A comparison of psychological functioning in couples undergoing frozen-thawed embryo replacement in various stages of treatment using the Mean Affect Adjective Check List (MAACL)

PURPOSE: The objectives were to identify the stage(s) of frozen embryo replacement cycle where the couples are most vulnerable to psychological dysfunction. Assessment was performed by using the Mean Affect Adjective Check-List (MAACL). METHODS: Thirty couples completed the MAACL questionnaire at the following stages: (a) pretreatment (visit 1), (b) before embryo transfer (visit 2), and (c) before pregnancy test (visit 3). Each partner had to complete a separate questionnaire set. RESULTS: For both partners, the depression score for visit 3 was significantly higher and the sensation seeking and positive affect scores were significantly lower than the corresponding scores for earlier visits. Anxiety scores were similar for all visits. For men, the hostility scores were significantly higher between visits 1 and 2 while in women the same was reported between visits 3 and 2. CONCLUSIONS: Psychological counselling should be targeted at couples especially after embryo transfer. MAACL is a useful method for measuring psychological dysfunction in these couples.     

Use of Yttrium-90 TheraSphere for the treatment of unresectable hepatocellular carcinoma

This is a retrospective analysis of a new treatment modality, intra-arterial administration of Yttrium-90 TheraSphere, for unresectable hepatocellular carcinoma (HCC). Patients with HCC not amenable to surgical treatment who had satisfactory physiological function without comorbid disease or significant pulmonary shunting were eligible for treatment. Patients were categorized into complete, partial, or no response based on serum alpha-fetoprotein (AFP) levels and CT or MRI imaging. Fourteen patients were considered candidates for treatment. Three patients were excluded due to significant hepatopulmonary shunting. Eleven patients were treated with TheraSphere. One patient (9%) had a complete response, eight patients (78%) had a partial response, and two patients (18%) showed no response. Partial and complete responders with AFP-associated HCC demonstrated a median decrease in AFP levels of 79 per cent at 73 days. No patients developed liver toxicity nor died due to treatment. Five patients (45%) died of progressive disease at a median of 7 months post-treatment. Six patients (54%) were alive at a median of 11 months (range, 9 to 20 months). Okuda stage 2 and 3 patients showed a median survival of 11 months and 7 months, respectively. Yttrium-90 TheraSphere treatment for unresectable hepatocellular carcinoma is well tolerated and appears to extend survival.     

Confocal endomicroscopic imaging of normal and neoplastic human tongue tissue using ALA-induced-PPIX fluorescence: a preliminary study

Confocal endomicroscopy is a novel and non-invasive microscopic technique that enables surface and subsurface imaging of living tissues or cells in vivo. The purpose of this study was to assess the possibility of utilizing a rigid confocal endomicroscope (RCE) system developed for detecting morphological changes in living normal and neoplastic human tongue tissue in combination with 5-aminolevulinic acid (ALA)-induced endogenous protoporphyrin IX (PPIX) fluorescence. Three patients with squamous cell carcinoma (SCC) of the tongue were examined using the novel RCE system with the excitation wavelength at 488 nm from an argon-ion laser and the detection wavelengths of the tissue fluorescence above 515 nm. Patients were topically applied with 0.4% of 5-ALA rinsing solution to the oral mucosa for approximately 15 min, and then the confocal endomicroscopic imaging of tissue PPIX fluorescence was performed on the lesion sites of the tongue after an optimal incubation period of 90-120 min. For comparison purposes, ALA-PPIX fluorescence confocal endomicroscopic imaging was also carried out on the normal sites of the tongue in vivo from two healthy volunteers. Image distortions due to tissue motion can be minimized using a specially designed tissue stabilizer attached to the RCE probe. Good quality ALA-mediated confocal fluorescence images of the tongue can be acquired in real-time, providing well-defined micro-morphological structures (e.g., filiform papillae, keratinized epithelium and fungiform papillae) of the tongue in vivo. Changes of tissue structures in oral tissue associated with cancer transformation can also be clearly identified using the RCE imaging. Preliminary results obtained in this study suggest that ALA-mediated rigid confocal endomicroscopy may have a significant potential for the rapid, non-invasive diagnosis and evaluation of early oral cancers in vivo.     

Immunological competence of children with pyogenic meningitis

A broad range of immunological tests was performed on 9 consecutive children with pyogenic meningitis. Two were found to have combined IgG and IgA deficiency. One had a combination of IgG deficiency and impaired neutrophil chemotaxis. Primary immunodeficiency disorders as a predisposing cause of pyogenic meningitis may be more common than previously suspected.     

