Artificial insemination homologous with oligospermic semen separated on albumin columns

Semen samples obtained from 27 infertile men were separated on human serum albumin (HSA) columns prior to artificial homologous insemination (AIH). The columns contained either a single 7.5% HSA layer or two 17.5% and 7.5% HSA layers. Separated specimens were free of seminal debris, had significantly improved motility and progressive drive, and had a decreased percentage of abnormal forms. The total sperm count was also significantly decreased after separation, especially with the two-layer technique. No conceptions occurred in 21 couples when two-layer separation was used, but four pregnancies in 12 couples resulted from AIH with semen separated on the single-layer column. The mean total count of motile sperm obtained for AIH was 5 million with the two-layer and 31 million with the one-layer technique.

Use of albumin gradients for X and Y sperm separation and clinical experience with male sex preselection

Semen samples obtained from 18 normal males and 37 husbands requesting male child preselection were separated on concentration gradients of human serum albumin. Separated semen obtained from the husbands was then used for artificial homologous insemination (AIH). A significant increase in the sperm motility, progressive drive, and percentage of Y-bearing sperm along with a decrease in the total sperm count and percentage of abnormal forms were observed in separated specimens. Fathers of three or more female children had a slightly smaller but statistically significant percentage of Y-bearing sperm in their semen samples than did normal males. Ten conceptions were achieved with separated semen. Seven pregnancies terminated in normal deliveries of five male and two female infants, one ended in a spontaneous abortion of a male fetus, and two patients are still expecting. The ratio of male to female conceptions in this small study parallels the ratio of Y to X sperm in the final specimen used for AIH.

Mianserin and lithium in the prophylaxis of depression

Forty-one out-patients with a history of at least three attacks of depressive illness were randomly allocated to treatment on a double-blind basis for one year with either mianserin 20 mg three times daily plus placebo lithium tablets, or to lithium tablets once daily plus placebo mianserin tablets. After one year, the dosage of mianserin was increased to 30 mg t.d.s. for a further six months. All but three of the patients had previously been stabilized on prophylactic lithium therapy. Lithium was found to be significantly superior to mianserin in avoiding admission to hospital or ECT. The overall affective morbidity index, calculated from global rating, showed no significant difference between drugs, but the index of the mianserin group was higher in the second six months than in the first. The lithium group showed no such change. Lithium remains the choice for the prophylaxis of unipolar recurrent depressive illness.

Endometrial prostaglandin F content in women wearing nonmedicated or progestin-releasing intrauterine devices

Prostaglandin F (PGF) was measured in endometrial samples from eight women wearing Lippes Loops and 14 women wearing Progestaserts after 6 months' use of the intrauterine devices (IUDs). In addition, in 37 women wearing dydrogesterone-T IUDs, endometrial PGF was measured after 1 month, 3 to 7 months, and 8 to 12 months of use. Endometrial samples were also obtained from 51 women without IUDs. The following means and standard errors of endometrial PGF, expressed in picograms per microgram of endometrial protein, were obtained in women without IUDs: early proliferative phase, 3.11 +/- 1.0; midproliferative phase, 4.1 +/- 0.7; late proliferative phase, 4.4 +/- 1.0; midluteal phase, 7.13 +/- 1.0; and late secretory phase, 6.08 +/- 1.0. The midproliferative phase mean was significantly different from the midsecretory phase mean (P is greater than 0.05). Except for one group, no differences were noted during the midproliferative and midsecretory phases among the groups of women wearing medicated and nonmedicated IUDs, when compared with values for women without IUDs. The only difference noted was during the midsecretory phase in the dydrogesterone group at 8 to 12 months. In these women, the mean endometrial PGF content was 2.8 +/- 0.8, significantly different (P is greater than 0.05) from that of women without IUDs (6.1 +/- 1.0).

Conception following insemination with a freeze-preserved retrograde ejaculate

Retrograde ejaculation, an infrequent cause of male infertility, may be the sequela of prostate or bladder neck surgery or the result of interruption in the sympathetic innervation to the bladder neck. The diagnosis is established by history and examination of the urine. In infertile couples artificial insemination homologous (AIH) using retrograde ejaculate recovered from the bladder has been successfully accomplished, but conception has occurred only in isolated cases. A literature review of the subject is presented. The technique of semen recovery from the bladder is time-consuming and uncomfortable to the patient, while the quality of the semen recovered is variable and the risk of iatrogenic urinary tract infection is increased. To avoid the above problems, and to have sperm available for AIH at the time of induced ovulation in an anovulatory wife, we were able to freeze-preserve ejaculate recovered from the bladder for future use. A case of conception following AIH with freeze-preserved retrograde ejaculate is presented.

