Prental diagnosis and subsequent team approach to the management of omphalocele

The diagnosis of omphalocele can now be made in the prenatal period with the use of ultrasound and the intraamniotic injection of radiopaque contrast material. By diagnosing omphalocele prior to birth a combined obstetric, neonatal and pediatric surgical approach can lead to a successful outcome of pregnancy and subsequent development of a normal infant.

Effect of the phosphodiesterase inhibitor Pentoxyfylline on human sperm motility

Tyrode fluid and Tyrode fluid plus Pentoxifylline were individually added to aliquots of semen samples obtained from 6 normal men and 6 infertile patients considered to have idiopathic normogonadotropic oligoasthenozoospermia. Pentoxifylline was added to final concentrations of 0.15, 0.30 and 0.60 mM. One aliquot with no addition served as control. Samples were incubated in 37 degrees C and observed by light microscopy at 30 minutes and at 1, 2 and 4 hours after obtaining the material. At observation time, semen quality was evaluated by determining the percentages of forwardly progressive spermatozoa, slowly progressive spermatozoa, "in situ" motile spermatozoa, live and non-motile spermatozoa and dead spermatozoa. Results reported included only the first and last category. Tyrode fluid did not affect significantly the motility and the duration of activity of spermatozoa. Ejaculated human spermatozoa both from normal and asthenozoospermic men added the Pentoxifylline at 0.30 and 0.60 mM showed a longer lasting activity than those of control semen and semen added only with Tyrode fluid.

Grazing incidence interferometry: the use of the Linnik interferometer for testing image-forming reflection systems

A simple interferometric method capable of displaying quantitatively the wave front aberration of any image-forming optical system is described. Its application for testing and aligning grazing incidence reflection optics at the same conjugates as those of short-wavelength use is demonstrated. The image-forming wave front from the system being tested is compared with a true spherical wave front generated within the interferometer from a point at the intended focus. The differences are displayed as a fringe pattern superimposed on an image of the exit pupil. Each fringe corresponds to one wavelength of separation between the actual image-forming wave front and the Gaussian reference sphere. The principle originates from a paper by W. P. Linnik published in Russian and German in 1933. A translation is included as an appendix. Four variations on Linnik's design are discussed, one of which avoids the use of transmitting optics and normal incidence reflections altogether and could therefore be used at ultraviolet or soft x-ray wavelengths.

A randomized study of instructional variations in nutrition counseling and their efficacy in the treatment of hyperlipidemia

The important of the educational diagnosis in instructing patients in a fat modified diet was examined in a double blind study. The educational diagnosis depended upon the assessment of three independent instructional parameters: the amount of structure, the teaching mode, and the language code preferred by the patient. Group I (67 patients) received traditional personalized counseling for 3 months. Group IIa (40 patients), whose instruction was matched to their preferred education attributes, was randomized against group IIb (36 patients), whose instruction was mismatched. Group IIIa (33 patients), receving matched instruction was randomized against group IIIb (35 patients), receiving high structure in the symbolic mode of instruction. The greatest reduction in serum cholesterol was seen in group I. At 3 months, no significant difference in serum cholesterol reduction could be shown between groups IIa and IIb, or IIIa and IIIb. However, the mean cholesterol reduction became significantly greater (P less than 0.05) in IIa than IIb at the 6 month visit. Seven day food diaries showed no significant differences in dietary intake and 1 and 3 months between matched and unmatched groups. The data did suggest that patients preferring high structure in the symbolic mode had a greater serum cholesterol reduction that other diagnostic groups. Analysis of variance showed an interaction between the preferred and instructional level of structure as related to the change in total fat, and saturated fat of the diet after 3 months.

Bromocriptine in the treatment of hyperolactinemic amenorrhea

Thirty women with secondary amenorrhea and hyperprolactinemia were studied; galactorrhea was present in 25 of them, and 18 were infertile. Serum prolactin (PRL) levels were high in all cases, between 26 and 120 ng/ml. All women were treated with bromocriptine in increasing doses from 2.5 to 5.0 or 7.5 mg daily, according to the response obtained, for 4 months. In 27 patients a PRL determination was performed during treatment; values returned to normal (up to 20 ng/ml) in 23 women and remained high in 4. Galactorrhea disappeared in 21 of 25 women. Ovulatory menses were re-established in 17 patients (56.6%). Seven women became pregnant (38.8%), one of them after bromocriptine and clomiphene were given simultaneously in the same cycle. According to our results and a literature review the following conclusions may be drawn: (1) bromocriptine is a useful therapeutic tool for re-establishing menstruation and inducing ovulation in patients with the hyperprolactinemic-amenorrhea syndrome; (2) the association of bromocriptine and clomiphene could be the next step in the treatment of patients who fail to ovulate with bromocriptine alone.

