Pregnancies after in vitro fertilization and transfer of human blastocysts

In a study of 29 cycles of IVF, ET was performed on day 5 after oocyte recovery when embryos had developed to the morula/blastocyst stage. Three preclinical pregnancies and three live births resulted (2 singleton and 1 twin), giving a viable PR per ET of 10%. It is concluded that while day 5 ET may well be important in terms of embryo biopsy for the preimplantation diagnosis of genetic disease, day 2 ET remains preferable for therapeutic IVF. Although these data would not support the introduction of day 5 ET into routine therapeutic IVF, delayed ET should be considered as an alternative approach to preimplantation diagnosis. Indeed, because the latter will generally involve the treatment of normal, fertile couples, it might be predicted that embryo survival rates, and thus the rate of pregnancy after day 5 ET, would be better than those presented here.     

The value of endometrial cell sampling in the management of post-menopausal women

The value of performing endometrial cytology on women receiving hormonal replacement therapy is discussed. Evidence is presented which shows that when this is routinely performed prior to beginning therapy, some 2% of women are found to have an abnormality ranging from polyps to carcinoma. When minimal dose combined oestrogen plus progestogen replacement therapy is used together with a monitoring procedure which involves routine annual Mimark endometrial sampling and curettage for abnormal cytology or bleeding, the risk of endometrial abnormality is reduced to a minimum. The benefits to be gained and the problems which detract from the use of endometrial cytology are discussed. It is recommended that every woman should have a routine cytological endometrial screening performed by a doctor experienced in the use of endometrial sampling equipment when she receives hormonal replacement therapy in the post-menopausal phase.     

Anaesthetic technique and pain in the newborn

This paper reviews the approach to pain during surgery in the newborn under five general headings: (1) current attitudes to pain in the newborn during anaesthesia and intensive care; (2) current evidence on the response of the newborn to pain; (3) current approaches to the management of pain in the newborn; (4) the complications of these approaches; (5) the resultant principles of the management of anaesthesia in the newborn.     

Pyruvate kinase activity in the lymphocytes of malnourished, anergic patients

Intralymphocytic pyruvate kinase (PK) has been reported to have decreased activity in protein calorie malnutrition. We studied the activity of this enzyme in the lymphocytes of normal, nonhospitalized individuals (Group 1: n = 14) and malnourished, anergic patients on the surgical ward (Group 2: n = 17). The mean activity in Group 2 (0.12 ± 0.02 U/10⁷ cells) was significantly decreased (P < 0.001) from that in Group 1 (0.28 ± 0.03 U/10⁷ cells). Five of the patients in Group 2 were studied following return to normal skin reactivity and prior to discharge from hospital; their mean activity had returned to the normal range (0.32 ± 0.08; P < 0.005). Kinetic studies of the enzyme in normal, nonhospitalized controls (Group 3: n = 7) and malnourished, anergic patients (Group 4: n = 5) showed a significant reduction in V_max of Group 3 (0.51 ± 0.02 U/10⁷ cells) as compared to Group 4 (0.35 ± 0.03 U/10⁷ cells), P < 0.005, K_m in Group 4 showed a significant increase (1.59 ± 0.26 mM) as compared to Group 3 (0.71 ± 0.09), P < 0.005. These studies show that significant changes occur in intralymphocytic PK activity, V_max and K_m in the malnourished, anergic patient and suggest that examination of this enzyme may help to define the lymphocytes of malnourished, anergic patients.