Biofluid Aspects of Embryo Transfer

Embryo transfer (ET) is the last stage of extracorporal fertilization during which the embryo is placed in the uterine cavity with a medium-filled catheter 2–3 days after in vitro fertilization. While fertilization in the laboratory occurs at very high rates (>:90%), the overall success of the procedure (i.e., take home baby) is still very low (<25%) and assumed to be mainly due to implantation failure. A computational model was developed to simulate ET within the uterine cavity by a fluid-filled catheter inserted into a two-dimensional channel with oscillating walls. The results showed that the speed at which the embryos are injected from the catheter dominates the procedure and controls the velocity of their transport within the uterine cavity. ET at excessively high injection speeds may lead to ectopic pregnancies, while uterine peristalsis affects transverse dispersion only during injection at low injection speeds. The presence of the catheter within the uterus does not affect flow patterns downstream of its tip. The potential risks to implantation failure due to mechanical factors involved in the ET processes are discussed. © 2003 Biomedical Engineering Society. PAC2003: 8719-j, 8710+e     

Oral session 42—Motor neuron disease (3)

Oral Sessions

Oral session 42—Motor neuron disease (3)     

Sweet's syndrome and subacute thyroiditis

A 63 year old woman developed biopsy documented lesions of acute febrile neutrophilic dermatosis (Sweet's syndrome) one week after the onset of subacute thyroiditis. This is only the second reported case of such an association. The role of cytokines in the development of both subacute thyroiditis and Sweet's syndrome may be the link between these two conditions.     

Plants used for the treatment of diabetes in Israel

In an extensive ethnobotanical survey (130 informants) of the medicinal plants of Israel, 16 species were found to be used for hypoglycaemic treatments. The list includes Achillea fragrantissima (Forssk.) Sch.-Bip, Ammi visnaga (L.) Lam, Atriplex halimus L., Capparis spinosa L., Ceratonia siliqua L., Cleome droserifolia (Forssk.) Del., Eryngium creticum Lam., Inula viscosa (L.) Ait., Matricaria aurea (Loefl.) Sch.-Bip, Origanum syriaca L., Paronychia argentea Lam, Prosopis farcta (Banks et Sol.) Macbride, Salvia fruticosa Mill., Sarcopoterium spinosum (L.) Sp., and Teucrium polium L.; eight of them (marked with an asterisk) are first recorded here as used for this purpose.     

Genitourinary malignancy presenting as an ocular metastasis: A case report and review of the literature

Metastases to the eye or orbit as the initial presentation of genitourinary malignancy are unusual and can be a diagnostic challenge. We report an 81-year-old man who presented with pain and proptosis in an eye that had been blind for 50 years. Radiologic investigations identified a mass involving the left globe and orbit. Histology of the enucleation specimen was consistent with a metastatic poorly differentiated carcinoma suggestive of a prostate primary. With the constellation of obstructive urinary symptoms, an abnormal digital rectal examination, elevated prostate-specific antigen and a positive bone scan, androgen deprivation therapy was initiated for metastatic prostate cancer. After an initial response to treatment, the patient’s disease progressed in a manner atypical for prostate cancer. After describing our case, we review the literature on ocular and orbital metastases and their relation to genitourinary malignancies.     

Treatment of severe late-onset Perthes’ disease with soft tissue release and articulated hip distraction: revisited at skeletal maturity

Purpose  Late-onset Perthes’ disease is diagnosed after 9 years of age. Conservative treatment and conventional surgical techniques have limited ability to reduce the pressure in the joint or change the shape of the femoral head. We used a combination of soft tissue release and joint distraction with a hinged mono-lateral external fixator for these patients. Ten of our patients reached skeletal maturity and were evaluated. Methods  Clinical assessment included: Harris hip score, hip range-of-motion (ROM), limb length discrepancy, and the Oxford hip questionnaire for pain and function. Radiographic assessment included: Sharp transverse acetabular inclination, the uncoverage percentage, the epiphyseal index before surgery (modified Eyre–Brook), at frame removal, and, at last follow-up, the epiphyseal quotient (of Sjovall) and the Stulberg classification. Results  Our study included eight boys and two girls (mean age at surgery 12.3 years, range 9.4–15.1, mean age at last follow-up 18.1 years, range 15.2–22.8). The mean follow-up was 5.7 years (range 4.3–7.8). The mean Harris hip score was 86.3/100 (range 48.5–96); one patient had <85 points. The hip ROM was slightly limited in most patients, and seven patients had limb shortening between 1–4 cm. The mean Oxford hip questionnaire score was 17.4/60 (range 12–31). The mean Sharp transverse acetabular inclination of the affected side was 42° (range 36–54) compared to 39° for the unaffected side (P = 0.045). The mean uncoverage percentage was 37% (range 27–47) compared to 20% for the unaffected side (P = 0.017). The mean epiphyseal index was 0.71 (range 0.31–0.92) before surgery, 0.79 (range 0.50–0.93) at frame removal (P = 0.012), and 0.72 (range 0.51–0.89) at last follow-up (P = 0.646). The epiphyseal quotient for the eight unilateral cases was 0.72 (range 0.49–0.91), and the Stulberg classification was type III for three cases and type IV for seven. Conclusion  Patient satisfaction for function and pain following the combined procedure was good. Radiographic parameters did not change significantly. This should be regarded as a salvage procedure.     

The predominance of benign histology in small testicular masses

ObjectivesTo evaluate the concordance between testicular tumor size and benign histology in order to identify a cut-off size, below which the rate of benign lesions would be highest.Methods and materialsDuring the years 1995–2008, we performed 131 consecutive testicular operations for testicular tumors. Ten of these were testicular preserving surgery, whereas the other 121 patients had radical orchiectomy. We searched for the rate of benign lesions in the following 3 groups of tumor diameter: 10 mm or less, 11–20 mm, and greater than 20 mm. ROC analysis was used to find the optimal size cut-off below which the rate of benign lesions would be highest.ResultsBenign lesions were found in 11 patients (8%), including epidermoid cyst (n = 4), Leydig cell tumor (n = 3), fibrosis (n = 1), adenomatoid tumor (n = 2), and 1 patient with a simple cyst. Small tumor size strongly correlated with benign histology. The mean diameter of benign vs. malignant lesions was 15 mm and 41 mm, respectively (P < 0.05). The rate of benign lesions in tumors with a diameter of 10 mm or less, 11–20 mm and greater than 20 mm was 50%, 17%, and 2%, respectively. Receiver Operating characteristic (ROC) analysis with 87% sensitivity and 83% specificity revealed a cut-off value of 18.5 mm tumor diameter below which the proportion of benign lesions was 38.5% compared with 2% above it (P < 0.05).ConclusionsWhile benign lesions comprise only 8% of all testicular tumors, their proportion among small lesions is much higher. With a size cut-off of 18.5 mm, 38.5% of smaller lesions are benign. These findings support consideration of testicular exploration for small testicular lesions aiming at preservation rather than predetermined radical orchiectomy.