Diagnosis of peripheral occlusive disease: comparison of clinical evaluation and noninvasive laboratory

One hundred and two patients with peripheral vascular disease were evaluated by the attending surgeon, residents and students, and the vascular laboratory prior to arteriography to test their ability to make a correct anatomic diagnosis. The attending surgeons made a correct anatomic diagnosis in 98 patients and were at least partially correct in the other four. Surgical housestaff and students were 62% totally correct, 35% partially correct, and 3% totally wrong. The vascular laboratory results were almost identical with the attending surgeon, but two patients could not be evaluated because of calcified arteries. The operation that was eventually performed was suggested initially by the laboratory and the attending surgeon in 98% of the patients.

On the relationship between gastrin, gastric secretion, and adjuvant arthritis in rats

The elevation of plasma immunoreactive gastrin known to occur during the induction of adjuvant-induced arthritis (Rooney et al., 1973) has been shown to be maximal at 7 days after injection. Gastrin administered exogenously accelerated and exacerbated the inflammatory joint disease. Some evidence has been presented that the endogenous immunoreactive gastrin had biological activity in terms of gastric acid secretion.

Effect of two phosphodiesterase inhibitors, cyclic adenosine 3':5'-monophosphate, and a beta-blocking agent on human sperm motility

Mann-fructose fluid (MF), and MF plus caffeine, MF plus pentoxifylline, MF (dibutyryl cAMP), MF plus propranolol, and MF plus propranolol plus dibutyryl cAMP were individually added to aliquots of semen samples obtained from 18 normal men. These drugs were added to a final concentration of 0.6 mM. One aliquot with no addition served as control. Samples were incubated at 37 degrees C and observed by light microscopy at 30 minutes and at 1,2, and 4 hours after obtained the material. At each observation time, semen quality was evaluated by determinating the percentages of forwardly progresssive spermatozoa, slowly progressive spermatozoa, "in situ" motile spermatozoa, live and nonmotile spermatozoa, and dead spermatozoa. Mann-fructose fluid resulted in a decrease in motility and the duration of activity of spermatozoa, Caffeine seemed to neutralize the deleterus effect on the buffer, whereas pentoxifylline and cAMP seemed to increase the duration of activity of spermatozoa. Propranolol resulted in a dramatic decrease in motility, an effect that could not be neutralized by the simultaneous addition of cAMP.

D-leucine-6-luteinizing hormone-releasing hormone ethylamide in the treatment of normogonadotropic oligoasthenospermia

The effectiveness of D-leucine-6-luteinizing hormone-releasing hormone ethylamide (D-Leu-6-LH-RH-EA) in the treatment of idiopathic normogonadotropic oligoasthenospermia was assessed in 17 patients selected on the basis of at least three previous sperm counts; a history of long-standing infertility; normal serum levels of luteinizing hormone, follicle-stimulating hormone, and testosterone; and lack of any evidence of other pathologic involvement. On testicular biopsy all patients showed hypospermatogenesis or arrest at the spermatid stage with the exception of two with more severe disorders. D-Leu-6-LH-RH-EA- was administered intramuscularly for 90 days at a daily dose of 5 microgram (four patients), 10 microgram (four patients), 20 microgram (five patients), and 200 microgram (four patients). The results showed no significant improvement in the parameters considered (number of spermatozoa per milliliter, percentage of live and motile spermatozoa, and percentage of forwardly progressive spermatozoa). D-Leu-6-LH-RH-EA does not seem promising for the treatment of oligoasthenospermic patients.

