Recurrence of hydrosalpinges after cuff neosalpingostomy in a poor prognosis population

Purpose: The purpose of this study was to determine the recurrence rate of hydrosalpinges after cuff neosalpingostomy in poor prognosis candidates. Methods: Forty consecutive patients with hydrosalpinx treated with cuff neosalpingostomy were included. Main outcome measures were recurrence rate of hydrosalpinx after cuff neosalpingostomy, intrauterine and ectopic pregnancy rates. Results: Intraoperatively, the mean size of the hydrosalpinx was 1.9±0.7 cm, and 77% of patients had evidence of pelvic adhesions. Recurrence of hydrosalpinx, whether unilateral or bilateral was 70% (28/40) per patient. Intrauterine and ectopic pregnancy rates were 5% (2/40) and 2.5% (1/40), with a total pregnancy rate of 7.5% (3/40). Conclusions: Most patients experience recurrence of hydrosalpinx after cuff neosalpingostomy, thus requiring additional surgery such as salpingectomy prior to in vitro fertilization (IVF). In a poor prognosis population, salpingectomy should be considered as the primary treatment for hydrosalpinx prior to IVF.Presented at the 59th Annual Meeting of the American Society for Reproductive Medicine, October 11–15, 2003, San Antonio, Texas.     

Influence of Changes in Arterial PCO2 on Cerebral Blood Flow and Cerebral Energy State during Hypothermia in the Rat

In order to study the relationship between arterial P_CO2 and cerebral blood flow (CBF) in hypothermia, the body temperature of artificially ventilated rats was decreased to 22C, and changes in CBF were evaluated from arteriovenous differences in oxygen content (AVD_O2) at Pa_CO2 values of 15, 30, 40 and 60 mm Hg. The results were compared to those obtained at normal body temperature (37C) over the Pa_CO2 range 15–60 mm Hg. Separate experiments were performed to evaluate CBF and CMR_O2 at 22C and a Pa_CO2 of 15 mm Hg, using an inert gas technique for CBF. The tissue contents of phosphocreatine, ATP, ADP, AMP and lactate were measured in hypothermic animals at Pa_co2values of 15, 30 and 60 mm Hg.
The results showed that changes in CBF were of the same relative magnitude in hypothermia and normothermia when Pa co2 was increased from about 35 to about 60 mm Hg. However, with a decrease in Pa_CO2 the reduction in CBF was much more pronounced in hypothermia, and at Pa_CO2 15 mm Hg CBF was less than 20 % of the value measured in normothermic and normocapnic animals. The results of the metabolite measurements gave no evidence of tissue hypoxia in spite of the pronounced reduction in CBF. Although the results demonstrate that the brain of a hypothermic animal is protected against the harmful effects of a lowered CBF, it may not warrant recommending hyperventilation in clinical cases of hypothermia, especially not in patients with arteriosclerosis or cerebrovascular diseases.     

Dietary weight loss decreases serum angiotensin-converting enzyme activity in obese adults

OBJECTIVE: To study the effect of dietary weight loss, postural change, and an oral glucose load on serum angiotensin-converting enzyme (ACE) activity in obese adults. RESEARCH METHODS AND PROCEDURES: Sixteen obese adult men and women with a mean body mass index of 35.7 +/- 4.3 kg/m(2) were studied after 1 week on a maintenance energy lead-in diet and after 5 weeks on an identical but 40% reduced-energy diet provided by the General Clinical Research Center (GCRC). ACE activity was measured spectrophotometrically. Plasma renin activity and serum aldosterone were measured by radioimmunoassay. RESULTS: All subjects lost weight, with a mean decrease in body weight of 7.0 +/- 2.1 kg or 6 +/- 3% of initial body weight (p < 0.00001). Systolic and diastolic blood pressure, supine plasma renin activity, and serum aldosterone levels decreased with weight loss (p < 0.05). Supine ACE activity decreased 23 +/- 12% with weight loss (p < 0.00001). Standing ACE activity, which was significantly higher than supine ACE activity before and after weight loss (p < 0.05), also decreased 18 +/- 17% with weight loss (p = 0.0007). A 75-g oral glucose load had no effect on serum ACE activity over a 3-hour period. DISCUSSION: In obese adults, serum ACE activity declines with modest weight loss, increases with postural change, and is unaffected by an oral glucose load.     

