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Reproductive Endocrinologist, Obstetrics & Gynecology
26 years of experience
Video profile
Accepting new patients

Education ?

Medical School
Sackler School Of Medicine (1984)
Foreign school

Awards & Distinctions ?

Patients' Choice Award (2008 - 2009, 2011 - 2014)
Compassionate Doctor Recognition (2011 - 2013)
Top 10 Doctor - Metro Area (2014)
Dallas/Fort Worth Metroplex
Reproductive Endocrinologist
American Board of Obstetrics and Gynecology
American Society for Reproductive Medicine
Texas Medical Association

Affiliations ?

Dr. Kaufmann is affiliated with 11 hospitals.

Hospital Affilations



  • Baylor Medical Center at Southwest Fort Worth
    Obstetrician & Gynecologist
    1400 8th Ave, Fort Worth, TX 76104
    • Currently 4 of 4 crosses
    Top 25%
  • Baylor All Saints Medical Centers
  • Harris Continued Care Hospital
    1301 Pennsylvania Ave, Fort Worth, TX 76104
  • Harris Methodist H E B
  • Texas Health HEB
  • Texas Health Southwest Fort Worth
  • Texas Health Harris Methodist Hospital Southwest Fort Worth
  • Texas Health Presbyterian Hospital Of Dallas
  • Harris Methodist - Springwood
    1608 Hospital Pkwy, Bedford, TX 76022
  • Texas Health Presbyterian Hospital Dallas
  • Texas Health Harris Methodist Hospital Fort Worth
  • Publications & Research

    Dr. Kaufmann has contributed to 28 publications.
    Title Motion Deficit of the Thumb in Cmc Joint Arthritis.
    Date January 2011
    Journal The Journal of Hand Surgery

    Idiopathic osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint is a common disabling disease that often causes pain and motion loss. The aims of this study were to characterize the multidimensional motion capability of the thumb CMC joint in a group with severe CMC OA and to compare it with a control group.

    Title Distal Radius Fracture Management in Elderly Patients: a Literature Review.
    Date June 2008
    Journal The Journal of Hand Surgery

    Distal radius fracture management in elderly patients remains without consensus regarding the appropriate treatment or anticipated outcome. Forty-one studies that included at least 10 patients with a minimum mean age of 65 years and that were indexed in Medline or Embase were reviewed. Treatment methods included pins and plaster, external fixation, K-wires, bone cement, and open reduction and internal fixation with plates. The methodological quality of each study was evaluated through use of a grading scale. Despite study heterogeneity, higher rates of infection were noted with external fixation and K-wire stabilization. Stratifying patients into low-demand and high-demand groups may improve the management of distal radius fractures in elderly patients. In sedentary patients with low demands, functional outcomes are good despite the presence of deformity. Patients with higher demands may benefit from fracture stabilization with locking volar plates. Volar plating with fixed-angle screws may be particularly suitable for elderly patients who may take longer to heal a fracture, be more susceptible to pin-track infection, and demonstrate earlier tendon irritation leading to rupture.

    Title Biomechanical Analysis of Flexor Digitorum Profundus and Superficialis in Grip-strength Generation.
    Date November 2007
    Journal American Journal of Orthopedics (belle Mead, N.j.)

    Grip strength is generated through extrinsic flexor tendon and intrinsic muscle actuation. In the study reported here, we analyzed the grip-generating properties of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons during grip-strength generation. In vivo gripping was reproduced in 11 cadaveric forearms through pneumatic tensioning of flexor tendons. A Jamar dynamometer (TEC, Clifton, NJ) was positioned in the hand at varying degrees of angulation measured between the Jamar compression axis and the second metacarpal. Maximum gripping strength during isolated FDP and FDS tensioning generated maximum compressive forces at different angles (P < .0001). The isolated FDP showed continued increased grip strength with larger angles and was most effective when the dynamometer handle was in contact with the distal phalanx. The isolated FDS was most effective at smaller angles when the handle made contact with the middle phalanx. The isolated FDS shows an initial increase in grip strength as the contact point moves toward the middle phalanx (P < .01) and then a tendency for grip strength to decline as the contact point moves over the distal phalanx (P < .01). The FDP and FDS tendons demonstrate unique abilities to generate compression on a dynamometer. This knowledge is important to consider when evaluating grip strength in patients who have injured the extrinsic finger flexors.

