An investigation of the relationship between emotional maladjustment and infertility

The purpose of this investigation was to examine the psychologic test results of women diagnosed with infertility as compared with the general population of women. The infertile group consisted of 150 women, whereas the control group included 50 women. Both groups were similar in regard to age and number of years married. The tests administered were: the 16 Personality Factor, the IPAT Anxiety Scale, the IPAT Depression Scale, the Tennessee Self-Concept Scale, and the Internal-External Scale (locus of control). Scores on a total of 41 test variables did not differ significantly between the two groups. In fact, the means and standard deviations for all variables were remarkably similar. This study concludes that significant emotional maladjustment is no more prevalent in women coping with infertility than for the general population of women. Results from this investigation cast doubt on the historical assumption that stress may be a causal factor in infertility.     

A minimally invasive alternative approach for reoperative grafting of the right coronary artery

BACKGROUND: Target vessel revascularization on a beating heart via a mini subxiphoid incision, not only eliminates the hazards of sternal reentry, but also avoids the detrimental systemic effects of extracorporeal circulation. AIM: The goal of the study was to develop and describe a safe and effective method to revascularize the right coronary artery in reoperative cases, using beating heart and minimally invasive techniques in lieu of the RGEA. METHODS: There were three men and four women with a mean age of 69 years; four were second time reoperations and three third time reoperations. Through a subxiphoid approach, a lower ministernotomy is performed. Once the coronary target is established, a Rultract retractor is used to gently elevate the right half of the sternum to take down the RITA. A mechanical stabilizer was used to provide stabilization for distal anastamoses. Flow was measured in all the grafts with the Medi-Stim before and after protamine administration. RESULTS: [table: see text] CONCLUSION: We believe that this technique provides another effective approach to the patient who requires reoperative coronary revascularization of the RCA.     

Phase I study of gemcitabine and liposomal doxorubicin in relapsed ovarian cancer

Twenty-three patients were enrolled in a phase I study conducted to determine the maximum tolerated doses (MTD) of combined liposomal doxorubicin (CAE) and gemcitabine (GEM) in relapsed ovarian cancer patients. A total of 82 courses are evaluable, with a median number of three cycles administered per patient (range 2-8). GEM was administered on days 1 and 8 by 30-min intravenous infusion immediately after CAE given by 60-min intravenous infusion on day 1; cycles were repeated every 21 days. The starting doses were CAE 20 mg/m(2) and GEM 600 mg/m(2). Following dose levels were 20/800; 20/1,000; 30/800; 30/1,000; 35/800, and 35/1,000 for CAE and GEM, respectively. The MTD was reached at dose level 5, with febrile neutropenia and thrombocytopenia as dose-limiting toxicities. After the MTD, granulocyte-colony stimulating factor was administered in 15% of cycles. Non-hematological toxicity was mild and manageable. All patients are so far evaluable for response. Among them, 5 partial responses (21.7%; 95% confidence interval, CI: 4.9-38.5), 5 disease stabilizations (21.7%, 95% CI: 4.9-38.5) and 13 progressions (56.6%, 95% CI: 36.4-76.8) have been registered. These results warrant further research in a phase II study.     

How to start a beating heart coronary artery surgery program

An important issue that is not addressed in the recent literature on beating heart coronary artery bypass surgery is the question of how to initiate a program in OPCAB in a center where conventional coronary artery surgery has been the routine. It is the aim of this article to describe what we consider to be safe steps for a conventional cardiac surgeon to take to ensure a successful initiation of OPCAB surgery in his or her institution. While modern OPCAB surgery has experienced major technical advances that have made the procedure more predictably successful than in previous years, these advances require the use of an array of new technology and skills. This article discusses some of the skills and devices, such as modern stabilizers, shunts, and blowers, that the beginning OPCAB surgery team will need to acquire and master when embarking on an OPCAB program. Initiation of an OPCAB program also requires that the entire surgery team believe in the efficacy of the procedure and approach it with enthusiasm. A team visit to a center that already performs OPCAB is an important element in initiating the new program. It is no longer necessary to learn the procedures by trial and error. Because it will occasionally be necessary to convert from OPCAB to conventional surgery, the team must be thoroughly familiar with both methods and should not be reluctant to rely on the heart-lung machine when the patient's safety requires it.     

Neuronal loss in Onuf's nucleus in three patients with progressive supranuclear palsy

Disorders of micturition have been reported only sporadically in patients with progressive supranuclear palsy (PSP). We report the results of a clinicopathological study of 3 patients with a definite diagnosis of PSP at various stages of their illness with sphincter abnormalities. Electromyography of the sphincter muscles was performed in all 3 patients and was abnormal in 2. Morphological and morphometric evaluation of Onuf's nucleus in the sacral spinal cord, which is involved in sphincter control, showed severe cell loss, presence of neurofibrillary tangles, neuropil threads, and glial inclusions. We conclude that bladder dysfunction and abnormal sphincter electromyographic results are due to pathological changes in Onuf's nucleus, and we propose that sphincter abnormalities should be included in the list of possible symptoms of PSP.     

The role of parenteral nutrition

Patients with acute leukemia who undergo hematopoietic stem cell transplantation (HSCT) are susceptible to malnutrition caused by several factors including intensive cytotoxic therapy. This paper discusses the significance of malnutrition in these patients and provides an overview of nutrition therapy by the oral, enteral, and parenteral routes. The goal is to investigate whether the use of parenteral nutrition (PN) produces improved clinical outcomes in patients with acute leukemia and to identify criteria for the selection of patients most likely to benefit from this therapy. Although PN may be appropriate for patients suffering from complications such as graft-versus-host disease (GVHD) and mucositis, the data available at this time do not support PN as first-line therapy for all recipients of HSCT.     

Redo left anterior descending artery grafting via left anterior small thoracotomy: an alternative approach

Reoperative left anterior descending artery (LAD) revascularization can be performed through a left anterior small thoracotomy (LAST approach) in patients requiring isolated LAD revascularization. If the left internal mammary artery has been previously used, however, the operation is generally performed either through a median sternotomy or through a full posterolateral thoracotomy for the necessity of connecting the vein graft to the ascending aorta or to the descending thoracic aorta, thus losing the advantages of a minimally invasive approach. In the case reported herein, we describe a technique in which reoperative revascularization of the LAD is accomplished through the LAST approach, using the stump of the left internal mammary artery as the inflow site of a saphenous vein coronary graft to the LAD.     

From telescope to binoculars. Dyadic outcome resulting from psychological counselling for infertile couples undergoing ART

Objective: This longitudinal study aims to evaluate the effect of psychological counselling on quality of life, marital satisfaction and need for parenthood in couples undergoing fertility treatments (ART).

Background: Recent guidelines on the ART suggest that psychological counselling should target both members of the infertile couple in order to improve their conjoint management of the infertility-related stress. However, studies on the dyadic outcome of couples are scarce.

Methods: 262 patients were originally considered in the study and completed questionnaires on quality of life, need for parenthood and marital satisfaction, before treatment (T1) and at the day of intrauterine insemination/embryo transfer (T2). For the purposes of this study, 34 counselled couples were then matched to 34 non-counselled couples by propensity scores. The Common Fate Model (CFM) was used to examine dyadic changes.

Results: Couples receiving counselling had higher dyadic quality of life and lower dyadic stress due to the need for parenthood at T2 compared to non-counselled couples. No differences were found on marital satisfaction.

Conclusion: The findings provide support for the effectiveness of counselling on interpersonal outcome. The CFM allows researchers to examine how the dyad as a whole responds to counselling, highlighting the change in the couple’s relational dynamics.