Principles of Total Care for Children with Leukemia —Psychosocial Interventions —

Today about 70% of children with leukemia are cured by intensive chemotherapy. Therefore how to deal with the children and their families before, during, and after the treatment has become a major concern for caregivers. And it is a fact that there are still a few patients who relapse and are destined to die. We are now taking care of two groups of patients. One group is truly cured and one group is dying. We have been trying to establish a good total care system that fits our society. We have formed medical teams which consist of doctors, nurses, and care workers. From our experience, we think the most important principle for the caregivers is frankness. Sometimes this is very difficult. Other important points of total care, especially from psychosocial aspects, are mentioned.     

Immunological Follow-up in Children Born to HIV-1 Infected Mothers

ABSTRACT. From November 1985 to January 1990 we examined 156 children born to 154 HIV-1 seropositive mothers every 3 months. Eighty-seven infants were over 18 months by January 1990. Six of them met the CDC criteria of HIV-1 infection or died from AIDS; a transmission rate of 7%. Six of the children aged less than 18 months also met the CDC criteria of HIV-1 infection. These 12 infected children were compared with the 81 presumably unifected children. The perinatal findings were similar in both groups. Most of the HIV-1 infected babies showed early abnormalities in humoral and cellular immunity, hypergammaglobulinemia, low percentage of CD4 circulating lymphocytes and increased spontaneous in vitro immunoglobulin production. These changes were persistent in the HIV-1 infected children, but sporadic in those uninfected. Immunological abnormalities were frequently found before clinical symptoms appeared. We conclude that repeated immunological abnormalities in babies born to HIV-1 seropositive mothers are suggestive of HIV-1 infection.     

Impact of a second insemination on the results of an in vitro fertilization-embryo transfer (IVF-ET) program

In an attempt to increase the fertilization and pregnancy rates in our program, a second insemination was carried out when the first insemination yielded fewer than two fertilized oocytes. One hundred eighty consecutive patients were studied retrospectively and thirty-four required second insemination, 35% of them by donor-semen. Fifty-five and nine-tenths percent of the patients had at least one fertilized oocyte for embryo transfer, but only 21.9% of the oocytes exposed to a second insemination were fertilized. No pregnancy resulted from the transfer of oocytes fertilized by the second insemination. There were no significant correlations between the success of fertilization after a second insemination and the number of oocytes retrieved, the protocol for the induction of superovulation, or the age of the female patient. Considering that the first insemination was done at a variable time after oocyte retrieval to allow oocyte maturation, we expected all oocytes to be mature at the time of first insemination and we considered the possibility of delayed fertilization as negligible since second insemination was done at least 24–30 hr after oocyte retrieval. Even though a second insemination provides further hope for the patient, by yielding additional fertilized oocytes for embryo transfer, its main value is that it may provide additional information about male fertility.     

Intrauterine fertilization capsules—A clinical trial

Treatment of 26 women with tubal infertility was attempted using intrauterine capsules loaded with oocytes and spermatozoa. The stimulation protocol was as used for in vitro fertilization and embryo transfer and consisted of short-term use of Buserelin, human menopausal gonadotropin, and human chorionic gonadotropin. Oocytes were collected by ultrasonically guided transvaginal aspiration, and spermatozoa were prepared by swim-up technique. The gametes were placed in agar capsules 4 hr after oocyte collection, and the capsules were introduced to the uterine fundus using an insertion tube and piston from an intrauterine device. Six complete capsules and parts of two other capsules were expelled. None of the women became pregnant, compared with a pregnancy rate of 21% per aspiration following in vitro fertilization and embryo transfer during the same period.     

A randomized prospective study on the effect of short and long Buserelin treatment in women with repeated unsuccessful in vitro fertilization (IVF) cycles due to inadequate ovarian response

Fifty four women with repeated unsuccessful in vitro fertilization (IVF) cycles due to inadequate ovarian response to stimulation with human menopausal gonadotropins (hMG) participated in this study. They were randomized to receive either gonadotropin releasing hormone agonist (GNRHa), Buserelin, prior to and during induction of ovulation by hMG (Group I—long protocol), or GnRHa starting on the first day of the cycle together with induction of ovulation by hMG (Group II—short protocol). Mean follicular phase serum luteinizing hormone (LH) and progesterone (P) levels were significantly lower in Group I than in Group II (P<0.01). Cancellation rate was significantly lower in Group I than in Group II (P<0.01). The long GNRHa protocol resulted in statistically significant lower cancellation rates, more oocytes per pickup (OPU), more embryos trans-ferred per patient, and a higher pregnancy rate. Significantly more hMG ampoules and more treatments days were required in the long GNRHa protocol. Our data demonstrate that the use of GNRHa prior to and during ovarian stimulation with hMG offers a very good alternative for patients with repetitive unsuccessful IVF cycles due to inadequate response.     

