Fertility Among Women With Recurrent Spontaneous Abortions—The Effect of Paternal Cell Immunization Treatment

PROBLEM : The risk of women whose chief complaint is recurrent spontaneous abortions (RSA) for secondary infertility (infecundability) has not been evaluated prospectively. The effect of paternal mononuclear cell immunization on conception rates is unknown. METHOD : Two hundred women whose chief complaint was RSA were randomly assigned to be immunized with paternal mononuclear cells either before or after (up to 6 postmenstrual weeks) conception. Fertility rates (both conception and live birth) were evaluated for the group immunized before conception and compared to those for the control group, who were not immunized until after conception, using life table and multiple logistic regression analyses. RESULTS : Prospectively ascertained, age-related conception rates for nonimmunized RSA controls appeared to be similar to those for general populations. Immunization before pregnancy had no significant effect (power ± 14%) on rates of conception (66% before, 77% after) or time to conceive (median weeks before 19.5, after 27.0). Live birth rates (before 59%, after 63%) were also similar for both groups (P = 0.7). CONCLUSION : Women whose only prior complaint was RSA were not at high risk for secondary infecundability, and immunization did not alter either conception rates or time to conceive. Postponement of immunization until after conception did not affect live birth rates for women selected for study because they did not have a history of prior infecundability or early repeated miscarriages.     

Factor XI deficiency and its management

The meeting offered participants, mostly interested in the manufacture or clinical application of factor XI concentrates, an opportunity to review evidence of their efficacy and some recent concerns about their safety.     

Saving a dental residency: a joint commitment

The ability of the hospital to financially sustain a quality dental residency program depends on achieving the required increase in the volume of patients and the appropriate payer mix proportions. Although the importance of achieving financial viability places the program at a continuing risk, the dental department and the hospital's administrative staff members have taken a significant step forward to assure viability of the residency program in a financially uncertain health care environment.     

PLATELET-ACTIVATING FACTOR IN THE CNS

Platelet-activating factor (PAF) is a phospholipid synthesized in a variety of cells throughout the body. Platelet-activating factor has been identified in the CNS and has a number of diverse physiological and pathological functions. It has been shown to be a modulator of many CNS processes, ranging from long-term potentiation (LTP) to neuronal differentiation. Excessive levels of PAF appear to play an important role in neuronal cell injury, such as that resulting from ischaemia, inflammation, human immunodeficiency syndrome (HIV) and meningitis. The beneficial effects of PAF receptor antagonists are many and give rise to possible therapeutic strategies for neurotrauma. Copyright © 1996 Elsevier Science Ltd.