Interaction of microbiology and pathology in women undergoing investigations for infertility

BACKGROUND: Cases of endometriosis with no tubal damage are associated with infertility, suggesting an immunological rather than mechanical barrier to reproduction. Laparoscopy and falloposcopy results of clinically asymptomatic women undergoing investigation of infertility were correlated with the outcomes of microbiological screening for Chlamydia trachomatis, Mycoplasma pneumoniae, Mycoplasma hominis, ureaplasma species, Neisseria gonorrhoeae, Neisseria meningitidis and Chlamydia pneumoniae. METHODS: A total of 44 women presenting to a hospital IVF service for laparoscopic or laparoscopic/falloposcopic investigation of infertility provided endocervical swabs, fallopian tube washings, and peripheral whole blood for analysis. RESULTS: Of these 44 women, 15.9% (7) showed evidence of C. trachomatis infection as detected by either PCR or EIA serology. Of these 7 women, 5 (71%) had no or mild endometriosis and 2 (29%) had moderate or severe endometriosis. Of the remaining 37 women who showed no evidence of chlamydial infection, 15 (40.5%) had no or mild endometriosis. CONCLUSION: Women with infertility, but without severe endometriosis at laparoscopy, showed a trend towards tubal damage and a higher rate of previous C. trachomatis infection. Although not statistically significant, this trend would suggest that, where moderate to severe tubal damage is found to be the primary cause of infertility, C. trachomatis infection could be a likely cause for such tubal damage.     

Supreme Court limits HMO lawsuits

ERISA allows patients to recover the value af whatever test, drug, or treatment was denied, but not damages for any injuries that result from a lack of care.     

Employers shift costs for alternative medicine

When considering a complementary and alternative medicine benefit, it is recommended that companies determine whether it is likely to improve productivity and help to attract and retain talented workers. Employers should also determine whether the CAM benefit is likely to reduce overall medical costs by decreasing use of treatments such as surgery, physical therapy, and pharmaceuticals.     

Many employees reluctant to use Internet for health information

While many people may use the Internet to research buying a new car or planning a vacation, they may be less likely to use it for obtaining information on a medical condition. Those who do use the Internet to gather health information are more likely to be white, well-educated, and higher-paid.     

Splenic infarction associated with anti-cardiolipin antibody: a report of two cases

There are few cases of splenic infarction associated with antiphospholipid antibody reported in the literature. We present two cases of splenic infarction associated with anticardiolipin antibody, one complicated by the development of a splenic pseudocyst. Clinical diagnostic features of splenic infarction are described. In addition, a review of the literature on thrombotic manifestations of antiphospholipid syndrome is presented.     

Cine magnetic resonance microscopy of the rat heart using cardiorespiratory-synchronous projection reconstruction

PURPOSE: To tailor a cardiac magnetic resonance (MR) microscopy technique for the rat that combines improvements in pulse sequence design and physiologic control to acquire high-resolution images of cardiac structure and function. MATERIALS AND METHODS: Projection reconstruction (PR) was compared to conventional Cartesian techniques in point-spread function simulations and experimental studies to evaluate its artifact sensitivity. Female Sprague-Dawley rats were imaged at 2.0 T using PR with direct encoding of the free induction decay. Specialized physiologic support and monitoring equipment ensured consistency of biological motion and permitted synchronization of imaging with the cardiac and respiratory cycles. RESULTS: The reduced artifact sensitivity of PR offered improved delineation of cardiac and pulmonary structures. Ventilatory synchronization further increased the signal-to-noise ratio by reducing inter-view variability. High-quality short-axis and long-axis cine images of the rat heart were acquired with 10-msec temporal resolution and microscopic spatial resolution down to 175 microm x 175 microm x 1 mm. CONCLUSION: Integrating careful biological control with an optimized pulse sequence significantly limits both the source and impact of image artifacts. This work represents a novel integration of techniques designed to support measurement of cardiac morphology and function in rodent models of cardiovascular disease.     

The role of vascular endothelial growth factor (VEGF) in renal pathophysiology

Vascular endothelial growth factor (VEGF) is an endothelial-specific growth factor that promotes endothelial cell proliferation, differentiation and survival, mediates endothelium-dependent vasodilatation, induces microvascular hyperpermeability and participates in interstitial matrix remodeling. In the kidney, VEGF expression is most prominent in glomerular podocytes and in tubular epithelial cells, while VEGF receptors are mainly found on preglomerular, glomerular, and peritubular endothelial cells. The role of VEGF in normal renal physiology is essentially unknown. The absence of prominent effects of VEGF blockade in normal experimental animals suggests a limited function during homeostasis, although a role in the formation and maintenance of glomerular capillary endothelial fenestrations has been suggested. VEGF and its receptors are up-regulated in experimental animals and humans with type 1 and type 2 diabetes. Inhibition of VEGF has beneficial effects on diabetes-induced functional and structural alterations, suggesting a deleterious role for VEGF in the pathophysiology of diabetic nephropathy. VEGF is required for glomerular and tubular hypertrophy and proliferation in response to nephron reduction, and loss of VEGF is associated with the development of glomerulosclerosis and tubulointerstitial fibrosis in the remnant kidney. No firm conclusions on the role of VEGF in minimal change or membranous glomerulonephritis can be drawn. VEGF may be an essential mediator of glomerular recovery in proliferative glomerulonephritis. Glomerular and tubulointerstitial repair in thrombotic microangiopathy and cyclosporin nephrotoxicity may also be VEGF-dependent. In conclusion, VEGF is required for growth and proliferation of glomerular and peritubular endothelial cells. While deleterious in some, it may contribute to recovery in other forms of renal diseases.     

Association of hematocrit value with cardiovascular morbidity and mortality in incident hemodialysis patients

BACKGROUND: Associations between hematocrit values and clinical outcome have been studied with conflicting results in cardiac patients, end-stage renal disease (ESRD) patients, and ESRD patients with cardiac disease. We studied dialysis patients to determine the relationship between hematocrit value and cardiac risk under current Dialysis Outcomes Quality Initiative (DOQI) practices. METHODS; Medicare data were used to study 50,579 incident hemodialysis patients selected from January 1, 1998, to December 31, 1999, who received hemodialysis for 9 months after the onset of ESRD. Patients were divided into groups on the basis of the hematocrit value: < or =30%, >30% to < or =33%, >33% to < or =36%, >36% to < or =39%, and >39%. For hospitalization, the follow-up extended to 21/2 years; for mortality, 3 years. RESULTS: Compared to patients with hematocrit values of >33% to < or =36%, patients with values of >36% to < or =39% and those with values of >39% had risk ratios for hospitalization due to cardiac disease of 0.92 (95% CI 0.88 to 0.97) and 0.79 (95% CI 0.72 to 0.87), respectively, and risk ratios for death due to cardiac disease of 0.92 (95% CI 0.87 to 0.98) and 0.83 (95% CI 0.74 to 0.93), respectively, in the follow-up period. CONCLUSION: The significant associations we report do not establish a causal relationship between higher hematocrit values and lower risks of cardiac morbidity and mortality. A randomized clinical trial in low-risk patients is needed to establish causality.     

Successful treatment of primary bilateral renal mucormycosis with bilateral nephrectomy

Bilateral invasive renal mucormycosis has previously been associated with a 100% mortality rate. We report a case of bilateral invasive renal mucormycosis in a patient treated with amphotericin B and bilateral nephrectomy who survived and is currently disease-free.