Pregnancy: Cumulative pregnancy rates and pregnancy outcome after in-vitro fertilization: >5000 cycles at one centre

Cumulative pregnancy rates and pregnancy outcome analysis areuseful methods for advising an infertile couple of the probabilityof in-vitro fertilization (IVF) success. All 5209 IVF cyclesin 2391 couples at University Hospital, London, Ontario, Canada,over 10 years were studied. Cumulative pregnancy rates wereestimated using life table analysis. The Cox proportional hazardsmodel was used to estimate the influence of covariates. Oocyteretrieval and embryo transfer were achieved in 84 and 64% ofcycles initiated respectively. There were 644 intra-uterineand 24 ectopic pregnancies (13%/cycle initiated, 15%/oocyteretrieval and 20%/embryo transfer). Cumulative pregnancy ratesfollowing six cycles were: tubal 55%, idiopathic 65%, endometriosis60%, multifactorial 63% and male 40%. There were 68 spontaneousabortions (10.6%) and three induced abortions for congenitalanomalies. The multiple gestation rate was 22%. Caesarean sectionand preterm delivery rates were 35 and 20% respectively, duein part to the high proportion of multiple gestations. Of 15deliveries which resulted in stillbirths and/or neonatal deaths,12 were multiple gestations; 18 pregnancies (3.3%) were complicatedby congenital malformations. No increases in congenital malformationsor spontaneous abortions were identified. Cumulative pregnancyrates were lower in cases of male infertility. Success ratesdid not decline with successive IVF cycles. IVF is an evolvinginfertility treatment.     

Effects of amount of contact between mother and child on the mother's nursing behavior

Short-term effects of different amounts of body contact between mother and newborn on human nursing behavior were studied. Extended contact immediately after parturition was related to an increase in affective components of maternal nursing behavior observed on postpartum Days 2 and 4.     

Two cases of children of homosexuals

The literautre is reviewed with reference to parental attitudes related to homosexuality, sex role typing, and object choice. Two cases of children of opposite-sexed homosexual parents are presented with projective testing indicating difficulties with gender role identity. It is our impression that the manifestation of sexual conflict in these homosexual parents expressed in attitudes and behavior toward the child is not unique and does not differ significantly from that of the heterosexual parent who has sexual conflicts. More long-term data are necessary to help us to understand the influences of parental homosexuality on the growing child.     

Physicians' difficulty with emergency department patients is related to patients' attachment style

Doctors experience 10-20 percent of patient interactions as being personally difficult, but the sources of difficulty are incompletely understood. In particular, physician-perceived difficulty has not been studied from the perspective of an established model of interpersonal relationships. Our objective was to determine whether a relationship exists between patients' attachment style and the degree of difficulty experienced by their attending physician in an Emergency Department in Pretoria, South Africa. Patients of an Emergency Department (n = 165) completed the Experiences in Close Relationships-Revised Questionnaire to measure attachment anxiety and attachment avoidance. Their physicians (n = 26), blind to the attachment measure, rated perceived difficulty using the Difficult Doctor-Patient Relationship Questionnaire. Four categories of attachment style were identified by cluster analysis of attachment scores. Patients were divided into difficult and non-difficult groups using a cut-off score. Two percent of patients with a secure attachment style were experienced as difficult, whereas the prevalence of difficulty in the insecure styles was 'preoccupied' 17 percent, 'dismissing' 19 percent and 'fearful' 39 percent (chi(2) = 16.383, df = 3, p = 0.0009), supporting the hypothesis that the physician's perception of patient difficulty is related to the patient's attachment style. The degree to which physicians serve attachment functions for patients in crisis merits further investigation.     

