Comparison between stimulated in-vitro fertilization and stimulated intrauterine insemination for the treatment of unexplained and mild male factor infertility

A prospective trial was undertaken to evaluate the efficacy of stimulated in-vitro fertilization (SIVF) and stimulated intrauterine insemination (SIUI) in couples with unexplained and mild male factor infertility. In all, 80 couples were allocated to treatment with SIVF or SIUI, both treatments following the same protocol [clomiphene citrate and follicle stimulating hormone (FSH) injection], except that higher doses of FSH were used in the SIVF treatment cycles. Initially, 41 couples were allocated to and started treatment with SIVF but eight cases were eventually converted to SIUI because of under-response. Similarly, although 39 couples were initially allocated to SIUI treatment, five of these converted to SIVF because of over-response. The treatment cycles that were converted either to SIUI or to SIVF were not considered as treatment failures but as treatment changes and so were included in the analyses. Of the final 38 SIVF cycles, four were cancelled (dysfunctional response), failed fertilization occurred in five cycles and 29 subjects reached embryo transfer. There were two biochemical pregnancies [positive human chorionic gonadotrophin (HCG) only], two clinical abortions and seven live births. Of the final 42 SIUI cycles, only two were cancelled, insemination being performed in the remaining 40 cases. The result was one clinical abortion, three ectopics and eight live births. The proportion of cycles with positive HCG was identical (28.9% per cycle treated for SIVF and 28.6% for SIUI) and the livebirth rates were also not different (18.4% per cycle treated for SIVF and 19.0% for SIUI). The cost per maternity of SIUI was approximately half that of SIVF (Pounds Sterling 1923 versus Pounds Sterling 4611) and so we conclude that, as SIUI had an efficacy that was not significantly different from SIVF (using similar protocols) but was more cost-effective, it must be considered the more appropriate form of management for the treatment of unexplained and mild male factor infertility. Indeed, it is hard to justify the routine use of IVF, as a first approach, in unexplained infertility.      

Antepartum pituitary necrosis in diabetes mellitus

Pituitary infarction occurred during pregnancy in two insulin-dependent diabetic patients aged 32 and 33 years. The diagnosis was delayed in each case before being confirmed biochemically and radiologically. A decreasing insulin requirement and recurrent hypoglycaemia made it possible to determine the exact time that pituitary infarction occurred during pregnancy. The clinical features of these cases should alert physicians to the possibility of pituitary infarction in diabetic pregnancy and minimize the delay in diagnosis.     

Use of carbon dioxide laser for the treatment of premalignant lesions of the oral mucosa

The carbon dioxide laser was used for the treatment of 20 lesions of the oral mucosa in 14 patients. These lesions ranged histologically from benign hyperkeratosis to verrucous carcinoma. The patients selected for this treatment were identified at high risk to develop malignant lesions in the oral cavity. Precise vaporization of the affected mucosa were carried out using the Cavitron 40-300-A CO2 Surgical Laser. Destruction of the surface epithelium and submucosa was achieved by using defocused beam at a setting of 10W. Biopsies were taken at 1 cm intervals at the time of laser treatment. Fourteen of the 20 procedures were carried out under local anesthesia on an outpatient basis. Seven procedures were performed under general anesthesia and 2 patients required 24 h postoperative observation. Local control was achieved in 17 of the 20 treated sites. Two of the three treatment failures occurred in patients in whom the final histology revealed either in situ or invasive squamous carcinoma. Only one patient with dysplasia was not controlled after vaporization of the lesion by the carbon dioxide laser. The laser continues to show encouraging results as an alternative to surgical resection of precancerous mucosal lesions of the oral cavity. Vaporization of the dysplastic lesion(s) with carbon dioxide laser is recommended for patients with an identifiable risk for the development of intraoral malignancy. This is an effective, nonmorbid, inexpensive, quick, and relatively painless method of managing this condition.     

Covert bronchogenic cyst as a cause of life-threatening cardiopulmonary impairment

We present a case in which a covert bronchogenic cyst resulted in two hospital admissions within three years, the second of which was characterised by life-threatening cardiopulmonary compromise requiring sustained support on the intensive therapy unit.     

