Effects of Cryopreserved Semen Quality and Timed Intrauterine Insemination on Pregnancy Rate and Gender of Offspring in a Donor Insemination Program

Purpose: Our purpose was to study the relationship among cryopreserved donor semen quality, pregnancy rates, and preconception sex selection after intrauterine insemination. Methods: We reviewed the records of the 203 women in our donor insemination program from 1987 to 1994 who became pregnant after more than one insemination cycle and had no female-factor infertility. They were categorized according to the number of cycles required for pregnancy. Semen samples from 54 donors were analyzed before freezing and after thawing. Specimens resulting in pregnancy were compared to specimens from the same donor that did not. Semen characteristics were compared to gender of the child. Results: Two hundred fifty two-women became pregnant of the 422 who were enrolled. The pregnancy rate per cycle was 13%. Semen quality was not related to pregnancy outcome or offspring gender. However, more male children (101 vs 83) were born. Conclusions: Semen characteristics in good-quality cryopreserved donor semen do not affect pregnancy rate or offspring gender.     

5-HT activates neural reflexes regulating secretion in the guinea-pig colon

The role of 5-hydroxytryptamine (5-HT) in neural reflexes regulating secretion was examined in muscle-stripped segments of guinea-pig colon set up in modified flux chambers. A 15-μL pulse of 5-HT (100 μ M ) to the mucosal bath (1.5 mL), which was continuously perfused, evoked an increase in short-circuit current (I_sc). The 5-HT-induced increase in I_sc was inhibited by tetrodotoxin, N-acetyl-5-hydroxytryptophyl-5-hydroxytryptophan amide (5-HTP-DP), GR82334 and atropine, but not by tropisetron. 5-HTP-DP reduced the response to a 5-HT pulse over the concentration range of 1 n M to 1 μ M . The I_sc response to a 5-HT pulse was unaffected by the cyclooxygenase inhibitor, piroxicam. This contrasted with a reduction in the I_sc response to mucosal stroking with a brush by piroxicam. The results suggest that a 5-HT pulse, like mucosal stroking, activates a secretory reflex that includes tachykinin and cholinergic neurons but, unlike mucosal stroking, does not release prostaglandins.     

Stenoses in dialysis fistulas: treatment with percutaneous angioplasty

Percutaneous transluminal angioplasty (PTA) was performed on 30 stenotic lesions in 25 dialysis access fistulas. The fistulas were in 23 patients with a mean age of 53 years. Lesions were detected with angiography within a few days after poor flow or increased venous pressure was documented during dialysis. Twenty-two lesions were in patients with polytetrafluoroethylene graft fistulas, five were in patients with bovine carotid fistulas, and three were in patients with endogenous arteriovenous fistulas. There were 28 venous stenoses (20 at the anastomotic site and eight more proximally) and two arterial stenoses. The overall success rate was 80%, with a 6-month patency of 76% and a mean patency after PTA of 9.4 months. Among the venous lesions, the success was 100% for proximal lesions and 71% for anastomotic lesions. There were two technical failures, which required surgery for revision of the fistulas, and four self-limited hematomas. PTA is a safe and effective treatment for stenoses in dialysis fistulas, particularly for lesions remote from the anastomotic sites.     

Anaesthetic management for mitral valve replacement

Anaesthetic management for mitral valve replacement in 138 patients is presented. Value of preoperative visits, control of haemodynamic status, cheerful operative surroundings and smooth induction is stressed. Haemodilution technique, effective myocardial preservation and modern monitoring facilities help to maintain the patients near-normal physiological status during the procedure. In patients with unstable cardiovascular status, postoperative overnight ventilation is advocated, which maintains better oxygenation, acid-base values and reduces the work of breathing. Management of patients by anaesthesiologists and surgeons as a team reduces the mortality and morbidity significantly.     

ROLE OF LEFT VENTRICULAR FUNCTION EVALUATION IN NON SPECIFIC ECG ABNORMALITY

A total of 373 subjects [367 service persons and 6 civilians) with ECG abnormality were evaluated with maximal TMT exercise, 86 (23%) of them showing positivity. Subsequent assessment including radionuclide ventriculography and coronary arteriography wherever necessary revealed coronary artery disease in 31 (8.3%). The remaining 55 were further evaluated by 2D and M-Mode echocardiography for exclusion of any other cardiac disease responsible for the ECG abnormality as well as for assessment of LV performance. Seven subjects showed minor structural cardiac anomalies – MVP in 5 and HOCM in 2. The remaining 48 showed no significant difference in the measurements of LV posterior wall and IV septal wall thickness, mitral septal separation, mitral valve excursion velocities, LV end-systolic/end-diastolic internal diameters and calculated percent fractional shortening, LV end-diastolic, end-systolic and stroke volumes as well as ejection fraction, on comparison with 20 age matched controls. These 48 service persons, thus evaluated were considered to have no organic heart disease or cardiac function impairment and were cleared for all strenuous duties including flying of sophisticated aircrafts or posting to high altitudes.KEY WORDS: LV systolic function, Non-specific ECG abnormality     

