent collapse. The presence of these abnormalities in fertile donors indicated that they were part of a normal process of axoneme instability in human sperm.
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PMID:Abnormal axonemes in sperm of fertile men. 371 56

To evaluate the role of ultrasound in diagnosing luteinized unruptured follicle (LUF), 37 women with unexplained infertility were examined for two to three menstrual cycles. Laparoscopy or laparotomy was performed on days 16 to 18 of the third study cycle in 25 patients. The LUF syndrome was suspected at ultrasound examination in 57 of 100 cycles observed. In the remaining 43 cycles, follicular collapse was observed in 33, and 10 were diagnosed as anovulatory. At laparoscopy or laparotomy on 25 patients, 18 of the 21 patients diagnosed as having LUF by ultrasound had a corpus luteum without a stigma. The other three cases diagnosed as LUF by ultrasound had ovulation stigmata. Additional findings in the 25 patients who underwent laparotomy or laparoscopy were endometriosis in 7 (5 of whom had LUF as well), ovulation in 5, bilateral hydrosalpinx in 1, and inability to visualize the ovaries because of adhesions in 1. The LUF syndrome was not a consistent change in the ovulatory pattern of most of the patients. It occurred by ultrasound diagnosis in three consecutive cycles in only 34% of patients.
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PMID:Diagnosis of luteinized unruptured follicle (LUF) syndrome by ultrasound. 622 25

Tripterygium wilfordii Hook F (TWHF) is a kind of Chinese herbal medicine used for 2000 years. It was applied externally for treatment of arthritis and inflammatory tissue swelling in early years. Recently, this drug has been found to have immunosuppressive effects which could successfully induce remission of some autoimmune disorders without obvious adverse effects. Although there are side effects of gastrointestinal upset, infertility and suppression of lymphocyte proliferation, little information about lethal toxicities has been reported. A case is presented here of a previously healthy young man who developed profuse vomiting and diarrhea, leukopenia, renal failure, profound hypotension and shock after ingestion of an extract of TWHF. In addition to his hypovolemic shock, serial electrocardiograms (ECG), cardiac enzyme studies, and echocardiography also showed some evidence of coexisting cardiac damage. He died of intractable shock 3 days after the abuse of TWHF. Further studies of the pathogenesis of peripheral collapse and possible cardiac toxicity, and determination of the therapeutic range of this drug are necessary before it is used extensively.
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PMID:Hypovolemic shock and mortality after ingestion of Tripterygium wilfordii hook F.: a case report. 762 89


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