Influence of complement on sperm motility

Isolated sperm from normo-, oligo- and astheno-spermic men were incubated for 20 h in medium supplemented with 8% heat-inactivated or untreated human serum, and in medium with heated or untreated serum deficient in complement factor C3. Before and after incubation, sperm motility was assessed by means of a computer-assisted semen analyser. The results did not show significant differences between the motility of sperm incubated in heated or untreated serum. It is concluded that heating of homologous serum is not necessary for preserving sperm motility and in some cases may even be disadvantageous.     

Acute effects of balloon valvuloplasty and pacing on left ventricular performance in children with moderate pulmonary valve stenosis, analysed by systolic and diastolic pressure--volume relationships

Right ventricular overload of volume and/or pressure type mayaffect left ventricular systolic and diastolic function. Thishas been shown in animal studies and has been suggested in non-invasivestudies in man. Altered geometry of the left ventricle, myocardialhypertrophy and changes in contractile state may be responsiblefor the change in function. Balloon valvuloplasty is an effectivetreatment for isolated valvular pulmonary stenosis in children,and results in an immediate decrease of right ventricular systolicpressure. Whether this results in immediate changes in leftventricular performance is unknown. Eight children (age 5·2to 13·9 years) with moderate pulmonary valve stenosisunderwent pulmonary balloon valvuloplasty under general anaesthesia.Left ventricular function measurements before and after valvuloplastywere performed using a combined micromanometer-conductance catheterto obtain end-systolic (ESPVR) and end-diastolic (EDPVR) pressure-volumerelationships employing inferior vena cava occlusion both atnormal and pacing-induced increased heart rates. Pulmonary valvuloplasty resulted in a decrease in peak systolicright ventricular pressure from 62·8±13·5to 34·4 ± 7·3 mmHg (P<0·001),without significant changes in left ventricular systolic andend-diastolic pressure, or in cardiac index. The ESPVR was fittedto a linear function to obtain the slope (E_es and the volumeintercept at 75 mmHg (V₇₅ The EDPVR was fitted to an exponentialfunction. At baseline, E_es was 1·68±0·99mmHg. ml^–1 and V₇₅ was 33·6 ± 21·8ml. Neither valvuloplasty nor pacing, which increased mean heartrate from 81 to 112 beats. min^–1 (P<0·001) resultedin significant changes of the parameters E_es, or V₇₅ The EDPVRwas not affected by valvuloplasty either, but pacing resultedin a change of its stiffness constant from 0·042 ±0·019 to 0·034 ± 0·018 mmHg . ml^–1(P<0·05) and pressure intercept from 0·97±0·51to 1·37±0·86 mmHg (P<0·05). Theeffect of pacing on left ventricular function before and aftervalvuloplasty was comparable. Neither balloon dilatation for moderate valvular pulmonary slenosis,nor pacing within the physiological range results in immediatechanges in left ventricular contractile performance in children.     

Cost‐effectiveness of ruling out deep venous thrombosis in primary care versus care as usual

Summary. Background: Referral for ultrasound testing in all patients suspected of DVT is inefficient, because 80–90% have no DVT. Objective: To assess the incremental cost‐effectiveness of a diagnostic strategy to select patients at first presentation in primary care based on a point of care D‐dimer test combined with a clinical decision rule (AMUSE strategy), compared with hospital‐based strategies. Patients/Methods: A Markov‐type cost‐effectiveness model with a societal perspective and a 5‐year time horizon was used to compare the AMUSE strategy with hospital‐based strategies. Data were derived from the AMUSE study (2005–2007), the literature, and a direct survey of costs (2005–2007). Results of base‐case analysis: Adherence to the AMUSE strategy on average results in savings of €138 ($185) per patient at the expense of a very small health loss (0.002 QALYs) compared with the best hospital strategy. The iCER is €55 753($74 848). The cost‐effectiveness acceptability curves show that the AMUSE strategy has the highest probability of being cost‐effective. Results of sensitivity analysis: Results are sensitive to decreases in sensitivity of the diagnostic strategy, but are not sensitive to increase in age (range 30–80), the costs for health states, and events. Conclusion: A diagnostic management strategy based on a clinical decision rule and a point of care D‐dimer assay to exclude DVT in primary care is not only safe, but also cost‐effective as compared with hospital‐based strategies.     