    Title Lower Median Nerve Block Impairs Precision Grip.
    Date June 2007
    Journal Journal of Electromyography and Kinesiology : Official Journal of the International Society of Electrophysiological Kinesiology

    The purpose of this study was to investigate precision grip impairment caused by a lower median nerve block at the wrist. The median nerve block was achieved by injecting bupivacaine hydrochloride into the carpal tunnel, which acutely simulated a median neuropathy. Seven healthy male subjects were instructed to grip, lift, and hold an instrumented handle within 60s using precision grip. The same tasks were performed before and after the nerve block. Force and torque data were recorded using two miniature 6-component force/torque transducers. The precision grip was quantified by the safety margin (i.e. the difference between the actual grip force and the minimal grip force to keep the object from dropping), the variation of grip force, and the migration area of center of pressure (i.e. the area defined by the center of pressure at a digit-transducer surface while holding the handle). Two subjects were unable to complete the precision grip tasks after the nerve block, and their data were excluded from the analyses. The median nerve block caused significant increases (P<0.05) in the safety margin of the grip force (>50%), the grip force variation (>80%), and the area of center of pressure migration (>250%). Median nerve block at the wrist impairs the fine motor control during precision grip. Our results corroborate the important role played by sensory function in hand fine motor control. Clinically, the measures related to precision grip have the potential to quantify impairment of hand function caused by neuromuscular disorders, to monitor the progress of a hand disorder, and to evaluate the efficacy of a treatment or rehabilitation procedure.

    Title Kinematics of the Midcarpal and Radiocarpal Joint in Flexion and Extension: an in Vitro Study.
    Date December 2006
    Journal The Journal of Hand Surgery

    PURPOSE: To apply carpal kinematic analysis using noninvasive medical imaging to investigate the midcarpal and radiocarpal contributions to wrist flexion and extension in a quasidynamic in vitro model. METHODS: Eight fresh-frozen cadaver wrists were scanned with computed tomography in neutral, full flexion, and full extension. Body-mass-based local coordinate systems were used to track motion of the capitate, lunate, and scaphoid with the radius as a fixed reference. Helical axis motion parameters and Euler angles were calculated for flexion and extension. RESULTS: Minimal out-of-plane carpal motion was noted with the exception of small amounts of ulnar deviation and supination in flexion. Overall wrist flexion was 68 degrees +/- 12 degrees and extension was 50 degrees +/- 12 degrees. In flexion, 75% of wrist motion occurred at the radioscaphoid joint, and 50% occurred at the radiolunate joint. In extension, 92% of wrist motion occurred at the radioscaphoid joint, and 52% occurred at the radiolunate joint. Midcarpal flexion/extension between the capitate and scaphoid was 0 degrees +/- 5 degrees in extension and 10 degrees +/- 13 degrees in flexion. Midcarpal flexion/extension between the capitate and lunate was larger, with 15 degrees +/- 11 degrees in extension and 22 degrees +/- 19 degrees in flexion. CONCLUSIONS: The capitate and scaphoid tend to move together. This results in greater flexion/extension for the scaphoid than the lunate at the radiocarpal joint. The lunate has greater midcarpal motion between it and the capitate than the scaphoid does with the capitate. The engagement between the scaphoid and capitate is particularly evident during wrist extension. Out-of-plane motion was primarily ulnar deviation at the radiocarpal joint during flexion. These results are clinically useful in understanding the consequences of isolated fusions in the treatment of wrist instability.

    Title Pulley Reconstruction Using Palmaris Longus Autograft After Repeat Trigger Release.
    Date November 2006
    Journal Journal of Hand Surgery (edinburgh, Scotland)

    We present a patient with a history of revision trigger release who experienced post-surgery limitation of active flexion as a result of bowstringing of the flexor tendons and required a double loop pulley reconstruction using a palmaris longus autograft.

    Title Arthroscopic Debridement and Closed Pinning for Chronic Dynamic Scapholunate Instability.
    Date July 2006
    Journal The Journal of Hand Surgery

    PURPOSE: For chronic dynamic scapholunate (SL) instability (>3 months after injury) open procedures (capsulodesis, limited intercarpal fusions, tenodesis, SL ligament reconstruction) have become popular in recent years but their long-term results have been suboptimal. We evaluated retrospectively the results of aggressive arthroscopic debridement of the SL ligament to bleeding bone in an effort to induce scar formation and closed pinning of the SL joint in patients unwilling to have an open procedure. METHODS: Eleven patients (mean age, 37 y) presenting with persistent posttraumatic pain and weakness to the wrist were diagnosed with dynamic SL instability (positive Watson scaphoid shift test result, SL gapping on grip-view radiographs, arthroscopic findings of a Geissler grade III or IV SL tear) and treated. Range of motion, grip strength, radiographic measurements, and the Mayo wrist score were used to evaluate the results. RESULTS: The mean follow-up period was 33 months (range, 12-76 mo). Three patients had subsequent surgery 9 to 11 months after the procedure. Subsequent surgeries included a dorsal capsulodesis, a four-corner fusion, and a wrist arthrodesis. Of the 8 remaining patients there were 2 excellent, 4 good, 1 fair, and 1 poor result based on the Mayo wrist score. In these patients the mean range of motion was 65 degrees of extension to 59 degrees of flexion and the mean grip strength was 82% of the uninjured contralateral extremity. Although persistent radiographic SL gapping in grip views was noted in all 8 patients none progressed to static instability or dorsal intercalated segment instability. CONCLUSIONS: The results of this technique are suboptimal; however, it may be an option for patients unwilling to have more than an arthroscopic procedure or those requiring maintenance of wrist motion, provided they understand the risks and benefits of this approach. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