Energy cost of physical task performance in men and women wearing chemical protective clothing

BACKGROUND: Chemical protective clothing (CPC) is required to perform certain occupations and is known to inhibit physical performance. Few data are available that quantify the physiological response of men and women during task performance while wearing CPC. HYPOTHESIS: The mobility of a task will have a significant effect on the change in energy cost. The energy cost of wearing CPC will be greater in women than men during physical task performance. METHODS: Energy cost (VO2) and the psychophysical scales, rating of perceived exertion (RPE) and respiratory distress (RD), were measured in 32 men and 26 women during the performance of 31 physical tasks. Tasks were categorized by mobility: stationary, intermittent or continuous. Between 6-12 men and 5-13 women conducted each task wearing 2 clothing conditions: battle-dress uniform (BDU, wt = 3.7 kg) and (CPC, wt = 9.3 kg). RESULTS: VO2 L x min(-1), was higher in CPC compared with BDU for the continuous task category for both genders. However, when VO2 (ml x kg(-1) clothed wt x min(-1)) was normalized for clothing weight, there remained a significant clothing effect for the continuous category, but there were no gender differences. VO2, expressed as a % VO2max, was significantly increased for BDU compared with CPC for the continuous task category only. This difference was significantly greater for women than men. Women exercised at a higher % VO2max and reported a higher RPE than men for all categories in both BDU and CPC. Both genders reported higher RD wearing CPC for the continuous task category only. CONCLUSIONS: There is an increase in energy cost wearing CPC during continuous tasks which can be attributed to both the clothing weight and the hobbling effect. Wearing CPC is more physiologically and psychologically demanding for women than men, especially when performing tasks of a continuous nature.     

Effect of high vs. low arterial blood oxygen content on cerebral energy metabolite levels during hypoxia with normothermia and hypothermia in the rat

The effects of different levels of arterial blood oxygen content (CaO2) on brain tissue adenosine triphosphate (ATP), phosphocreatine (PCr), lactate, and reduced nicotinamide adenine dinucleotide (NADH) were studied during cerebral hypoxia in normothermic and hypothermic male Wistar rats with unilateral carotid ligation. Animals were exposed to hypoxia (PaO2 19--26 torr) for 25 min, and brain tissue metabolite values measured microfluorometrically were compared with those of normothermic normoxic controls. CaO2 was 4.0 +/- 0.2 ml/dl (mean +/- SEM) at PaO2 26 torr in normothermic animals. CaO2 was increased to 8.2 +/- 0.3 ml/dl at PaO2 26 torr by means of bicarbonate infusion producing a leftward shift of the oxyhemoglobin-dissociation curve in one normothermic hypoxic group. In all normothermic hypoxic groups ATP and PCr decreased and lactate and NADH increased significantly compared with control values. There was no significant difference in brain tissue metabolite values among these groups despite an increase in CaO2 by twofold in one group. Hypothermia (32 C) resulted in CaO2 8.4 +/- 0.2 ml/dl at PaO2 26 torr. This was decreased to 4.0 +/- 0.2 ml/dl by decreasing PaO2 to 19 torr in another group at the same temperature. ATP and PCr were well preserved in both groups despite the difference in CaO2s. Although the lactate and NADH levels were increased in the hypothermic group with CaO2 4.0 +/- 0.2 ml/dl, they were significantly lower than those values in normothermic hypoxic groups. These results indicate that the increase in CaO2 produced by hypothermia is not a major determinant in hypothermic protection during cerebral hypoxia.     

