Evaluation of sperm motility by laser--Doppler-spectroscopy in an in-vitro fertilization programme

Laser-Doppler-spectroscopy represents a new, fast and reliable technical method for the assessment of several parameters of sperm motility including the percentage of spermatozoa which are motile, and mean spermatozoal velocity. Serial measurements of these parameters in routine andrological work permit standards for four main spermiogram diagnoses to be established. Laser-Doppler-spectroscopy was used to verify alterations in the motility of spermatozoa after capacitation in an in-vitro fertilization programme. An enhancement of 16% for total sperm motility and 36% for mean spermatozoal velocity could be observed. The results of in-vitro fertilization after various spermigram diagnoses, combined with long-term observations of mean spermatozoal velocity, may be considered as another step towards the elucidation of sperm-oocyte interactions. Comparisons between the development of embryos revealed significant differences between normo- and asthenozoospermic men versus oligozoospermic patients.

[Side effects of YAG laser treatment]

In enucleated pig eyes endothelial cell damage was demonstrated after YAG laser coagulation. The extent of the damage can be correlated to the distance between the laser focus and the endothelium, and to the energy. Similar effects and correlations can be demonstrated on intraocular implant lenses in an experimental model.

[Topography of the corneal endothelium following surgical trauma]

In a prospective study preoperative and postoperative endothelial cell densities were determined after intracapsular cataract extraction with and without implantation of intraocular lenses. There was a characteristic disparity in cell densities measured at different points--near the corneal wound, at the center, and below the center. The cell loss measured near the corneal wound is partly compensated for by elongation of the cells below the center. Consequently, the cell loss is not only made good in the immediate postoperative period; cell migration also continues for prolonged periods of time until homogeneity of the cell pattern is almost completely restored.

[Doppler ultrasonic evaluation of the efficiency of extra-intracranial anastomoses]

We report on the results obtained by means of directional continuous-wave Doppler sonography in 33 patients with superficial temporal-to-middle cerebral artery anastomoses. Recurrent transient ischaemic attacks or a recent mild neurological deficit were considered as justification for bypass surgery in cases of angiographically proven occlusions of one or both internal carotids, severe intracranial carotid artery disease, or stenoses and occlusions of the M-1 segment of the middle cerebral artery. The efficiency of the anastomosis was evaluated by the modified Pourcelot indices (relative end-diastolic flow velocity) of the preauricular superficial temporal artery and of the bypass-supplying branch at the edge of the burr-hole. The influence of intermittent compression of the bypass-supplying branch on the modified Pourcelot index of the ipsilateral common carotid was used as a further criterion for sonographic evaluation. All efficient anastomoses, defined by a modified Pourcelot index of at least 0.20 at the edge of the burr-hole, exhibited an average reduction of 0.08 in the relative end-diastolic flow velocity in the common carotid during compression. In the 18 patients with unilateral occlusion of the internal carotid, bypass surgery was predominantly efficacious (by the above criterion) in those patients who showed a reduction in the sum of the modified Pourcelot indices of the remaining brain-supplying arteries of at least 10% as compared with age-matched controls. The subgroups of existing and absent collaterals through the ophthalmic artery did not show any differences with respect to the percentage of efficient anastomoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Doppler sonography in basilar artery occlusion

We have investigated 6,972 patients with directional continuous-wave Doppler sonography within the last three and a half years, and have derived criteria for the sonographic diagnosis of basilar artery occlusion or tight stenosis in conjunction with 1,071 retrograde brachial angiograms. By sonographic patterns, we have suspected obstruction of the basilar artery or of both distal vertebral arteries in nine cases. Either bilateral sonographic silence or the absence of a diastolic flow component of the vertebral arteries served as criteria in the sonographic evaluation. Angiography of the vertebro-basilar system, performed in eight cases, showed near or complete occlusion in the distal vertebrals or in the proximal basilar artery. Degrees of stenosis less than an 80 percent reduction in lumen diameter could not be detected sonographically. Two further basilar artery occlusions were detected by means of angiography despite negative Doppler sonography: one of these patients showed an extensive collateral circulation between the posterior inferior and the superior cerebellar arteries, and one patient had an occlusion only of the middle and rostral thirds of the basilar artery, the proximal third and the anterior inferior cerebellar arteries being widely patent. Thus, we believe that directional CW Doppler sonography is very useful in the diagnosis of near or complete occlusion of both distal vertebral arteries or of the proximal basilar artery.