    Title Scapulothoracic Dissociation: Evaluation and Management.
    Date February 2006
    Journal Injury

    Scapulothoracic dissociation is an infrequent injury with potentially devastating outcomes. Knowledge of this injury is based on small patient series and case reports. The aim of this article is to review the evaluation, management and functional outcomes following scapulothoracic dissociation. Often caused by high traction forces applied to the shoulder girdle, there is a complete loss of the scapulothoracic articulation with lateral scapular displacement and intact skin. This is frequently associated with muscular, ligamentous and osseous injuries to the shoulder girdle, vascular injuries to the subclavian, or axillary, vessels and brachial plexus lesions. In the acute setting, the timely diagnosis of the associated neurovascular injuries is crucial. Severe neurovascular and soft tissue compromise often requires an early above-elbow amputation. Further, complete brachial plexus avulsions are associated with a limited potential for functional recovery.

    Title Quantifying the Effect of the Distal Intrinsic Release Procedure on Proximal Interphalangeal Joint Flexion: a Cadaveric Study.
    Date December 2005
    Journal The Journal of Hand Surgery

    PURPOSE: The distal intrinsic release procedure is a popular treatment for intrinsic hand tightness. The literature remains ambiguous regarding the optimal amount of extensor hood to excise. Our goals were to quantify the mathematic relationship between the amount of extensor hood excised and proximal interphalangeal (PIP) joint flexion and to determine the minimum amount of extensor hood excision required to significantly change PIP joint flexion capability (the ability to achieve a change from the initial PIP joint angle). METHODS: We simulated the distal intrinsic release procedure by sequentially excising 5-mm strips (perpendicular to the long axis of the finger) of the extensor hood of cadaveric fingers beginning 5 mm proximal to the PIP joint center. We tensioned the intrinsic muscles to each digit to produce an intrinsically tight state and tensioned the flexor digitorum superficialis to produce an antagonist force and simulate the intrinsic tightness test. We measured PIP joint angle (the angle of the long axis of the middle phalanx relative to the proximal phalanx) in response to greater portions of excised extensor hood to quantify its contribution to intrinsic tightness. RESULTS: The relationship between the amount of extensor hood excised and the PIP joint flexion capability appeared quadratic, not linear. For the index, ring, and small fingers significant changes in PIP joint flexion were detected after resection of 59%, 26%, and 33%, respectively, of the extensor hood length. Although our results did not show statistical significance for the middle finger we project the critical amount to be at least 65%. CONCLUSIONS: We show PIP joint flexion changes after the distal intrinsic release procedure. We recommend excising a finger-dependent minimum amount of tissue before expecting a significant increase in PIP joint flexion capability.

    Title [attributed Risk to Smoking for Lung Cancer, Laryngeal Cancer and Esophageal Cancer]
    Date October 2002
    Journal Revista De Saúde Pública

    OBJECTIVE: Lung, laryngeal and esophageal cancers have smoking as one of their main risk factors. The objective of this study was to evaluate the population attributed risk (PAR) of smoking for these forms of cancer. METHODS: The study was based in three case-control studies conducted in medium size cities in Brazil. Incident cases of lung cancer, laryngeal cancer and esophageal cancer seen at a hospital setting and diagnosed through biopsy were analyzed; controls were hospitalized patients with another diagnoses. Smoking was the exposure factor measured at three levels: non-smokers, former smokers and smokers, which were defined using a questionnaire applied by trained interviewers. For effect measure, odds ratio was used and the populational attributed risk for smoking was then calculated for a 95% CI. RESULTS: A total of 122 lung cancer cases and 244 controls, 50 cases of laryngeal cancer and 48 cases of esophageal cancer, and 96 controls for both of them were studied. The prevalence of smoking exposure was 34%, which is the overall prevalence of smoking in this city's adult population. Odds ratios (OR) for the PAR analysis were the adjusted OR for confounding variables from each study. Lung cancer PAR was 63% (95% IC, 0.58-0.68) for former smokers and 71% (95%IC, 0.65-0.77) for smokers. Larynx cancer PAR was 74% (95% IC, 0.70-0.78) and 86% (95%IC, 0.81-0.85) for former smokers and smokers, respectively. Esophageal cancer PAR was 54% (95%IC, 0.46-0.62) for smokers. CONCLUSION: Smoking is an avoidable risk factor and smoking cessation could be responsible for significant reductions in the incidence of these three forms of cancer.