Treatment of traumatic pancreatic pseudocysts in children: the role of percutaneous catheter drainage

Six cases of successful percutaneous catheter drainage (PCD) of pancreatic pseudocysts in children ages 3–13 years are presented. All cases involved blunt abdominal trauma and presented with abdominal pain, vomiting, epigastric tenderness without a palpable mass, and elevated serum amylase. Indications for PCD were an enlarging pseudocysts and marked abdominal pain. Catheter placement was accomplished using CT guidance 15.3±1.8 days (mean ± SEM) following injury. Two patients had transgastric PCD. None of the pseudocysts were infected. Catheters were left in place until the drainage ceased, the serum amylase approached normal, the pseudocyst resolved on ultrasound, and the asymptomatic patient tolerated enteral feedings with the catheter clamped. The mean duration of catheter drainage was 18.3±3.7 days. At the time of catheter insertion, the range of serum amylase values was 242–2810 IU/l, while discharge values were 50–147 IU/l (normal: 16–108 IU/l). The mean hospital stay was 36.2±3.8 days and the mean length of total parenteral nutrition was 27.5±4.5 days. All pseudocysts were treated successfully without complication. PCD of traumatic pancreatic pseudocysts in children was performed safely and effectively in our study. Use of this therapeutic modality allowed earlier treatment, decreased the duration of symptoms, and avoided abdominal operation. PCD may prove to be the treatment of choice for pancreatic pseudocysts in children.Presented at the 22nd Annual Meeting of the Pacific Association of Pediatric Surgeons, Portland/Sunriver, Oregon, May 24, 1989.     

A microcomputer data base system for an in vitro fertilization clinic programmed in BASIC

A computer program was developed for the IBM personal computer to be used for in vitro fertilization and gamete intrafallopian transfer clinics. This program, written in BASIC, allows input, editing, updating, sorting, and printing of patient data. Statistical functions permit summation of patient data based on various combinations of user-defined treatment cycles, diagnoses, and protocols, thus making possible comparison of pregnancy and other patient data between and among various treatment groups and diagnoses. The statistical information can be continually updated and revised when new data become available on patients (such as confirmation of pregnancy by ultrasound or live births) and at the end of each cycle. The formats used are useful in assimilating individual clinic data for various surveys and other reporting requirements. The program can be easily modified by anyone with minimal training in the BASIC programming language.     

Effect of removal of cumulus cells from one-cell mouse embryos on in vitro development

The effects of the removal of cumulus cells from fertilized mouse oocytes (one-cell embryos) and the presence of streptomycin in culture medium on in vitro development were studied. Ham's F-10 medium with (0.075 g/liter) or without streptomycin was supplemented with human serum (15%). Cumulus-intact embryos were harvested from oviducts after mice were superovulated with pregnant mare's serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG). Hyaluronidase (300 IU/ml) was used to remove the cumuli. Embryos were cultured (i) with cumulus/without streptomycin (n=238), (ii) with cumulus/with streptomycin (n=185), (iii) without cumulus/with streptomycin (n=210), and (iv) without cumulus/without streptomycin (n=218). Embryonic development was assessed 24, 96, and 120 hr after initiation of culture. Percentage two cells and percentage small or expanded blastocysts were not different (P>0.05) among experimental groups. Percentages hatched blastocysts for the four groups were (i) 36±8 and 54±7, (ii) 35±8 and 55±6, (iii) 19±5 and 42±6, (iv) 23±5 and 47±5 at 96 and 120 hr, respectively. Percentages all (small, expanded, and hatched combined) blastocysts were (i) 74±5 and 74±5, (ii) 74±9 and 72±5, (iii) 56±6 and 63±5, and (iv) 61±5 and 63±5 at 96 and 120 hr, respectively. A greater (P<0.05) percentage of embryos developed to blastocysts and hatched by 96 and 120 hr, when they were cultured with the cumulus intact. There was no effect of streptomycin on embryonic development. Cumulus cells may act as nurse cells during a critical stage of the development of the embryo.     

Ovarian cyst aspiration prior to initiating ovarian hyperstimulation for in vitro fertilization

Twenty-three consecutive patients presenting for in vitro fertilization were evaluated with transvaginal sonography on cycle day 3, prior to initiating ovarian hyperstimulation. Three of these patients were noted to have large ovarian cysts. All three underwent transvaginal aspiration of the cysts, followed immediately by initiation of ovarian hyperstimulation. Following oocyte retrieval, in vitro fertilization, and embryo transfer, all three women achieved pregnancy. We conclude that cyst aspiration is not contraindicated when an ovarian cyst is encountered in the follicular phase of an in vitro fertilization cycle.     

Ovarian stimulation for in vitro fertilization in low-responder patients using pulsatile intravenous follicle stimulating hormone

There is a subset of patients who fail to respond adequately to exogenous gonadotropin stimulation for in vitro fertilization (IVF). In this study, six such low-responder patients who had inadequate stimulations with high-dose intramuscular (im) follicle stimulating hormone (FSH) were treated in a subsequent cycle with pulsatile intravenous (iv) FSH. A paired analysis was performed to compare the cycles using high-dose im FSH with those using pulsatile iv FSH. Trough serum FSH levels were significantly higher with pulsatile iv FSH. No significant difference was noted in the stimulation characteristics or the number or quality of oocytes retrieved and embryos transferred. No pregnancies occurred in either group. While pulsatile iv administration of gonadotropin increases serum FSH levels, it does not appear to have a major impact on follicular stimulation or outcome in low-responder patients undergoing IVF.