Absorption of nicotine from small cigars

The absorption of nicotine from cigars was measured in 7 male subjects who each smoked a single small cigar containing 14C-nicotine. The proportion of nicotine in the mainstream smoke delivered to the smoker's mouth was greater than that observed for cigarettes, but the proportion of nicotine in the cigar smoke which was retained by the smoker was about the same. The total dose of nicotine retained varied between 1 and 4.5 mg. Arterial plasma concentrations of nicotine were as high as those achieved by cigarette smoking but rose more slowly. Some nicotine from small cigars is absorbed by inhalation of the smoke into the lungs and some by buccal absorption.

Pituitary and testicular response to LH-RH and to a long-acting analogue (D-leu-6-LH-RH-ethylamide)

The LH, FSH and testosterone response to 50 microgram i.v. LH-RH and to 2.5, 5.0, 10.0, and 20.0 microgram i.m. D-Leu-6-LH-RH-ethylamide was studied in 6 subjects with normogonadotrophic, idiopathic oligozoospermia. All injections were given between 8:00 and 9:00 a.m. at weekly intervals. Blood samples were collected before and 30 and 45 minutes after injection of LH-RH, and before and 2, 4, 6, 12, and 24 hours after D-Leu-6-LH-RH-ethylamide injections. Serum levels of LH, FSH, and testosterone were measured by triplicate by R.I.A. LH and FSH responses to LH-RH showed peak values at 30 minutes, whereas following injections of D-Leu-6-LH-RH-ethylamide, maximal values were recorded between 4 and 6 hours and were higher than those obtained with LH-RH. A significant rise of serum testosterone levels was observed after all stimuli, with peak values 45 minutes after LH-RH and 4 to 6 hours after D-Leu-6-Lh-RH-ethylamide injections. The testosterone levels obtained following LH-RH and different doses of the analogue did not differ significantly from one another. The same sequence of maximal LH and FSH values was obtained after injections of LH-RH and of D-Leu-6-LH-RH-ethylamide, particularly at doses of 10.0 and 20.0 microgram. This suggests that the gonadotrophin response to these agents would be a true reflection of the individual mode of pituitary response.

Luteinizing hormone (LH), follicle-stimulating hormone, and testosterone responses to consecutive injections of D-leucine-6-LH-releasing hormone ethylamide in normal men

Luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone (T) responses to three consecutive intravenous injections of D-Leu-6-LH-releasing hormone ethylamide (D-Leu-6-LH-RH-EA) at 3-hour intervals were studied in six healthy, fertile, male volunteers 34.2+/-1.6 years of age. Each man received three injections of 20 microng of D-Leu-6-LH-RH-EA at 6:00 A.M., 9:00 A.M., and 12:00 noon, respectively. Blood samples were obtained before the first injection and at 1, 2, 3 (before the second injection), 4, 5, 6 (before the third injection), 7, 8 and 9 hours after the beginning of the test. Serum levels of LH, FSH, and T were determined by radioimmunoassay with the double-antibody technique. The response to the first injection of D-Leu-6-LH-RH-EA confirmed the longer duration of the stimulation of LH and FSH release caused by this compound as compared with that caused by LH-RH. Serum T levels rose significantly, almost paralleling the variations experienced with gonadotropins. The second injection caused a slight increase in LH and T responses in relation to the first injection. Two and three hours after administration, the third stimulus resulted in hormone levels lower than those obtained with the first two injections. Possible explanations for this finding might be a reduction of pituitary responsiveness as a result of multiple stimulation with D-Leu-6-LH-RH-EA, or spontaneous circadian variation of the pituitary response, or a combination of factors.

Differences in the mechanism of tolerance to dinitrophenylated bovine gamma globulin when induced in normal adult mice or in reconstituted irradiated mice: dependence of the mechanism of tolerance on the structural organization of the lymphoid system