Effects of rifampicin and cimetidine on pharmacokinetics and pharmacodynamics of lamotrigine in healthy subjects

OBJECTIVE: To study the effects of rifampicin, a potent inducer of the microsomal P450 enzyme system and of specific isoforms of the uridine 5'-diphosphate(UDP)-glucuronyl-transferase enzyme system, and cimetidine, a known inhibitor of the hepatic microsomal cytochrome P450 enzyme system, on pharmacokinetics and pharmacodynamics of lamotrigine in healthy subjects. METHODS: Ten healthy male subjects received a single oral dose of 25 mg lamotrigine after a 5-day pretreatment with (1) cimetidine 800 mg divided into two equal doses, (2) rifampicin 600 mg, or (3) placebo. Serum and urine samples were analyzed using high-performance liquid chromatography. Changes in electroencephalographic (EEG) power were determined up to 48 h after lamotrigine administration. RESULTS: The values of the pharmacokinetic parameters of lamotrigine were: clearance over bioavailability (CL/F) 2.60+/-0.40 l/h, renal clearance (CLR) 0.10+/-0.03 l/h, terminal half-life (t1/2) 23.8+/-2.1 h, mean peak serum concentration (Cmax) 0.29+/-0.02 microg/l, time to reach Cmax (tmax) 1.6+/-0.28 h, and total area under the serum concentration-time curve (AUC0-infinity) 703.99+/-82.31 microg/ ml/min (mean +/- SEM). The amount of lamotrigine excreted as glucuronide was 8.90+/-0.77 mg. Rifampicin significantly increased CL/F (5.13+/-1.05 l/h) and the amount of lamotrigine excreted as glucuronide (12.12+/-0.94 mg), whereas both t1/2 (14.1+/-1.7 h) and AUC(0-infinity) (396.24+/-60.18 microg/ml/min) were decreased (P<0.05). Cimetidine failed to affect pharmacokinetics of lamotrigine. Lamotrigine did not change EEG power. CONCLUSION: Rifampicin altered pharmacokinetics of lamotrigine due to induction of the hepatic enzymes responsible for glucuronidation, while coadministration of cimetidine to ongoing lamotrigine therapy has negligible effects on lamotrigine pharmacokinetics. Lamotrigine administered as a single dose of 25 mg has no effect on EEG power in healthy subjects.     

Inadequate parental understanding of asthma medications

The parents of 128 children with asthma were interviewed about their knowledge of asthma medications. Simple understanding of the modes of action of these drugs was present in only 42.2% (for beta 2-agonists), 12.1% (methylxanthines), 11.7% (cromoglycate), 0% (inhaled corticosteroids), and 3.6% (oral corticosteroids) of parents. Simple understanding of when to use these drugs was present in 13.4% (beta 2-agonists), 4% (methylxanthines), 50% (cromoglycate), 47.1% (inhaled corticosteroids), and 0% (oral corticosteroids). Some understanding of the side effects was observed in 51.6% (beta 2-agonists), 40.4% (methylxanthines), 10% (cromoglycate), 5.9% (inhaled corticosteroids), and 25% (oral corticosteroids). Poor parental knowledge about the pharmacology of asthma was underlined by the inclusion of antibiotics, antihistamines, and decongestants as medications used in asthma. This study also uncovered the continuing misuse of compound methylxanthine preparations and non-selective sympathomimetics in a small percentage of patients.     

Isthmic spondylolysis of the lumbar spine: MR imaging at 1.5 T

The appearance on magnetic resonance (MR) images of the normal pars interarticularis in 13 patients was reviewed and contrasted with that of the pars in eight patients with spondylolysis. The pars defect usually had an intermediate signal intensity with all pulse sequences; however, this intensity was somewhat variable depending on the exact ratio of cartilage, fat, and fluid within each bone defect. The pars defect was best seen with spin-echo 600/20 (repetition time msec/echo time msec) images. In three cases, out-of-phase images showed the spondylolysis best, because of extension of fat to the borders of the defect. The sagittal view allowed one to separate spondylolysis from the joint space of posterior facets since the orientation of the defects is perpendicular to the facets; thus, a common pitfall encountered with cross-sectional axial imaging techniques is avoided. MR imaging poorly delineated bone fragments around the defect, which may produce nerve root impingement, but revealed other numerous complications that occur with spondylolysis, including spondylolisthesis and herniation of the disk above.     

The many epidemiological faces of AIDS with special reference to Hong Kong and implications for prevention and control

By 1987, only 3 cases of acquired immunodeficiency syndrome (AIDS) had been reported in Hong Kong. All 3 involved males who had been infected through sexual contact with a European or North American. In 2 cases, the sexual contact was homosexual; the 3rd case involved a man who had frequent sexual contact in New York and Miami with female prostitutes. The Government of Hong Kong moved rapidly to establish an AIDS Expert Advisory Committee to carry out a public educational campaign and formulated clear guidelines for health workers. In recognition of the need for epidemiologic data, a seroprevalence program was initiated in 1985 to define risk groups and the prevalence of infection. During a 21-month surveillance period, 38,312 individuals were screened for antibodies to human immunodeficiency virus (HIV), 72 (0.2%) of whom were confirmed to be seropositive. Of the 61 individuals for whom a history was available, 12 (20%) were homosexual or bisexual men, 46 (75%) had a history of transfusions of blood or blood products (largely for hemophilia), and 3 reported sexual contact with female prostitutes outside of Hong Kong. Only 2 of the 72 positive tests involved women. None of the sera from the 1123 intravenous drug abusers and 1360 prostitutes screened contained antibodies to HIV. Consistent with a lack of documented local heterosexual spread of HIV infection is the absence of cases among infants and children. To reduce the risk of parenterally spread infection, universal blood donor unit screening for HIV antibody and the introduction of heat-treated Factor VIII have been implemented. In addition, an AIDS Education and Publicity Committee was established in 1986 to heighten public awareness of the risk factors involved in HIV infection.