    Title Bilateral Congenital Subtalar Dislocation: a Case Report.
    Date May 2002
    Journal Clinical Orthopaedics and Related Research

    Fixed bilateral congenital subtalar dislocations were identified in a 2.5-year-old boy. The patient had been treated previously with a short-leg cast on each foot for 2 months. On presentation the patient ambulated on the medial malleoli and medial aspects of his feet. The patient's activity was limited by pain. At 2.5 years of age, open reduction and pinning of bilateral subtalar joints with soft tissue release and lengthening of the achilles, peroneal, and extensor tendons was done. A thick fibrous band connected the talus and calcaneus laterally. Postoperative treatment included casting for 12 weeks and wearing rigid ankle-foot orthoses which he used for 8 years. There was no recurrence at 10-year followup. The patient has been brace-free for 2 years and is able to ambulate and play school sports without pain. The patient's subtalar range of motion is normal. Radiographic alignment is near normal without degenerative changes. To the authors' knowledge, there has been no previous report of this condition in the literature.

    Title Development and Use of a Wrist Fusion Plate for Children and Adolescents.
    Date May 2002
    Journal Journal of Pediatric Orthopedics

    Arthrodesis is a widely accepted treatment for several destructive disorders of the wrist joint. Previous literature has shown that compression plating is a reliable technique for achieving rigid fixation and fusion in adults. The goal of this study was to apply similar principles of adult wrist fusion to children, using a custom-designed fusion plate sized for children. Five children underwent wrist fusion using rigid fixation and dorsal plate application. Mean age at time of surgery was 16.4 years. The indication for surgery was paralysis (spinal cord injury) in three and spasticity (cerebral palsy and traumatic brain injury) in two. Surgery was performed through a dorsal approach and combined with carpectomy in the two patients with spasticity. Follow-up averaged 2.2 years and radiographs showed solid fusion and proper alignment of plate and screws. Improved stability and limb function were noted by patients and family. There were no instances of hardware failure, and plate removal has not been required.

    Title Changes in Strain Distribution Along the Radius and Ulna with Loading and Interosseous Membrane Section.
    Date March 2002
    Journal The Journal of Hand Surgery

    The changes in strain distribution along the radius and ulna with loading and interosseous membrane (IOM) section were analyzed in this biomechanical study. Four cadaveric upper extremities were dissected and strain gauges applied. The forearm was loaded at the distal radius with a carpal implant after being positioned upright in neutral forearm rotation. Strain measurements were recorded before and after transection of the IOM. Before IOM transection, increased compressive strain was measured on the ulnar border of the ulna, while increased tensile strain was recorded on the dorsal aspect of the ulna, the dorsal aspect of the radius, and the lateral border of the radius when compared with the unloaded forearm. This suggests bowing of the radius and ulna with the convex side dorsally and bowing of the radius with the convex side radially. After IOM transection, increased tensile strain on the lateral border of the radius and the ulnar border of the ulna was measured when compared with the loaded forearm with an intact IOM. No change in strain patterns was measured by the strain gauges located on the dorsal aspect of the radius or ulna after IOM transection. The increased tensile strain during constant load application suggests increased bending moments acting on the radius and ulna after IOM transection.

    Title Primary Extraosseous Cemento-ossifying Fibroma of the Auricle.
    Date October 1999
    Journal Head & Neck

    BACKGROUND: A mass of the auricle is uncommon. An enlarging lesion may be the result of a reactive process, or a benign or malignant neoplasm. The literature is reviewed, and a case of extraosseous cemento-ossifying fibroma of the auricle is presented. METHODS: A 22-year-old white man presented with a 3-month history of an enlarging 2 cm mass in the right concha cavum. An incisional biopsy demonstrated cemento-ossifying fibroma. The lesion was resected en bloc, and the patient did well. There is no evidence of recurrence. RESULTS: Pathological examination of the excised mass revealed a well-circumscribed but unencapsulated spindle cell lesion with foci of osteoid and cementum deposition. It did not involve the auricular cartilage, and there was no connection with the overlying epidermis. CONCLUSIONS: This is a case report of an extraosseous cemento-ossifying fibroma of the auricle. This benign tumor should be completely excised because local recurrence may otherwise result.

