Genetic Control of Autoantibody Production to Spermatozoa in Vasectomized Rats*

ABSTRACT: Previous studies from our laboratory using vasectomized rats of different inbred strains have suggested that MHC-linked genes do not play a major role in the formation of autoantibodies to spermatozoa. In the present paper, we demonstrate that sperm autoantibody production is not influenced by genes in the major histocompatibility complex, using vasectomized congenic rats and various crosses between high and low responder strains. We also show that autoimmune responses to spermatozoa are not influenced by genes on the Y-chromo-some.     

Current maternal attitudes to infant feeding methods

Summary Mothers' feeding practices and their attitudes to breast and bottle feeding were investigated. Sixty-four per cent started to breast feed and 35% continued past 2 months, a continuation rate which is higher than previously reported. Also higher than previously reported was the proportion of working class women breast feeding. This may reflect a current trend. Most women decided on their infant feeding technique early in pregnancy, and 80% followed that decision. For those who changed their minds about feeding practice postnatally, and for those who were initially undecided, the hospital was influential. Analysis of women's attitudes revealed that primiparous women found breast feeding more pleasurable and less restricting than they had anticipated. The results are discussed in relation to attempts to encourage breast feeding.     

The hospital inpatient stay: the experience of first-time parents

The experience of hospital inpatient stays at childbirth was studied in a longitudinal study of the experiences of 96 first-time parents during the transition to parenthood. For women, the prospect of birth was a major worry during pregnancy. Negative expectations proved in general to be justified by events, with many women reporting predominantly bad memories of the experience. Satisfaction with the hospital inpatient stay is also considered: a major source of dissatisfaction was inadequate help with breast feeding, which produced many difficulties. Middle class mothers were in general more dissatisfied with their hospital stay, as were women who had Caesarean births. Relationships were found between antenatal class attendances and the likelihood of a normal delivery and reported pain during childbirth. The role and experience of fathers was also considered. Most expected to be at the birth from an early stage in pregnancy; more than two-thirds were present for the delivery and half or more at the labour. Their experience at this time was more positive than that of their partners. But during the hospital stay, this role was much more marginal. The results are discussed in terms of their implications for antenatal preparation, breast feeding and paternal involvement.     

Th1 and Th2 Cytokines and IgE Levels in Identical Twins with Varying Levels of Cigarette Consumption

Some have suggested that tobacco smoke may skew the immune system toward a Th2 pattern, however the effects of genetics or childhood exposures could explain these results. We compared PMBC supernatant or serum Th1 (INF-) and Th2 (IL-4, IL-5, and IL-13) cytokine and IgE levels in members of 45 pairs of nonasthmatic monozygotic twins with varying levels of current cigarette consumption to determine if smoking was associated with Th1/Th2 function after accounting for genetic factors. A statistically significant dose-response was observed between levels of smoking and IL-13 (p=0.05). Mean IL-13 level among heavy smokers (20+ cigarettes/day) was 146% higher than that among nonsmokers (+26.2 pg/mL; p=0.04). The mean IL-5 level among heavy smokers was 166% higher than that among light (<20 cigarettes/day) smokers (+3.4 pg/mL; p=0.03). No statistically significant differences in INF-, IL-4, or IgE levels were observed. Smoking appears to be associated with increased levels of IL-13.     

LAPAROSCOPIC REPAIR OF RENAL ARTERY ANEURYSM

PURPOSE: We describe technical considerations of the laparoscopic repair of a renal artery aneurysm. MATERIALS AND METHODS: A 57-year-old woman presented with a 3 cm. aneurysm of the distal left main renal artery at its bifurcation. Using a purely laparoscopic 4-port transperitoneal technique the aneurysm was completely mobilized from its location behind the renal vein. Its 3 feeding vessels were controlled individually with bulldog clamps. The aneurysm sac was bivalved and precisely trimmed to conform with the diameter of the main renal artery. Vascular reconstruction was performed with running freehand laparoscopic suturing and intracorporeal knot tying using 4-zero polypropylene suture. RESULTS: Warm ischemia time was 31 minutes, total operative time was 4.2 hours, blood loss was 100 cc and hospital stay was 2 days. Postoperatively renal scan showed improved perfusion and renal arteriography confirmed adequate repair of the aneurysm. CONCLUSIONS: Laparoscopic repair of the renal artery aneurysm is feasible. To our knowledge we present the initial clinical report of laparoscopic renovascular surgery in the literature.     