Preoperative Core Needle Biopsy does not Increase Local Recurrence Rate in Breast Cancer Patients

Summary Objective. Several case reports and clinical studies in the literature demonstrate needle track seeding after core needle biopsy in patients with breast cancer in up to 50% of cases. The impact of this observation on local recurrence and overall survival rate is, however, not fully investigated. Patients and design. We retrospectively analysed 719 patients after breast conserving surgery and postoperative radiotherapy for stage I and II breast cancer. We divided this group into patients with (189) and without (530) preoperative core needle biopsy. Demographic data, local recurrence and overall survival rate were compared between these two groups. Result. Preoperative core needle biopsy did not significantly influence the local free recurrence rate (median follow-up time of 78 and 71 months, respectively). The prognostic factors and the postoperative therapy did not differ significantly between the two groups. Conclusion. Preoperative core needle biopsy seems to have no detrimental impact on local recurrence and overall survival after breast conserving surgery and postoperative radiotherapy.     

Two types of frontal glands inDiphyllobothrium dendriticum (Cestoda,Pseudophyllidea) and their fate during the maturation of the worm

Two types of frontal glands were detected in plerocercoids ofDiphyllobothrium dendriticum and their fates during the development from plerocercoid to adult worm were followed. Type I—the green glands—dominate the scolex of the larvae. They are located posteriorly and peripherally in the scolex and in the cortical and medullary parenchyma of the neck. The glands empty into the frontal pit. Type II—the golden glands—have earlier eluded observation or been mingled with the green glands. The golden glands are confined to the scolex and are closely associated with the nervous system. The green glands are activated during the first day of cultivation in vitro and in vivo. Already after 12 h of cultivation most of the green gland material has been secreted. The process continues, rapidly emptying ducts and cells. The green glands disappear completely within three days. The golden glands remain, on the whole, unaltered throughout the maturation of the worm and still occur in the adult worm. The roles of the two glands are discussed.     

The influence of 0.5 % isoflurane on a vecuronium-induced neuromuscular blockade

The influence of adding 0.5% isoflurane to a narcotic-based anaesthesia on the duration of effect and recovery time after repetitive administration of vecuronium was studied in ten healthy patients. The twitch response in the adductor pollicis muscle was recorded after supramaximal train-of-four (TOF) stimulation of the ulnar nerve at the wrist. Prior to endotracheal intubation a bolus dose of vecuronium (0.08 mg/kg b.w.) was given. During surgery repeated injections of vecuronium (0.02 mg/kg b.w.) were administered at a TOF ratio of 0.25. Hand-skin temperature, systolic blood pressure, end-tidal CO2 and isoflurane concentrations were continuously monitored. Before and after 90 min administration of isoflurane, the duration of effect was 21 +/- 4 and 24 +/- 5 min (mean +/- s.d., P less than 0.05) respectively. Corresponding recovery times were 270 +/- 60 and 280 +/- 70 s (n.s.). Skin temperature remained unchanged and systolic blood pressure showed only minor variations. The addition of 0.5% isoflurane to a narcotic-based anaesthesia causes a moderate increase in duration of effect but no change in recovery time from a repetitive vecuronium-induced neuromuscular blockade of 0.02 mg/kg.     

Blue wing disease of chickens: signs, pathology and natural transmission

A new peracute disease of chickens is described. The disease is called blue wing disease (BWD) and has occurred frequently in all parts of Sweden since the first outbreak in 1972. Most of the outbreaks have affected broilers at the age of 2 to 4 weeks with a mortality rate of 1 to 60%. BWD is characterised by skin lesions in the form of ecchymotic haemorrhages, most frequently on the wings. These lesions are often infected secondarily by bacteria, leading to a gangrenous dermatitis. Infectious bursal disease, inclusion body hepatitis and infectious aplastic anaemia, which also have been associated with gangrenous dermatitis, are not found in the outbreaks of BWD. BWD is closely related to certain parent flocks, which suggests that the disease is transmitted vertically. The parent flocks which transmit the disease do not show any signs of disease themselves.     

Are you in control of the method or is the method in control of you?

The starting point for this article is the concept that there is a risk in slavishly adhering to one particular method in nursing education. With this approach in mind, the aim was to examine the use of an educational model with drama in relation to Gadamer's idea of method, as well as to discuss the conditions for lifeworld dialogues in learning encounters.