Predictive value of abnormal sperm morphology in in vitro fertilization

In patients with acceptable sperm count and motility, two patterns of abnormal morphology, judged with strict criteria, were identified and described. Patients with less than 4% normal forms and less than 30% morphology index (summation of normal and slightly amorphous forms) had a fertilization rate of 7.6% of the oocytes (P pattern, poor prognosis). Patients with normal morphology between 4 and 14% had a significantly better fertilization rate of 63.9% of the oocytes (P less than 0.0001). Cases with greater than 14% normal forms fertilized within the normal range for the laboratory. By evaluating sperm morphology with the proposed strict criteria, its predictive value in in vitro fertilization is enhanced.     

Echocardiogram‐gated multislice spiral CT in functionally univentricular heart following long‐lasting Waterston–Cooley anastomosis

Waterston–Cooley anastomosis may be carried out in patients with tricuspid atresia to provide pulmonary perfusion. It is associated with several complications, including preferential blood flow to the right lung, hypoplasia of the left pulmonary artery, obstruction of the anatomosis or rupture of pulmonary aneurysms. We study a patient with thrombosis in the pulmonary arteries following surgical construction of a Waterston shunt in childhood. Imaging findings and clinical symptoms are discussed with emphasis on echocardiogram‐gated multislice spiral CT.     

Giant bronchial carcinoid tumors: a multidisciplinary approach

BACKGROUND: Bronchial carcinoid tumors account for approximately 2% of all lung tumors. Although they were considered benign lesions, they are now categorized malignant, occasionally with poor prognosis. The clinical symptoms can be highly variable and are often present for many years before diagnosis. Whereas some carcinoids are entirely asymptomatic, others are accompanied by carcinoid or paraneoplastic syndromes. METHODS: We describe the multidisciplinary management of a 34-year-old female patient with a massive actively secreting bronchial carcinoid tumor of the right lung. Furthermore, we provide a review of the literature regarding the operative treatment and the perioperative management of pulmonary carcinoid tumors with respect to surgical, anesthetic, radiologic, and pathologic considerations. RESULTS: In the reported case, the first symptoms were chronic watery diarrhea, skin flushing, progressive shortness of breath, and increasing right shoulder pain. When the patient initially presented at our institution, the tumor had already reached an enormous size and it involved the right and left atrium as well as the atrial septum. Using an evidence-based, multidisciplinary approach the patient was treated successfully with extended surgical resection. CONCLUSIONS: Carcinoid tumors are potentially curable even if they reach a significant size and thus an aggressive strategy is warranted. The management of such cases requires careful investigation, planning, and treatment with collaborative expertise provided by a multidisciplinary team. We demonstrated that this approach can lead to a favorable outcome in what first appeared to be a formidable and unresectable tumor.     

Interval between insulin injection and breakfast in diabetes

The relationship between the insulin-breakfast interval, postprandial increase in blood glucose, and glycaemic control was studied in 58 children with diabetes. Patients recorded insulin-breakfast intervals in a home diary over a seven day period, and during a 24 hour period at the weekend provided eight serial capillary dried blood spots for glucose analysis. The highest mean blood glucose value occurred two hours after breakfast and showed a significant correlation with fructosamine concentrations. Weekend insulin-breakfast intervals ranged from 2-30 minutes, with 70% reporting intervals of less than 15 minutes. There was a significant correlation between the weekend insulin-breakfast interval and the after breakfast increase in blood glucose with a mean increment of 0.4 mmol/l in the 30 minute group and 7.2 mmol/l in the 2 minute group. Over the whole study period, children with mean insulin-breakfast intervals of two to 12 minutes had a mean fructosamine concentration of 376 mumol/l compared with 341 mumol/l in those with intervals of 15-35 minutes. This study has shown that the interval between insulin injection and breakfast significantly influences the morning postprandial rise in blood glucose and consequently short term glycaemic control. It is therefore important that patients are encouraged to leave an interval of about 30 minutes between insulin injection and breakfast.     

Lactose absorption and mucosal disaccharidases in convalescent pellagra and kwashiorkor children

Oral lactose and glucose/galactose loading tests were done in Bantu children convalescing from kwashiorkor and pellagra. Small bowel biopsies and disaccharidase estimations were performed in all except 2 patients. Lactose absorption was more impaired and intestinal lactase levels were lower in the pellagra than in the kwashiorkor group. The fact that diarrhoea after admission to hospital was less common in pellagra than kwashiorkor was ascribed to a lesser lactose load due to the early introduction of a mixed diet in the former group, in comparison with milk feeds only in the latter group. The absence of troublesome diarrhoea while on moderate quantities of lactose in the diet, in the presence of low intestinal lactase levels, but evidence of lactose malabsorption after loading, has a bearing on preventive and therapeutic nutrition programmes in non-Caucasian children. Lactase deficiency is not necessarily synonymous with symptomatic lactose intolerance if the threshold is not exceeded. Concern is expressed that excessive caution against the use of milk may lead to a worsening of infantile malnutrition in developing countries.     

The effect of pentoxifylline on sperm movement characteristics and zona pellucida binding potential of teratozoospermic men

This study investigates the effect of pentoxifylline on spermmovement and zona pellucida binding. Spermatozoa from nine teratozoospermicpatients (10.2 ± 6% normal forms) were included in thestudy. Test samples were diluted with a 4 mM solution of pentoxifylline,and control samples with Ham's F-10 culture medium only. Zonapellucida binding potential was measured under hemizona assayconditions (HZA). Sperm motility was evaluated at the start(0 h postswim-up) and end (4 h) of the HZA, under test-tubeconditions and under HZA conditions (50µ droplet underoil). Motilityparameters tested included the curvilinear velocity(VCL), straight line velocity (VSL) and linearity (LIN). Comparedto the controls, pentoxifylline-treated samples showed an immediatestimulation of sperm motility, under test-tube conditions, witha significant elevation of VCL at 0 h incubation (102.77 ±14.4 versus control value 84.60 ± 10.6 µm/s; P< 0.005), which however was reversed after 4 h incubation(73.16 ± 4.6 versus control value 85.47 ± 12.8µm/s; P < 0.005). A decline in sperm motility from0 to 4 h incubation was noted for all the pentoxifylline-treatedsamples, under both test tube conditions (VCL: 102.77 ±14.4 versus 73.16 ± 4.6 µm/s, P <<;<<0.005; VSL: 27.2 ± 10 versus 10.66 ± 2.2 µm/P <<; 0.005; LIN: 23.65 ± 7.1 versus 11.86 ±1.8%, P<<; 0.005) and HZA conditions (VCL: 100.04 ±13.1 versus 76.00 ± 7 µm/s, P <<; 0.005;VSL: 26.40 ± 8.7 versus 9.14 ± 4.5 µm/s,P <<; 0.005; LIN: 26.2 ± 12 versus 11.05 ±4.3%, P <<; 0.005). Pentoxifylline also showed no effecton the zona binding capacity of the sperm population, sinceno significant difference in zona binding capacity was seenbetween control and test samples. In conclusion, the effectof pentoxifylline on teratozoospermic spermatozoa is short-lived,and despite its stimulatory potential pentoxifylline shows nobeneficial use in enhancing zona pellucida binding of teratozoospermicspermatozoa.