LAPAROSCOPIC INTRACORPOREALLY CONSTRUCTED ILEAL CONDUIT AFTER PORCINE CYSTOPROSTATECTOMY

PURPOSE: We present our technique of laparoscopic ileal conduit creation after cystoprostatectomy in a porcine model performed in a completely intracorporeal manner. METHODS AND METHODS: After developing the technique in 5 acute animals laparoscopic cystoprostatectomy with intracorporeally performed ileal conduit urinary diversion was performed in 10 surviving male pigs. A 5-port transperitoneal technique was used. All steps of the technique applied during open surgery were duplicated intracorporeally. Specifically cystectomy, isolation of an ileal conduit, restoration of bowel continuity and mucosa-to-mucosa stented bilateral ileoureteral anastomosis formation were performed by exclusively intracorporeal laparoscopic techniques. RESULTS: Surgery was successful in all 10 study animals without intraoperative or immediate postoperative complications. Blood loss was minimal and average operative time was 200 minutes. Stenosis of the end ileal stoma specifically at the skin level was noted in 6 animals. Three deaths occurred 2 to 3 weeks postoperatively. At sacrifice renal function was normal in all surviving animals. No ileo-ureteral anastomotic strictures were noted on pre-sacrifice radiography of the loop or at autopsy examination of the anastomotic sites. CONCLUSIONS: Laparoscopic ileal conduit urinary diversion after cystoprostatectomy may be performed completely intracorporeally in the porcine model. Clinical application of this technique is imminent.     

Exposure and safety of higher doses of recombinant factor VIIa ≥250 μg kg−1 in individuals with congenital haemophilia complicated by alloantibody inhibitors: the Haemophilia and Thrombosis Research Society Registry experience (2004–2008)

Summary. Recombinant factor VIIa (rFVIIa) is a well‐established treatment for managing bleeding episodes in individuals with congenital haemophilia complicated by alloantibody inhibitors (CHwI). The safety and efficacy of standard dosing (90–120 μg kg^?1every 2–3 h) are well‐established; however, the desire to optimize therapy with one or more higher doses instead of multiple lower doses has created a need for evidence of the safety and efficacy of such regimens. Analysis of data from the Haemophilia and Thrombosis Research Society (HTRS) Registry was performed on episodes where doses of ≥250 μg kg^?1 were reported. From 2041 rFVIIa‐treated bleeds, 172 bleeding episodes were identified in 25 individuals with CHwI who were treated with ≥1 higher doses (≥250 μg kg^?1, ≥270 μg kg^?1 or ≥300 μg kg^?1) of rFVIIa between January 2004 and November 2008. Bleeds occurred in individuals ranging in age from 0.4 to 41.7 years who were predominantly non‐Hispanic and white (40%) with haemophilia A (88%). Bleed types most frequently treated with higher doses of rFVIIa were spontaneous (62–65%) or traumatic (27–32%). Bleed locations most frequently treated with higher doses of rFVIIa were joint (60–68%) or muscle (20–25%). A total of 1521 rFVIIa doses were administered (median, three doses per bleed); 26% were 250 μg kg^?1 or higher (initial dose, 82%). Bleeding stopped in 93% (160/172) of bleeds treated with rFVIIa 250 μg kg^?1 or higher. No serious adverse drug‐related events or thrombotic complications were reported. This data analysis from the HTRS Registry provides evidence of the safe and effective use of higher doses of rFVIIa (≥250 μg kg^?1) in US practice.