    Title Human Pregnancies After Transfer of Fresh (four- to Eight-cell) Versus Frozen-thawed Blastocysts Resulting from Intracytoplasmic Sperm Injection.
    Date November 1998
    Journal Journal of Assisted Reproduction and Genetics

    PURPOSE: The objective of this study was to obtain expanded blastocysts following intracytoplasmic sperm injection (ICSI) and Vero-cell co-culture, cryopreserve them at this stage, and transfer the frozen-thawed blastocysts to obtain pregnancies. METHODS: Twenty-two couples with severe male-factor infertility or failed fertilization in a previous in vitro fertilization cycle were included in this study. ICSI was performed for all of them, and sperm-injected oocytes were immediately subjected to Vero-cell co-culture for varying intervals. Then 14 couples were treated by embryo transfer at the four- to eight-cell stage (Group I), whereas 8 couples were treated by transfer of frozen-thawed blastocysts (Group II). RESULTS: Percentages of cleaved embryos and term survival rates were 57.1 and 73.3% for Group I and 50.0 and 37.5% for Group II, respectively. CONCLUSIONS: Blastocysts obtained after ICSI and Vero-cell co-culture can retain developmental competence after cryopreservation and thawing. Transfer of frozen-thawed blastocysts derived by these means holds promise for establishment of viable pregnancies.

    Title Preimplantation Genetic Diagnosis for Tay-sachs Disease: Successful Pregnancy After Pre-embryo Biopsy and Gene Amplification by Polymerase Chain Reaction.
    Date April 1995
    Journal Fertility and Sterility

    OBJECTIVE: To determine the ability to apply preimplantation genetic diagnostic techniques to screen for and prevent Tay-Sachs disease (TSD). DESIGN: A couple, both carriers for the 4 base pair (bp) insertion in exon 11 of the beta-hexosaminidase A gene, which results in TSD, underwent IVF, pre-embryo biopsy, polymerase chain reaction (PCR) DNA amplification of the biopsied blastomeres, and pre-embryo transfer. One to two blastomeres were aspirated using a biopsy pipette that was inserted through an opening in the zona formed with acidified phosphate buffer. Polymerase chain reaction was performed on the individual blastomeres for 20 cycles followed by an additional 30 cycles using nested primers. This yielded amplified DNA products of 272 and 276 bp for the normal and mutant gene, respectively. Heteroduplex formation was used for identification of normal, homozygous affected, and heterozygous pre-embryos. RESULTS: Seven of 13 oocytes fertilized normally and were biopsied at the four- to eight-cell stages. Deoxyribonucleic acid amplification occurred in four of seven pre-embryos (one homozygous affected and three homozygous normal pre-embryos). The three normal pre-embryos that continued to cleave after biopsy were transferred on the evening of day 3 after retrieval. Subsequently, a single gestational sac was observed and the genetic diagnosis was confirmed at amniocentesis. CONCLUSION: A successful pregnancy and birth were accomplished after preimplantation genetic diagnostic screening for the prevention of TSD.

    Title Low Periconceptional Maternal Serum Thymosin Alpha 1 Levels Are Associated with Blighted Pregnancies.
    Date October 1993
    Journal American Journal of Reproductive Immunology (new York, N.y. : 1989)

    OBJECTIVE: The thymus-derived peptides, thymosin alpha 1 and thymosin beta 4, are believed to contribute to the maintenance of immune homeostasis. They are also associated with the hypothalamic-pituitary-adrenal-gonadal axis and may play a role in reproduction. STUDY DESIGN: Patients were recruited from a university hospital setting. Eligible candidates were 24 to 38 years old who were being seen in an ovulation induction and in vitro fertilization program. Serial maternal serum thymosin alpha 1 and beta 4 levels were assayed preconceptual and then twice in the first trimester by ELISA in 28 women with known ovulation dates who successfully conceived as demonstrated by positive serum beta human chorionic gonadotropin (hCG). Thymosin alpha 1 and beta 4 serum levels for viable pregnancies (group I; N = 19) were compared to pregnancies that aborted (group II; N = 9) using repeated measures of multivariate analysis of variance (MANOVA). Periconceptional (preovulatory and early pregnancy) thymosin alpha 1 and beta 4 values between groups I and II were compared using repeated measure one-way ANOVA. RESULTS: Thymosin alpha 1 levels from pregnancies that remained viable were significantly higher than those from pregnancies that spontaneously aborted. Preovulation thymosin alpha 1 levels also tended to be lower in pregnancies that subsequently aborted. Thymosin beta 4 levels were similar between the two groups. CONCLUSION: Decreased maternal serum thymosin alpha 1 levels may be associated with periconceptional endocrine and/or immune disturbances preceding miscarriage.