Long-term neonatal heart preservation

Donor availability is a major limiting factor in neonatal heart transplantation. Prolonging donor heart preservation would facilitate distant heart procurement. Forty-two neonatal (1 to 5 days) piglet hearts in seven groups were arrested with cold cardioplegic solutions, stored for 12 hours at 4 degrees C in storage solutions, and reperfused with blood from an adult support pig. The cardioplegic solutions used were a crystalloid solution with potassium chloride 30 mEq/L and bicarbonate (Stanford), the Stanford cardioplegic solution with the addition of calcium (1.2 mmol/L), or an intracellular solution (Sacks) with added glucose. Storage solutions were normal saline, Sacks II, or Sacks II with glucose 20 gm/L. Reperfusion was done with normal blood or modified blood for 20 minutes with superoxide dismutase, catalase, aspartate, glutamate, citrate-phosphate-dextrose, potassium, tromethamine, and 50% dextrose followed by normal blood. Evaluation of stroke work index after 60 minutes of recovery (as percent of control) was performed using the isolated, blood perfused, working heart preparation in all groups: Group I (Stanford cardioplegia, saline storage, normal blood reperfusion) had a recovery of 11%; group II (Stanford + calcium, saline, normal blood) 8%; group III (Stanford + calcium, saline, modified blood, superoxide dismutase 35,000 U/L, catalase 35,000 U/L) 37%; group IV (Stanford + calcium, Sacks II, modified blood, superoxide dismutase 35,000 U/L, catalase 35,000 U/L), 47%; group V (Stanford + calcium, Sacks + glucose, modified blood, superoxide dismutase 35,000 U/L, catalase 105,000 U/L) 89%; group VI (Stanford + calcium, Sacks + glucose, modified blood, superoxide dismutase 150,000 U/L, catalase 150,000 U/L) 107%; group VII (Sacks + glucose, Sacks + glucose, modified blood, superoxide dismutase 35,000 U/L, catalase 105,000 U/L) 115%. Conclusions: The neonatal heart stored hypothermically for 12 hours tolerates normal blood reperfusion poorly. Modified blood reperfusion markedly improves the recovery. Complete functional recovery was achieved by the intracellular Sacks plus glucose storage solution and modified blood reperfusion with oxygen-derived free radical scavengers (high catalase). Extended preservation of the neonatal heart is feasible.     

Interleukin-1β System (Ligand, Receptor Type I, Receptor Accessory Protein and Receptor Antagonist), TNF-α, TGF-β1 and Neuropeptide Y mRNAs in Specific Brain Regions During Bacterial LPS-Induced Anorexia

Bacterial lipopolysaccharide (LPS) or endotoxin induces neurological manifestations including anorexia. It is proposed that LPS-induced cytokine production is involved in the generation of neurological manifestations and in neuroinflammatory/immunological responses during Gram-negative infections. For example, LPS-induced effects can be blocked or ameliorated by the interleukin-1 receptor antagonist (IL-1Ra). Here, sensitive and specific RNase protection assays were used to investigate the effects of the intracerebroventricular (i.c.v.) administration of LPS on mRNA levels of interleukin-1β (IL-1β) system components, tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β1, and neuropeptide Y (NPY) in the cerebellum, hippocampus, and hypothalamus. The same brain region sample was analyzed with all of the antisense probes. The data show simultaneous local induction of multiple cytokine components messenger ribonucleic acids (mRNAs) within specific brain regions in anorectic rats responding to i.c.v. administered LPS (500 ng/rat). Interleukin-1β and IL-1Ra had a similar mRNA induction profile (hypothalamus > cerebellum > hippocampus). Interleukin-1 receptor type I (IL-1RI) mRNA also increased in all three brain regions examined, and the soluble form of IL-1 receptor accessory protein (IL-1R AcP II) mRNA was induced in the hypothalamus. Tumor necrosis factor-α mRNA levels increased in the hypothalamus > hippocampus > cerebellum. Levels of membrane bound IL-1R AcP, TGF-β1, and NPY mRNAs did not change significantly in any brain region. The results suggest that: (1) endogenous up-regulation of IL-1β and TNF-α in the hypothalamus contribute to LPS-induced anorexia; and (2) the ratio IL-1Ra/IL-1β, and IL-1β ↔ TNF-α interactions may have implications for Gram-negative infections associated with high levels of LPS in the brain-cerebrospinal fluid.     

Permeation of water contaminative phenols through hairless mouse skin

As a means of determining the risk of absorption of water contaminative phenolic compounds through the skin, the permeation of a number of phenols, all on the U.S. Environmental Protection Agency's list of priority pollutants, through hairless mouse skin has been studied, usingin vitro diffusion cell methods. Experimentally determined permeability coefficients through intact skin and stratum corneum denuded skin and permeability coefficients derived therefrom for the viable tissue layer and the stratum corneum, which are the tissue's major contributing substrata, have been correlated with their log K_{octanol/water} partition coefficients. Permeability coefficients for the whole skin and the stratum corneum systematically increased with increasing phenol lipophilicity to limiting values of about 0.15 and 0.30 cm/hr, respectively. The values of the permeability coefficients for the viable tissue were roughly the same for all compounds (0.36 cm/hr). Because of the inductive effects of Cl and NO₂ substituents on the aromatic ring, phenolic analogs containing these moieties are acidic and, consequently, their overall skin permeabilities were highly pH-dependent in the range of pH values seen for surface waters. High fluxes were noted for such phenols at low pH, where they exist essentially in a non-ionized state. Though low, fluxes of the compounds were measurable at pH's pK_a's, indicating that phenolic anions also pass through the skin. With the exceptions of relatively polar phenol and the mono-nitro phenols, the free acid forms of all the phenols studied permeated skin with ease and at rates approaching those of denuded skin. The intact skin permeability coefficient of the free acid form of 4-nitro phenol was exceptionally low, which suggests that it might associate intermolecularly.