Tolerance can be induced in adult mice by a single intravenous injection of 0.5 mg dinitrophenylated bovine gamma globulin. The cellular mechanism of the unresponsive state is different depending upon whether the tolerance is induced in normal intact adult mice or in reconstituted, irradiated mice. The tolerant state induced in intact mice is characterized by a high avidity of the residual antibody-forming cells in partially tolerant animals and a prompt reversibility on cell transfer. The overall properties of this unresponsive state are consistent with the hypothesis that it is mediated by the production of small amounts of high affinity antibody in response to the tolerance-inducing injection of antigen. In contrast, the unresponsiveness induced in reconstituted, irradiated mice by the same procedure was characterized by a low avidity of the residual antibody-forming cells in partially tolerant animals and stability on transfer of spleen cells from unresponsive into irradiated recipients. No suppressor cell activity was detected and mixed cell transfer studies were consitent with the view that this unresponsive state represented a B-lymphocyte clonal deletion. The presence or absence of T lymphocytes in the population of cells used for reconstituting the irradiated recipients did not effect the ease of tolernace induction or the cellular mechanism of the tolerant state which was produced. If irradiated mice reconstituted with B and T lymphocytes were rested for 2 wk before tolerance induction then a reversible "high affinity"-type tolerance is obtained such as is typical of normal intact animals. Restorationof a "normal" response to the tolerance-inducing injection of antigen is dependent upon the presence of thymus cells in the population of cells used for reconstitution. It is suggested that the structural integrity of the lymphoid tissue is critical in determining whether B cell will be rendered tolerant after exposure to antigen in vivo.

Treatment of idiopathic normogonadotropic oligoasthenospermia with synthetic luteinizing hormone-releasing hormone

An assessment of the effectiveness of synthetic luteinizing hormone-releasing hormone (LH-RH) in the treatment of idiopathic normogonadotropic oligoasthenospermia was made in 21 subjects selected on the basis of at least three previous sperm counts; a history of long-standing infertility; normal urinary gonadotropin excretion; normal serum levels of luteinizing hormone, follicle-stimulating hormone, and testosterone; and lack of any evidence of other clinical, endocrine, vascular, infectious, and/or urologic involvement. On testicular biopsy, 14 patients showed hypospermatogenesis or arrest up to the spermatid stage (group 1), while the remaining 7 had more severe spermatogenetic disorders (group 2). Libido and/or potency were previously unaltered in all subjects. Five patients in group 1 and five patients in group 2 received intramuscular injection of 100 to 500 mug of LH-RH daily for no less than 60 days (long-term treatment); the remainder received the drug for 30-day periods, with 30-day intervals (short-term treatment). Qualitative and quantitative assessment of the results during and after treatment showed frank improvement in spermatozoal concentration, vitality, and motility in group 1 patients, particularly in those undergoing long-term treatment (three of five patients under these conditions were able to impregnate their wives). The long-term regimen also resulted in predomantly qualitative improvements in group 2 (one of five patients impregnated his wife). The short-term regimen was less effective. Improvements under either regimen usually occurred at the end of, or after, treatment. Six of seven patients in group 1 who were followed for a long period retained values above preliminary values for 90 to 150 days after the drug was discontinued. Increased libido and potency were spontaneously reported by 15 patients, 20 to 30 days after the start of administration of synthetic LH-RH.

Response of luteinizing hormone and follicle-stimulating hormone to different doses of D-leucine-6-LH-RH ethylamide in oligospermic patients

The rise in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels after intramuscular administration of D-leucine-6-LH-RH ethylamide was studied in seven patients with idiopathic normogonadotropic oligospermia. Four tests with 2.5, 5.0, 10.0, and 20.0 mug of the analog, respectively, were carried out at 8 A.M. on each subject. The interval between tests was 1 week. Serum levels of LH and FSH were determined by radioimmunoassay before (-15 And 0 minutes) and 2, 4, 6, 12, and 14 hours after each injection. No differences in the basal values for either hormone were observed. D-Leucine-6-LH-RH ethylamide produced significant increases in LH and FSH levels for 6 to 12 hours after the injection. Peak values were obtained between 4 and 6 hours. A dose-response relationship for both gonadotropins was observed. The highest average levels of LH and FSH were obtained after injection of 20.0 mug of the drug. A great individual variation in magnitude of response was observed which seemed to be related to the functional reserve of the pituitary. It is suggested that doses of 10.0 to 20.0 mug of D-leucine-6-LH-RH ethlamide/day could be used for chronic treatment in male infertility.