    Title The Yag Laser Used in Micromanipulation to Transect the Zona Pellucida of Hamster Oocytes.
    Date May 1993
    Journal Journal of Assisted Reproduction and Genetics

    PROBLEM: Since there has been no reported use of the YAG laser to micromanipulate oocytes, our purpose was to study whether (1) a YAG laser could be used to open the zona pellucida of hamster oocytes; (2) human sperm could reach the ooplasm and (3) under sperm penetration assay conditions, sperm would bind and penetrate the ooplasm. RESULTS: A YAG 100 laser was used at 10 W and 0.4-sec pulse width to open eight of eight ooplasm oocytes. The opening in the zonae was 0.25 to 1.0 rad (10 to 40 microns). For the initial eight oocytes and two parallel controls, the coarse appearance of the ooplasm was unchanged after 3 days. Next, in 11 of 12 manipulated oocytes, the sperm clustered at the opening of the zona. When 16 more oocytes were opened and exposed to sperm in sperm penetration assay conditions, each ooplasm bound sperm. There was no penetration noted. Each manipulation time was < 1 min. To clarify the laser effect, oocytes were exposed to laser energy then utilized as the interactive surface in the sperm penetration assay. It was found that only 20% bound sperm with no penetration. CONCLUSION: While the time factor compares favourably with other methods of zona opening, further study needs to be performed to minimize effect to the exposed oocyte.

    Title Preimplantation Genetic Analysis.
    Date September 1992
    Journal The Journal of Reproductive Medicine

    Advanced reproductive technologies have afforded us access to human preembryos, allowing the possibility of preimplantation genetic diagnosis of certain genetic diseases. This paper thoroughly reviews both the micro-manipulation and molecular biologic aspects of this new and exciting branch of medicine. In addition, some of the moral and ethical considerations relating to preembryo genetic diagnosis are discussed.

    Title In Vitro Exposure of Preimplantation Mouse Embryos to Cocaine and Benzoylecgonine Inhibits Subsequent Development.
    Date August 1992
    Journal Teratology

    Cocaine is used by over 20% of women of reproductive age. Although there have been numerous studies focusing on its effects on reproductive processes, none has evaluated its direct effect on preimplantation development. We have investigated the effect of cocaine and its major metabolite, benzoylecgonine, on in vitro preimplantation mouse embryogenesis. One-cell embryos were exposed at the one-, two-, four-, or eight-cell stage for 24 hr to medium containing 0-400 micrograms/ml cocaine or benzoylecgonine and then cultured to the blastocyst stage. Cocaine had its strongest inhibitory effect at the earliest stages of development. At the one- and two-cell stages, there was a significant inhibition of blastocyst formation following exposure to cocaine concentrations of 25-400 micrograms/ml, and at the four-cell stage there was an inhibitory effect at 100 and 400 micrograms/ml cocaine. Benzoylecgonine inhibited the development of embryos to blastocyst only at the one- and two-cell stages, at concentrations of 100-400 micrograms/ml. These findings suggest that cocaine is capable of blocking preimplantation embryogenesis, particularly following exposure at the earliest stages, and that this toxicity may abate as cocaine is biotransformed to benzoylecgonine.

    Title Cocaine Inhibits Mating-induced, but Not Human Chorionic Gonadotropin-stimulated, Ovulation in the Rabbit.
    Date June 1992
    Journal Biology of Reproduction

    The effects of cocaine on ovulation and corpus luteum function were investigated in New Zealand White rabbits. Forty females were randomly assigned to control and cocaine-treated groups. Controls were given vehicle s.c. daily for 5 days and cocaine-treated rabbits received 40 mg/kg cocaine hydrochloride s.c. daily for 5 days. One hour after the last cocaine dose, half the control and half of the cocaine-treated groups were mated with fertile males and the other half of each group received hCG i.v. Serial blood samples were obtained over 4 h on the day of mating or hCG treatment (Day 0), and then at intervals from Days 1-18. No mated, cocaine-treated rabbits ovulated, vs. 6 of 10 controls (chi-square: p = 0.01). In contrast, all animals given hCG had comparable numbers of corpora lutea (control: 7.1 +/- 0.8; cocaine: 5.7 +/- 0.8). Peak levels of benzoylecgonine (the major cocaine metabolite) occurred between 180 and 240 min after cocaine administration. In cocaine-treated animals that were mated, Day 0 serum LH (repeated measures MANOVA, p less than 0.01) and FSH (p less than 0.03) concentrations were lower than those in pregnant controls. Serum LH and FSH levels for all hCG recipients (cocaine-treated and control) did not differ. Serum prolactin concentrations in mated, pregnant rabbits were higher than in all other groups; cocaine treatment did not affect this hormone.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Preclinical Models for Human Pre-embryo Biopsy and Genetic Diagnosis. I. Efficiency and Normalcy of Mouse Pre-embryo Development After Different Biopsy Techniques.
    Date March 1992
    Journal Fertility and Sterility