[Doppler sonography in intracranial circulation disorders of the internal carotid artery. A comparative Doppler sonography-angiography study]

During the past 33 months we have investigated 6,587 patients using directional continuous-wave Doppler sonography of the carotid arteries. On the basis of 1,671 retrograde brachial and direct carotid angiograms we have developed criteria for demonstrating a significant increase in the peripheral resistance of the internal carotid artery. We distinguished stenoses proximal (15 cases) and distal (4) to the origin of the ophthalmic artery, supraclinoid internal carotid artery occlusions (8), stenoses (2) and obliterations (10) of the middle cerebral artery that developed suddenly. Stenoses in the carotid siphon (proximal or distal to the origin of the ophthalmic artery) showed a reduction of more than 40% in the relative end-diastolic flow velocity (modified Pourcelot's index); in addition, stenoses proximal to the origin of the ophthalmic artery exhibited an alternating flow, or flow reversal, in the supratrochlear artery to a variable extent. Stenoses distal to the origin of the ophthalmic artery only rarely revealed the increase in orthograde flow velocity that had been theoretically expected in the supratrochlear artery. Stenoses of the middle cerebral artery exceeding the extent of atherosclerotic irregularities proved to be an exception. Supraclinoid obliterations of the internal carotid artery were reliably demonstrated by Doppler sonography. However, the reliably demonstrated by Doppler sonography. However, the majority of the occlusions of the middle cerebral artery that developed suddenly could not be detected by this means, probably due to anastomoses between the anterior and middle cerebral arteries, which were detected by means of angiography. Thus, we believe that continuous-wave Doppler sonography is a reliable tool for detecting stenoses of the carotid siphon of more than 60% reduction in lumen diameter as well as supraclinoid carotid artery occlusions. Resistance to the cerebral blood flow that is located more peripherally cannot be diagnosed reliably by this method.

[Endothelium protective effect of hyaluronic acid]

In an experimental study the endothelia of porcine corneas were exposed to mechanical trauma under controlled conditions. Endothelial damage was caused by a polymethylmethacrylate (PMMA) plastic sphere shaped like the optical part of an intraocular implant. Two power settings were investigated. At the high power setting an average damage of 4.63 mm2 (+/- 1.33) was observed under saline, whereas application of hyaluronic acid 1% reduced the endothelial cell loss to 3.006 mm2 (+/- 0.87). At a low power setting the endothelial cell loss under saline was 2.18 mm2 (+/- 0.65); the average damage under hyaluronic acid was 0.55 mm3 (+/- 0.29). The results were statistically significant. The cell protective effect of a viscous substance against a mechanically shearing force was thus demonstrated in a biomechanical model.

[Needs and technical prerequisites of an improved supply of donor material for penetrating keratoplasty]

The supply of donor material for keratoplasty is still considered a problem in many clinics. Preservation of donor tissue makes it possible to improve material selection. As far as the grafting of typed corneas is concerned, corneal organ culture offers a valuable time interval for planning the operation. In these preservation techniques the transplanted tissue is trephined from the endothelial side. With an optimal trephining technique the number of viable endothelial cells transplanted can be increased.

Amniotic fluid glucose values in normal and abnormal pregnancies

Glucose values were determined in 102 urine samples of newborn infants and in 2295 amniotic fluid (AF) samples of women between the 14th and 42nd week of pregnancy. One thousand, six hundred fifty-five of the AF samples derived from normal pregnancies, 50 from pregnancies with fetal malformations, 115 from cases of hydramnios, 246 from pregnant women with an abnormal oral glucose tolerance test, and 230 from insulin-dependent diabetics. Mean AF glucose concentration rises slightly between the 14th and 17th week of pregnancy, decreasing from 46 to about 16 mg% at the end of pregnancy. In cases of fetal malformations, 68% of the glucose levels was below the tenth percentile of normal values. Hydramnios showed no deviation from normal values. In patients with abnormal glucose tolerance, AF glucose increased by a total of 42% and by 67% in fetal hyperinsulinism. Insulin-dependent diabetics had glucose values elevated by a total of 77% and by 106% in fetal hyperinsulinism. The AF glucose profile reflects the level of maternal blood glucose that is transported to the fetus and excreted in the fetal urine as a major source of glucose in AF.

Technical aspects in ultra-large corneal grafts

The larger the corneal graft, the more difficult is the excision of the button and especially suturing of the graft. The instruments and microsurgical unit are adapted to size and dimensions of animal surgery. The mathematical correlation between the diameter of the graft, the thickness of the cornea, and the length of the wound edges and suturing material can be calculated.

Prenatal diagnosis of campomelic dysplasia by ultrasonography

Consanguineous partners had a boy with campomelic dysplasia who died of increasing respiratory distress soon after birth. The next pregnancy was monitored frequently by ultrasonography and a healthy male infant was born at term. During a further pregnancy, ultrasonography suggested campomelic dysplasia in the 16th week of gestation. This was confirmed in the 18th week. The pregnancy was terminated and the fetus showed the typical radiological, anatomical and histological findings.

[Possibilities and biological properties of variously applied methods of corneal preservation]

As the demand for donor corneas increases, not only fresh donor material but also increasing numbers of preserved corneas are being transplanted. The simple eye-banking procedures such as the moist chamber and the McCarey-Kaufman medium provide sufficient endothelial cell viability for short periods. The methods of organ culture of corneoscleral disks extend storage periods to up to four weeks. Cryopreservation as a method of long-term storage has not come to be widely used owing to the complicated procedure involved and the considerable damage thus caused to endothelial cells. Thus, the organ culture method may represent a compromise between extended storage periods and good endothelial cell viability.