Pituitary-gonadal response to acute I.M. stimulation with clomiphene citrate in normal men

In order to asses the effect of acute i.m. injection of clomiphene citrate (CC) on LH, FSH, and testosterone (T) secretion, five normal, fertile men received 5 mg of the drug dissolved in 2 ml 0.9% saline, while a further five were injected 10 mg of the same preparation. All tests were performed at 8 a.m. Blood samples were drawn at 0, 30, 60, 120 and 180 minutes of the injection. Serum LH, FSH, and T values were determined by the double antibody radioimmunoassay technique. A significant rise of the LH, FSH, and T levels was obtained in both groups. Peak LH values were obtained at 30 minutes (average), whereas FSH and T peaks occurred at 60 minutes. The 180-minute values were similar to basal. The results seem to indicate that intramsucularly administered CC could be useful, as a rapid test, in evaluating the function of the hypothalamic-pituitary-gonadal axis.

Response of luteinizing hormone and follicle-stimulating hormone to different doses of synthetic luteinizing hormone-releasing hormone by intramuscular administration in normal and oligospermic men: preliminary report

The response of LH and FSH levels to intramuscularly administered synthetic LH-RH was studied in two healthy volunteers and three oligospermic patients. Four tests with 50, 100, 250, and 500 mug of LH-RH, respectively, were carried out on each subject at 8 am; the interval between tests was one week. The serum levels of LH and FSH were determined by radioimmunoassay (double-antibody method) before each injection, and 60, 120, 180, and 240 minutes after each injection. No differences in the basal values of either hormone were observed. In both oligospermic and normal men, maximal responses were obtained with doses between 100 and 250 mug. With 500 mug, levels decreased rather than increased. Maximal peaks occurred between 60 and 180 minutes after injection. In the two normal subjects, the responses of LH and FSH were similar. Two of the three oligospermic patients showed discordant responses. From the results, we can assume that LH-RH doses between 100 and 250 mug should be used as a basis for chronic treatment.

Use of synthetic luteinizing hormone-releasing hormone in treatment of oligospermic men: a preliminary report

Synthetic luteinizing hormone-releasing hormone (LH-RH) was administered to four normogonadotropic, oligospermic men (24 to 39 years of age) who had no endocrinologic, urologic, or associated vascular disease, to assess its possible therapeutic value in male infertility. Previous testicular biopsies of these subjects indicated alteration of spermiogenesis only. LH-RH (mean dose, 500 mug/day) was administered intramuscularly for 100 to 135 days. Each patient had at least two sperm count before starting therapy and had one every 20 to 30 days during and for two to five months after treatment. The sperm count, semen volume, sperm motility and morphology, and seminal plasma concentrations of fructose and citric acid were studied in each semen sample. In three of the four patients, urinary LH and FSH excretion and plasma testosterone levels were also measured. The sperm count increased clearly in two subjects 30 to 80 days after therapy started; the response was small in the third subject and negative in the fourth. The remaining parameters followed variable courses. Libido increased in all subjects. In the post-treatment period, the two patients who had shown the best response during treatment experienced a new and abrupt increase in the sperm count which remained well above initial values at the end of follow-up. LH-RH appears to be of value in the treatment of certain types of oligospermia, but several issues remain unsettled.

Daily variations of FSH, LH and testosterone response to intravenous luteinizing hormone-releasing factor (LRF) in normal men

The responses of FSH, LH and testosterone to acute stimulation with synthetic LRF were studied in 6 healthy, fertile men aged 33.4 plus or minus 1.6 yr (X plus or minus SE). Fifty mug of LRF were given, iv at 0600 h, 1200 h, 1800 h and 0000 h, at 1-week intervals, to all 6 volunteers simultaneously. Blood samples were collected by venipuncture before (-5 and 0 min) and 8, 16, 32, 64 and 128 min after LRF injection. Plasma levels of FSH, LH and testosterone were determined by double antibody radioimmunoassay techniques. The responses of FSH and LH to LRF injection showed a clear difference at the times studied. Maximal values were obtained at 0600 h and 1800 h while the response at noon was not significant for LH and absent for FSH. Testosterone secretion showed a clear-cut response to LRF in all the subjects. At three of the four studied times (0600 h, 1800 h, 000 h) plasma testosterone was already increased at 8 min reaching its maximum at 16 min and persisted high until the end of the study. The noon response reached its maximum at the end of the test period. The daily variations of FSH and LH responses to acute LRF stimulation should be taken into consideration in clinical practive and the increment in testosterone secretion makes this test a useful indicator for androgenic testicular reserve.