    OBJECTIVE: To compare the usefulness of three micromanipulative methods at two different stages of pre-embryo development and to assess possible effects on postbiopsy survival and development. DESIGN: Four-cell and eight-cell mouse pre-embryos were biopsied using enucleation, aspiration, or extrusion of single blastomeres. After biopsy, pre-embryos were observed for in vitro and in vivo development. SETTING: Laboratories of The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School. PATIENTS, PARTICIPANTS: Only mice were used. INTERVENTIONS: Pre-embryo biopsy, developmental normalcy and pre-embryo transfer were studied. MAIN OUTCOME MEASURE(s): Few pre-embryos died as a result of biopsy trauma. High postbiopsy survival rates were associated with normal intrauterine and postnatal development. RESULTS: Expanded blastocyst formation rates from four-cell and eight-cell pre-embryos were 94.6%, 96.7% (controls); 80.7%, 89.1% (enucleation); 90.1%, 91.7% (aspiration); 83.1%, 91.5% (extrusion), respectively. Live birth rates at the four-cell stage were slightly lower in the enucleation group than in the blastomere aspiration and extrusion groups or controls (49.2% versus 58.8%, 56.3% and 66.7%, respectively). For the eight-cell stage, there were no differences between the groups. No developmental abnormalities were found in body or organ weights, in neonates or at 3 weeks of age, or in their subsequent ability to reproduce a second generation. CONCLUSIONS: Biopsy of mouse pre-embryos produces only a small loss of viability because of trauma and permits normal prenatal and postnatal development among surviving pre-embryos.

    Title First Trimester Maternal Serum Lysosomal Enzymes: Implications for Carrier Testing and Prenatal Diagnosis.
    Date May 1991
    Journal Fetal Therapy

    Carrier detection for lysosomal storage diseases is sometimes possible by evaluating maternal serum levels of specific enzymes. However, lysosomal enzymes (LE) can be modified by maternal hormonal changes in pregnancy or embryonic contributions. Maternal serum was obtained prospectively in the follicular phase and at 2-5 and 7-11 weeks after conception from 13 infertility patients with precisely known ovulation dates. Eleven enzyme activities were determined fluorimetrically using 4-methylumbelliferyl substrates. Using repeated measures ANOVA, alpha-N-acetyl-glucosaminidase (p less than 0.05), hexosaminidase A (p less than 0.005) and hexosaminidase A and B (p less than 0.005) increased during the first trimester, and 8 enzymes did not change significantly. Our data show differing patterns of LE in the first trimester. These may be explained by: (1) variability of maternal reaction to hormonal changes of pregnancy, or (2) variable embryonic contributions suggesting differential ontogeny and placental transfer of these enzymes. The increase in levels of the 3 specific LE in maternal serum may interfere with the accuracy of carrier testing in early pregnancy, but pregnancy should not interfere with the other 8.

    Title The Effect of Cocaine on Oocyte Development and the Follicular Microenvironment in the Rabbit.
    Date December 1990
    Journal Fertility and Sterility

    We examined the effects of cocaine exposure in the rabbit on in vitro oocyte development and on steroidal content of follicular fluid (FF) and serum progesterone (P). Cocaine hydrochloride (0, 10, 20, 40, or 80 mg/kg) was administered daily subcutaneously for 5 days to New Zealand White female rabbits before superovulation. On the last day of cocaine administration, animals were given human chorionic gonadotropin intravenously, and laparotomy was performed 6 to 8 hours later. During laparotomy, ovaries were removed, the number of follicles recorded, oocytes retrieved, and FF was obtained. In vitro fertilization (IVF) was then performed on the oocytes and the rate of cleavage observed. For all cocaine dosage groups, no differences were observed in the number of follicles present, number of oocytes retrieved, or IVF and cleavage rates. Cocaine did, however, decrease periovulatory serum P, and FF P, whereas FF estradiol concentrations increased. This suggests that short-term cocaine exposure affects the follicular steroid milieu, possibly by delaying granulosa cell luteinization.