Fetal insulin balance: gestational diabetes and postpartal screening

It must be determined whether high neonatal birth weight (greater than or equal to 4000 g) is due to genetic factors or to a disorder of maternal carbohydrate metabolism. Oral glucose tolerance tests are known to be unreliable during the puerperium. If the mother's carbohydrate metabolism was disturbed during pregnancy, neonatal overweight may result from fetal hyperinsulinism. This can be diagnosed by determining the insulin in the umbilical cord blood. Mature neonates of metabolically healthy women show an insulin level of 9.2 +/- 4.4 microU/ml (N = 180) in the umbilical cord blood. The third, tenth, 50th, 90th, and 97th percentiles were calculated as 1.4, 4.3, 8.8, 15.4, and 17.7 microU/ml, respectively. With insulin values over 20 microU/ml in the umbilical cord blood, a disturbance of maternal carbohydrate metabolism during pregnancy is likely. Among 4560 births in one year, 335 neonates weighed 4000 g and more, corresponding to a proportion of 7.35%. In one quarter of the infants over 4000 g, high birth weight was associated with fetal hyperinsulinism. This corresponds to a frequency of 1.8% of all births.

Gestational diabetes and screening during pregnancy

The oral glucose tolerance test is an unreliable test in screening for diabetogenic fetal disease. In diabetogenic fetopathy due to gestational diabetes (White class A diabetes), the insulin content in the umbilical cord blood as well as in the fetal urine is considerably raised. As increased amounts of insulin pass into the amniotic fluid via the fetal urine, the fetal disease can be diagnosed from the amniotic fluid insulin content. In 75 pregnant women with potential diabetes, the blood sugar value was below 160 mg/dL at maximum under glucose loading in 28 patients; it was over 200 mg/dL in 25 patients. However, diabetogenic fetopathy was present in only 14 patients. The endangered and the healthy fetus could be distinguished in each case by amniotic fluid insulin content. The mean amniotic fluid insulin values in diabetogenic fetopathy were about seven times the normal.

[Doppler sonogram in basilar artery thromboses]

We have investigated 6,380 patients with directional c-w Doppler sonography within the last 3 1/2 years, and have suspected obstruction of the basilar artery or of both distal vertebral arteries in 7 cases. Either bilateral sonographic silence or an absent diastolic flow component of the vertebral arteries were employed as criteria in the sonographic evaluation. Angiography of the vertebro-basilar system, performed in 6 cases, confirmed the diagnoses: basilar artery occlusion was found in 4 patients, 1 patient revealed tight stenosis of the basilar artery in its entire length, and 1 patient exhibited occlusion of both distal vertebral arteries. Three further basilar artery occlusions were detected by means of angiography despite initially negative Doppler sonography within the same period of time; 1 of those patients, however, met the above criteria for basilar artery occlusion upon sonographic reevaluation on the following day. Thus, we believe that directional c-w Doppler sonography is very useful in the diagnosis of basilar artery obstruction.

Insulin levels in amniotic fluid of normal and abnormal pregnancies

The normal level of insulin in amniotic fluid between the 13th and 42nd weeks of pregnancy was determined by means of 988 single analyses in individual healthy women. Insulin passes into the amniotic fluid via the fetal urine, and its level does not depend on fetal gender. Between the 13th and 25th weeks of gestation, the insulin level increases by an average of 1.3 to 5.1 microU/ml. From the 27th to the 42nd weeks, an increase of 6 to 9.1 microU/ml is observed. In the same period, the 97th percentile rises from 11.2 to 18 microU/ml. In 543 patients with pregnancy disorders, lower levels of insulin in amniotic fluid were observed in intrauterine fetal death, placental insufficiency, fetal growth retardation, and malformations. Elevated levels of insulin were observed in rhesus disease. In the treatment of pregnant women with betamimetics and glucocorticoids, the mean amniotic fluid insulin level rose to more than double the normal values.

[Prepartal diagnosis of fetal abnormalities from the viewpoint of the obstetrician]

Over a period of 51/2 years 685 amniocenteses were carried out for genetic and obstetric indications at the University Department of Obstetrics and Gynecology Graz. In 39 cases (5,7%) the procedure had to be repeated. Chromosome diagnosis was achieved in altogether 99% of cases. Chromosome aberrations or malformations were found in 25 patients (3,6%). 18 pregnancies (2,6%) ended with a miscarriage or missed abortion up to the 28th week of gestation following amniocentesis. Leakage of amniotic fluid following amniocentesis was recorded in eight women. Seven of these gave birth at term, while one woman had an abortion. No case of maternal injury, bleeding or infection was recorded. In conclusion, when the risk of giving birth to a malformed child is compared with possible complications following amniocentesis there can be no doubt that this procedure is definitely indicated.