Premature labor treatment with ritodrine in multiple pregnancy with three or more fetuses

Modern treatment for anovulatory infertility increases the incidence of multiple pregnancies with three or more fetuses and predisposes to prematurity with high perinatal mortality and mortidity. Premature labor was successfully treated in four multifetal pregnancies with ritodrine hydrochloride, a beta-mimetic drug relaxing the uterus. Another patient misdiagnosed as false labor was not treated and lost three out of four premature babies. Beta-mimetic treatment is indicated in multiple pregnancies even in false labor, or when painless progress in cervical dilatation is observed, to avoid asymptomatic progression into true labor. In contrast to singleton pregnancies, advanced labor with more than four centimeters cervical dilatation should not preclude good chances for successful treatment. Persistence in treatment and repreated use of the most effective intravenous route combined with oral ritodrine administration is needed because of marked tendency to recurrences of premature labor. Progressive increase in the dose of oral ritodrine may be indicated by decrease in therapeutic response. Maternal tachycardia should be considered as an index of patient responsiveness to the beta-mimetic treatment. The therapy is most successful when the patient is hospitalized from the first episode of treatment until at least the 37th week of pregnancy. This is probably less expensive than prolonged hospitalization of several prematures in an intensive care nursery.

72 kidney transplants at the Medical College of Georgia 1968-1976

Seventy-two kidneys have been transplanted-47 from related donors, and 25 from cadaver donors-into 63 recipients. No donor died or experienced a complication requiring more than one extra week of hospitalization. Six recipients died. Three of the six recipients died from complications. Two of the six died only because they declined to resume hemodialysis, and one died in prison of unusual circumstances after seven and one-half years of good health and kidney function. Five patients are surviving by virtue of a second transplant. Eight patients are now on hemodialysis. Seven patients with transplants are not in excellent physical health and five other patients with excellent health and renal function are nonetheless frequently depressed and easily upset over minor physical disabilities. A majority of the recipients have been rehabilitated to a gratifying extent.

Cutaneous phycomycosis (mucormycosis) with fatal pulmonary dissemination

Phycomycosis of the skin manifested as a spontaneous solitary ulcer of the leg in a patient with uremia. The infection later spread to the lungs and produced fatal pulmonary infarction. Histopathologic study of the lesions revealed broad nonseptate fungal hyphae that had invaded vascular channels, with areas of necrosis and acute inflammation. Primary cutaneous phycomycosis is rare. In the studied cases, dissemination of infection did not occur. The unusual feature of fatal pulmonary dissemination of primary cutaneous phycomycosis as observed in our patient has not been described in the leterature.

Heterotopic pregnancy following clomid treatment

A case of concomitant intra- and extrauterine pregnancy after clomiphene treatment is reported. The incidence of multiple ovulations and multiple pregnancies is higher after induced ovulation. The increased likelihood of combined intra- and extrauterine pregnancy in patients with a higher rate of fraternal twinning is discussed.

Peutz-Jeghers syndrome

Peutz-Jeghers syndrome is an uncommon genodermatosis. The clinical and radiological features of Peutz-Jeghers syndrome are described in a 12-year-old male child. The relevant literature is briefly reviewed.

Cloxacillin and sodium fusidate in management of shunt infections

The effectiveness of two oral antibiotics, cloxacillin and sodium fusidate, has been evaluated in the treatment of shunt infections among 37 patients allocated at random to two treatment groups. Both proved to be safe bactericidal agents giving adequate serum M.I.C. when taken by mouth. Treatment should always be started on the basis of the clinical presentation without waiting for the bacteriologist's report. The commonest infecting organism is Staphylococcus aureus. Nine shunts were lost in this study, eight through Staphylococcus aureus infection. The nasal carrier state is of considerable importance in perpetuating these shunt infections.

Order of birth and schizophrenia

In a previous survey of hospital in-patients it was observed that among schizophrenics the earlier born were affected to a greater extent (Rao and Sundararaj, 1964). Following a suggestion by Slater (personal communication) the work was extended and further data collected on a larger number of patients to determine the role of birth order in schizophrenics. The present communication reports the findings.