Satellite in vitro fertilization: The Oregon experience

Objective: This study was designed to compare the results of preliminary evaluation, ovarian hyperstimulation, and monitoring of patients at a distant in vitro fertilization satellite center with those treated at the main campus of the program.Study design: Fifty-four patients completing oocyte retrieval cycles at the Eugene satellite Oregon Health Sciences University in vitro fertilization program for the period Jan. 1, 1991, through Dec. 31, 1993, were compared with 222 patients at the main campus for age, peak estradiol level, number of oocytes, retrieved, number of embryos, clinical pregnancy rate, and pregnancy outcome.Results: There were no statistically significant differences between the Eugene in vitro fertilization satellite center and the main campus for any of the factors analyzed with the exception of clinical pregnancy rate. The clinical pregnancy rate per cycle at the Eugene satellite center was 39% while the Portland main campus rate was 23% (p = 0.027), presumably because of a larger number of couples with severe male factor infertility at the central site.Conclusion: A distant in vitro fertilization satellite program was highly successful in the Oregon experience. In addition to greater convenience to the patients, the program was highly comparable to main campus program in measured parameters of ovarian hyperstimulation, oocyte retrieval, number of embryos, and pregnancy rate.     

眩晕的神经放射学特征

眩晕患者的诊断过程始于对病史以及随后的全身体格检查和神经系统检查的准确评价。这步骤通常能够识别确切的病因，或者至少可鉴别周围性眩晕和中枢性眩晕。神经放射学检查必须作为选择性诊断手段加以考虑，包括CT、MRI、MR血管造影（MRA）以及血管造影术。对于周围性眩晕、良性阵发性位置性眩晕、迷路炎、Meniere病、外淋巴瘘、局部外伤、中毒性迷路炎、急性中耳炎和慢性中耳渗液等疾病的诊断而言，影像学技术的作用是有争议的。CT和MR可用来排除其他病理学原因和证实诊断。分辨率和增加和能够增强迷路内液的特殊MRI序列的应用，使我们能够对迷路的结构和病理学变化进行更详细地分析。T1和T2对比序列检查都是必需的。当怀疑中耳类以及在外伤后眩晕随访时，需要进行高分辨率CT检查。中枢性眩晕的病因很多，包括椎基底循环血管病变、多发性硬化、偏头痛相关性眩晕、小脑和脑干肿瘤以及中枢神经系统感染，其中脑缺血和多发性硬化最为常见。在这些情况下，影像学检查应该是强制性的。CT能够诊断大多数小脑出血以及小脑和脑干的急性缺血，增强的MRI已经证实是检测后颅窝病病变最为敏感的工具。弥散加权MRI能够比常规MRI更早地显示急性缺血性改变。MRA能提供类似血管造影片的颅内血管图像。有证据表明，有时可避免进行侵入性的血管造影术。MRA的分辨率不如传统的血管造影术，还可能受到活动和其他伪影的影响。选择性的后循环血管造影通常对治疗决策有提示作用。     

Morphological variation of layer III pyramidal neurones in the occipitotemporal pathway of the macaque monkey visual cortex

We compared the morphological characteristics of layer III pyramidal neurones in different visual areas of the occipitotemporal cortical 'stream', which processes information related to object recognition in the visual field (including shape, colour and texture). Pyramidal cells were intracellularly injected with Lucifer Yellow in cortical slices cut tangential to the cortical layers, allowing quantitative comparisons of dendritic field morphology, spine density and cell body size between the blobs and interblobs of the primary visual area (V1), the interstripe compartments of the second visual area (V2), the fourth visual area (V4) and cytoarchitectonic area TEO. We found that the tangential dimension of basal dendritic fields of layer III pyramidal neurones increases from caudal to rostral visual areas in the occipitotemporal pathway, such that TEO cells have, on average, dendritic fields spanning an area 5-6 times larger than V1 cells. In addition, the data indicate that V1 cells located within blobs have significantly larger dendritic fields than those of interblob cells. Sholl analysis of dendritic fields demonstrated that pyramidal cells in V4 and TEO are more complex (i.e. exhibit a larger number of branches at comparable distances from the cell body) than cells in V1 or V2. Moreover, this analysis demonstrated that the dendrites of many cells in V1 cluster along specific axes, while this tendency is less marked in extrastriate areas. Most notably, there is a relatively large proportion of neurones with 'morphologically orientation-biased' dendritic fields (i.e. branches tend to cluster along two diametrically opposed directions from the cell body) in the interblobs in V1, as compared with the blobs in V1 and extrastriate areas. Finally, counts of dendritic spines along the length of basal dendrites revealed similar peak spine densities in the blobs and the interblobs of V1 and in the V2 interstripes, but markedly higher spine densities in V4 and TEO. Estimates of the number of dendritic spines on the basal dendritic fields of layer III pyramidal cells indicate that cells in V2 have on average twice as many spines as V1 cells, that V4 cells have 3.8 times as many spines as V1 cells, and that TEO cells have 7.5 times as many spines as V1 cells. These findings suggest the possibility that the complex response properties of neurones in rostral stations in the occipitotemporal pathway may, in part, be attributed to their larger and more complex basal dendritic fields, and to the increase in both number and density of spines on their basal dendrites.      

Cerebrospinal fluid monoamine markers are decreased in dementia of the Alzheimer type with extrapyramidal features

We measured monoamine metabolites and biopterin in the CSF of 37 patients with dementia of the Alzheimer type (DAT), with or without extrapyramidal signs, and in 14 age-matched healthy controls. Compared with concentrations in DAT and controls, the concentrations of homovanillic acid (HVA) and biopterin were significantly decreased in DAT with extrapyramidal signs (EDAT). CSF 3-methoxy-4-hydroxy-phenethyleneglycol and 5-hydroxyindoleacetic acid did not differ significantly among these groups. Age at onset of dementia was positively correlated with CSF HVA (r = 0.49, p less than 0.05). The two dementia groups did not differ significantly in the extent of ventricular dilation as measured by quantitative CT, but EDAT patients had lower Mini-Mental State Examination scores than did DAT patients. When patients were matched for age and dementia severity, CSF HVA and biopterin concentrations remained significantly lower in EDAT than in DAT patients. These results indicate that EDAT patients form a distinct subgroup of DAT with evidence of central monoamine dysfunction.     

Topical indomethacin and prostaglandins in normal and aphakic rabbit eyes

Lenses were removed from rabbit eyes using an extracapsular technique. Animals were in three groups; no treatment (NT), post-treatment (PT) and pre- and post-treatment (PPT). Treatment consisted of 2% topical indomethacin given three times a day after surgery, except for the PPT group that received 3 drops on the day prior to surgery and drops at 3 hours and 1 hour before surgery. Prostaglandin levels in ocular tissues and fluids were determined at 7, 14 and 21 days post-surgery. Indomethacin decreased prostaglandin formation in most ocular tissues, and was more effective in the PPT group than in the PT group. The data indicate that topical indomethacin suppresses prostaglandin formation from ocular tissues, and that local prostaglandin release from retina and choroid can provide locally high prostaglandin concentrations, regardless of their source, after lensectomy.     

Tropical pyomyositis

A 22 year old male presented with symptoms of diffuse muscle pain and multiple abnormal laboratory findings that were eventually attributed to tropical myositis. Computed tomography scan was more reliable than ultrasound and served as a guide to needle aspiration and pathologic diagnosis.