MIDDLE EAR RECONSTRUCTION – OUR EXPERIENCE

A comparative study of ossicular reconstrution using four different graft material was carried out on 40 patients as a second stage procedure from July 1989 to June 1991. The graft materials used were : aulologus ossicular bone graft, allogeneic ossicular bone graft, autologus cartilage and bio-compatible materials. All patients were observed for a period ranging from one to two years. Extrusion of ossicular graft was prevented by use of a lace of cartilage between the ossicular graft and neotympanic membrance. Satisfactory results were obtained with cartilage graft in 6%, allogeneic ossicles 70%, autologus ossicular graft 80% and bio-compatible materials 33.3%.KEY WORDS: Ossiculoplasty, Autologus and allogeneic ossicular graft, Total ossicular replacement prosthesis, Partial ossicular replacement prosthesis     

CARDIOVASCULAR RISK FACTOR CLUSTERING AND CORONARY ARTERY DISEASE : A 4-YEAR FOLLOW UP STUDY OF 257 SERVICE PERSONNEL

Two hundred and fifty seven service personnel with established diagnosis of (a) silent ischaemia (40.47%) (b) Q-infarction (25.68%) and (c) non-Q-infarction (33.85%) along with 50 age-matched controls were subjected to stress tests before and after identification and control of risk factors. Lack of exercise (63.0%), dietetic indiscretion (47.4%) and cigarette smoking (40.4%) were the main risk factors. Hypercholesterolaemia (22.1%), alcohol over-indulgence (17.1%), positive family history (16.3%), diabetes mellitus (9.7%) and hypertension (6.2%) were other contributing factors. Clustering or multiplicity of risk factors was seen in 61.1% cases. All patients were advised for control of risk factors along with necessary specific therapy wherever indicated. Initial stress test was positive in 83.3% of the total and on repetition, after 4 years, the positivity dropped to 45.9% with a rate of improvement of 44.9%. Patients with silent ischaemia showed the maximum improvement (57.8%) following the risk factor intervention. Only 4 cases (1.56%) showed deterioration with reinfarction during the 4-year follow up.KEY WORDS: Coronary disease, Risk factors, Prevention and control     

Lumbar Spine Fusion in the Treatment of Degenerative Conditions: Current Indications and Recommendations

The role of arthrodesis in the treatment of degenerative disorders of the lumbar spine is controversial. Most patients with these conditions can be successfully treated nonoperatively. Lumbar fusion, with or without instrumentation, is associated with more complications, especially in the elderly population. Therefore, the potential benefits to be obtained by means of arthrodesis must be measured against the risks. Arthrodesis is indicated as an adjunct to decompression for patients with spinal stenosis associated with degenerative or iatrogenic spondylolisthesis and in the treatment of progressive degenerative lumbar scoliosis and iatrogenic instability resulting from extensive decompression. The occurrence of two or more episodes of disk herniation at the same segment is a relative indication for arthrodesis. In patients with incapacitating nonradicular back pain, arthrodesis should be a consideration only after failure of a trial of nonoperative treatment lasting more than 12 months and after secondary gain issues (e.g., workmen's compensation) have been adequately resolved. Arthrodesis has a poor success rate when used to treat back pain associated with multilevel disk degeneration seen on magnetic resonance images.     

The determination of environmental 2-ethoxyethanol by gas chromatography

A gas Chromatographic procedure for the determination of 2-ethoxyethanol (C₂H₅OCH₂CH₂OH) was developed by using the general principles of analysis of solvent vapors. 2-Ethoxyethanol was sampled by adsorbing on activated carbon. It was desorbed with carbon disulfide plus 2-propanol (0.5%). The analytical column was packed with 10% free fatty acid phase on Chromosorb-P AW. The analysis was conducted at 130° C isothermal using a flame ionization detector. Addition of 2-propanol (0.5%) to carbon disulfide improved (P0.01) desorption of 2-ethoxyethanol adsorbed on activated carbon. The mean desorption efficiency of carbon disulfide plus 2-propanol (0.5%) was 87.9±2.86% (n=15). Based on a 101 air sample and detector sensitivity of 2×10^–10AFS, the calculated limit of detection of 2-ethoxyethanol was 0.1 ppm. The precision (coefficient of variation) for this analytical procedure was 3.34% (n=12). In conclusion, 2-ethoxyethanol adsorbed on activated carbon can be desorbed with carbon disulfide plus 2-propanol (0.5%). Subsequently the desorbed 2-ethoxyethanol can be analyzed by gas chromatographic identification on 10% FFAP using a flame ionization detector.The abstract of this research paper constituted a part of the proceedings of the 4th Annual Meeting of The American College of Toxicology held at Arlington, Virginia, November 30 to December 2, 1983 (Sidhu 1984)