Metabolic Changes in the Cerebral Cortex of the Rat Induced by Intravenous Pentothalsodium®

The effects of thiopental on cerebral metabolism were evaluated by means of measurements of cerebral metabolic rate for oxygen (CMR_o2) and of tissue levels of organic phosphates, glycolytic substrates, citric acid cycle intermediates and selected amino acids. Shortly after the beginning of thiopental administration, CMR_o2 was reduced to half the normal value, and there were signs of retardation of glycolytic flux at the phosphofructokinase step. Inhibition at this regulatory enzymatic step could be related to an increase in phosphocreatine and a fall in inorganic phosphate concentration. The rise in phosphocreatine, and the unchanged levels of ATP, ADP and AMP demonstrate that induction of anaesthesia with thiopental is unrelated to energy failure.
Changes in citric acid intermediates included a fall in malate, and probably also in citrate, α-ketoglutarate and fumarate, with a tendency towards reduction in the pool of citric acid cycle intermediates; and the amino acid changes were dominated by a progressive rise in aspartate. It is suggested that these changes are secondary to a reduced rate of pyruvate delivery, and to a decrease in malate/oxaloacetate ratio.     

Highly active antiretroviral therapy improves neurocognitive functioning

Although the effects of highly active antiretroviral therapy (HAART) have resulted in substantial improvements in the systemic health of patients with HIV infection, concerns remain that these medications, which cross the blood-brain barrier poorly, may have a less beneficial effect on nervous system function. This raises the possibility that there may be a progressive long-term decline in neurologic function in patients with adequate systemic response. In a prospective longitudinal study, subjects were evaluated immediately before instituting HAART. Forty-eight subjects underwent ultrasensitive HIV RNA quantitative evaluation of both plasma and cerebrospinal fluid as well as neurologic and neuropsychological examinations. They were reevaluated 6 months after treatment initiation while receiving stable HAART. Both plasma and cerebrospinal fluid viral levels significantly declined after treatment. There was significant improvement in neurologic and neuropsychological functioning after HAART. These results indicate that despite the poor central nervous system penetration of most of these agents, there is satisfactory short-term improvement in both central nervous system viral burden and nervous system function with HAART. However, because treatment failure is increasingly likely over time, continued longitudinal evaluation of this group of subjects is required.     

Serial noninvasive evaluation of cardiovascular hemodynamics during pregnancy

M-mode echocardiography, in combination with electrocardiography and phonocardiography, has been used to measure pulmonary capillary pressure as well as other cardiac functions. Serial hemodynamic evaluations by use of this technique were performed in seven healthy pregnant women in the recumbent position. Each patient had five studies: four antenatal studies and one postpartum study that served as a control. Mean pulmonary capillary pressure was within normal limits throughout pregnancy and the puerperium. Cardiac output did not increase significantly by the end of the first or second trimester but became elevated by 31% in the early third trimester. This elevation in cardiac output persisted until delivery and resulted from a comparable increase in heart rate. Stroke volume and ejection fraction did not change significantly, while peripheral vascular resistance fell, although not significantly, reaching a nadir at approximately 28 weeks of gestation. Our findings indicate that maternal cardiac output increases due to an increased heart rate and reduced afterload.     

Using Symptom Validity Tests to Detect Malingered ADHD in College Students

Recently there has been growing concern that college students may feign symptoms of ADHD in order to obtain academic accommodations and stimulant medication. Unfortunately research has only begun to validate detection tools for malingered ADHD. The present study cross-validated the results of Sollman, Ranseen, and Berry (2010) on the efficacy of several symptom validity tests for detection of simulated ADHD among college students. Undergraduates with a history of diagnosed ADHD were randomly assigned either to respond honestly or exaggerate symptoms, and were compared to undergraduates with no history of ADHD or other psychiatric disorders who were also randomly assigned to respond honestly or feign symptoms of ADHD. Similar to Sollman et al. (2010) and other recent research on feigned ADHD, several symptom validity tests, including the Test of Memory Malingering (TOMM), Letter Memory Test (LMT), Digit Memory Test (DMT), Nonverbal Medical Symptom Validity Test (NV-MSVT), and the b Test were reasonably successful at discriminating feigned and genuine ADHD. When considered as a group, the criterion of failure of 2 or more of these SVTs had a sensitivity of. 475 and a specificity of 1.00.