    Title Variability of Precision Pinch Movements Caused by Carpal Tunnel Syndrome.
    Journal The Journal of Hand Surgery

    PURPOSE: Carpal tunnel syndrome (CTS) impairs the performance of fine motor tasks of the hand, leading to clumsiness. Precision pinch by the thumb and index finger is a frequent task that requires the fine control of each digit as well as the coordination of the 2 digits. The purpose of this study was to examine the performance of precision pinch movements impaired by CTS. METHODS: Sixteen CTS subjects and 16 gender- and age-matched control subjects were instructed to repetitively perform the precision pinch movement with the thumb and index finger. A marker-based motion analysis method was used to obtain the kinematic data of the thumb and index finger during the precision pinch movements. Pinch performance was quantified by the variability of tip positions, joint angles, and tip distance at the pinch closures in the repeated movements. RESULTS: The CTS subjects performed the precision pinch movements less consistently compared with performance of the control subjects. The inconsistency was demonstrated by the increased variability of the tip positions of the 2 digits and the joint angles of the index finger. However, the variability of thumb joint angles was not significantly different between the 2 groups. The tip-to-tip distance, an indicator of thumb and index finger coordination, was relatively reproducible for both groups. Still, the CTS subjects showed a 50% greater variability of the tip distance compared with that of the control subjects. CONCLUSIONS: Carpal tunnel syndrome impairs the performance of precision pinch movement as indicated by the increased variability. The results correlate with the observed clumsiness or lack of dexterity for patients with CTS.

    Title Morphological Analysis of the Transverse Carpal Ligament.
    Journal Hand (new York, N.y.)

    Transection of the transverse carpal ligament (TCL) for carpal tunnel syndrome is commonly performed, yet actual knowledge of TCL morphology is rudimentary and the anatomical terminology is inconsistently used. The purpose of this study was to perform a morphological analysis of the TCL, to redefine the anatomical terminology concerning the TCL and surrounding structures, and to evaluate any correlation between external, measurable hand dimensions, and TCL dimensions. A silicone casting technique and digitization were employed to measure the morphology of the TCL in cadaveric specimens and to construct a three-dimensional TCL model. The TCL was the thickest distally at the midline and ulnar segments and the thickest proximally at the radial segment. External hand dimensions did not significantly correlate with TCL dimensions. The TCL thickness distribution is variable along the radioulnar axis. The thickness of the TCL was 2.1 +/- 0.8 mm, ranging from 1.3 to 3.0 mm.

    Title Morphological Analysis of the Carpal Tunnel.
    Journal Hand (new York, N.y.)

    Although carpal tunnel release is one of the most commonly performed procedures in the USA, the morphology of the carpal tunnel as determined previously in the literature has been questioned. Previous methodology has been questioned for accuracy by recent studies. The purpose of this study was to perform a morphological analysis of the carpal tunnel and correlate carpal tunnel and hand dimensions. The carpal tunnels of ten cadaveric specimens were emptied of their contents and a silicone cast of the carpal tunnel was then created. This cast was then digitized, and the dimensions of the carpal tunnel were calculated. These dimensions were compared with the measured hand dimensions of the specimens. The width, depth, tilt angle, length, cross-sectional area, and volume of the carpal tunnel were 19.2 +/- 1.7 mm, 8.3 +/- 0.9 mm, 14.8 +/- 7.8 degrees , 12.7 +/- 2.5 mm, 134.9 +/- 23.6 mm(2), and 1,737 +/- 542 mm(3), respectively. Width, depth, and cross-sectional area did not change significantly along the length of the carpal tunnel, but tilt angle did. The width of the palm strongly correlates with the width of the carpal tunnel. Other dimensional correlations did not reach statistical significance. The carpal tunnel is of uniform dimension along its length. The long axis of the carpal tunnel in cross-section rotates volarly from the radial side of the hand increasingly with distal progression along the carpal tunnel. Based on our analysis of ten cadaveric specimens, the width of the carpal tunnel may be estimated by the width of the palm using the equation: [Formula: see text].

    Title Osteoarthritis of the Distal Interphalangeal Joint.
    Journal The Journal of Hand Surgery

    Osteoarthritis occurs with the highest prevalence in the distal interphalangeal joint of the hand and has been divided into an erosive and a nonerosive form. The pathogenesis of the early stages of osteoarthritis is poorly understood, but considerable emphasis has been placed on the role of cartilage and subchondral bone as well as soft tissue structures such as collateral ligaments and tendons. Radiographic evaluation represents the most standardized method to quantify disease progression, with different systems having been developed for defining and grading radiographic features. This current concepts article examines the recent knowledge base regarding the etiology, pathogenesis, and evaluation of osteoarthritis of the distal interphalangeal joint.

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