A COMPARISON OF NSP-RETICULONS WITH CONVENTIONAL NEUROENDOCRINE MARKERS IN IMMUNOPHENOTYPING OF LUNG CANCERS

Neuroendocrine-specific protein (NSP)-reticulons are endoplasmic reticulum-associated protein complexes, which have been identified as markers for neuroendocrine differentiation. In this study, the expression of two members of the family of NSP-reticulons, NSP-A and NSP-C, have been investigated in different types of lung cancer and compared with the expression patterns of five conventional neuroendocrine markers, the neural cell adhesion molecule (NCAM), synaptophysin, chromogranin A, Leu-7, and neurofilament proteins. NSP-A and NSP-C antibodies were reactive with most carcinoid tumour and small cell lung carcinoma (SCLC) cases, while atypical carcinoid tumours showed a variable expression. In the total group of neuroendocrine tumours, a high concordance of expression was found between NSP-A and NSP-C, while their expression correlated well with NCAM and synaptophysin positivity. Chromogranin A, Leu-7, and neurofilament proteins were shown to be expressed to a limited extent in these neuroendocrine tumours. In a selected group of non-SCLCs known to exhibit neuroendocrine features, NSP-A expression was detected at much higher frequency than NSP-C. In virtually all NSP-A positive cases, this expression was associated with one or more of the other neuroendocine markers. NSP-A expression showed a stronger correlation with conventional neuroendocrine markers than NCAM. In detecting neuroendocrine differentiation in non-SCLC, NSP-A is more sensitive than synaptophysin, chromogranin A, Leu-7, and neurofilament proteins. It is concluded that NSP-reticulons are valuable markers in the diagnosis of neuroendocrine differentiation in non-SCLC and should be used in conjunction with NCAM. © 1997 John Wiley & Sons, Ltd.     

The bone marrow in Hodgkin''s disease: the non-involved marrow

One hundred and nineteen methacrylate-embedded trephine biopsy specimens from 80 patients with Hodgkin's disease are reviewed. Although marrow involvement was found in 4% of the untreated patients, the present study was mainly concerned with the marrow unaffected by specific infiltrates and in negative specimens. The non-involved bone marrow in Hodgkin's disease invariably showed alterations of three types; stromal damage, inflammatory infiltration, and disturbed haematopoiesis. Each of these features can be found in the absence of one or both of the others. In severe examples, all three of these components usually occur simultaneously, giving histological pictures that mimic Hodgkin-specific infiltrates, sometimes in association with clinical suggestions of bone marrow involvement or replacement. But trephine biopsies of sufficiently high histological quality offer alternative explanations for the pancytopenia, for instance intramedullary phagocytosis, reactive sclerosing inflammation resembling auto-immune disorders, or a disturbance of haematopoiesis itself. This disturbance could be due to a defect inherent in the haematopoiesis associated with Hodgkin's disease, possibly predisposing for leukaemia in longterm survivors who have received chemotherapy and/or irradiation. The disturbed erythropoiesis proved to be strongly correlated with the stage of the disease at the time of biopsy. This finding could contribute to staging procedures, when laparotomy is contraindicated.     

JOINT SCINTIGRAPHY FOR QUANTIFICATION OF SYNOVITIS WITH 99mTc-LABELLED HUMAN IMMUNOGLOBULIN G COMPARED TO LATE PHASE SCINTIGRAPHY WITH 99mTc-LABELLED DIPHOSPHONATE

The ability of scintigraphy with technetium 99m-labelled polyclonalhuman immunoglobulin G(^99mTc-IgG) to detect and quantify arthritisactivity was studied in 24 patients with RA and in 10 patientswith OA. The results of ^99mTc-IgG scintigraphy were comparedwith those of scintigraphy with ^99mTc-labelled hydroxymethylene-diphosphonate(HDP). The mean joint scores of ^99mTc-IgG scintigraphy in RApatients with active disease were significantly higher (P<0.001)than the mean scores in patients with inactive disease. Themean joint scores were also higher in patients with erosionscompared to those in patients without erosions (P<0.05).For ^99mTc-HDP scintigraphy no significant differences were foundbetween the mean joint scores of these patient groups. Comparisonof scintigraphic results between patients with RA and OA revealedthat the mean joint score of ^99mTc-IgG scintigraphy was significantly(P<0.001) higher in the patients with RA than in patientswith OA, whereas for ^99mTc-HDP scintigraphy this differencewas not significant. These results show that ^99mTc-IgG scintigraphy,when compared to ^99mTc-HDP scintigraphy, is a more specificmethod of detecting synovitis and, also, shows differentiationbetween differentiation between different degrees of arthritisactivity in RA. KEY WORDS: Technetium-99m human immunoglobulin G, Rheumatoid arthritis scintigraphy, Inflammation scintigraphy, Scintigraphic quantitation of synovitis