Lack of infection in HIV-exposed individuals is associated with a strong CD8(+) cell noncytotoxic anti-HIV response

Individuals repeatedly exposed to HIV, but who remain uninfected, form a population enriched for persons likely to have either natural or acquired resistance to the virus. We have studied four such exposed uninfected cohorts, representing 60 individuals, for evidence of protective immunity. This population included participants exposed to HIV through anal or vaginal receptive intercourse on multiple occasions over many years. We observed CD8(+)-cell noncytotoxic inhibition of HIV replication in acutely infected CD4(+) cells in the vast majority of individuals most recently exposed to the virus (within 1 year). The levels of this CD8(+)-cell response were sufficient to inhibit the in vitro infection of the exposed subjects' peripheral blood mononuclear cells. We found no evidence of a significant role for CCR5 Delta32 mutation in this population, nor did CD4(+) cell susceptibility to infection or HIV-specific cytotoxic T-lymphocytes correlate with resistance to infection in the individuals tested. Therefore, the observed strong noncytotoxic CD8(+)-cell anti-HIV responses may be an antiviral immune activity contributing to the apparent protection from infection in these exposed uninfected individuals.

Contralateral hemilaryngotracheal flap reconstruction of the hypopharynx in pyriform carcinoma resection

OBJECTIVES

To simplify the approach and reconstruction for advanced hypopharyngeal cancer, a modified technique-laryngotracheal fissure approach and laryngotracheal flap reconstruction--is presented.

STUDY DESIGN

Prospective.

METHODS

From August 1991 to December 1995, 44 consecutive patients with advanced hypopharyngeal cancer, mostly involving pyriform sinus, were operated on with this technique. The functional and oncologic results and complications were evaluated.

RESULTS

Reconstruction was completed by using the laryngotracheal flap in 75% of patients, while the other 25% required additional patch-on pectoralis major myocutaneous flaps. Pharyngoesophageal stenosis occurred in one patient after radiotherapy and pharyngocutaneous fistula was noted in two. No local recurrence was noted. Seven cervical metastases developed in the follow-up period and six over the contralateral neck not treated surgically. The 5-year Kaplan-Meier disease-free survival was 46.8%.

CONCLUSIONS

The authors' experience indicates that this is a simplified, radical treatment for most advanced hypopharyngeal cancer, with high applicability, good oncologic results, and low complication.

Local circulation and aerosol water-soluble ions--a case study in Taiwan during Mei-yu season

The Mei-yu (plum rain) season is a short but important period when the weather changes from spring to summer in Taiwan. In this study, size-segregated aerosols were collected alternately at 5 sampling sites in northwestern Taiwan from June 16 to 24, 1994. For the first time in Taiwan, this study revealed the aerosol mass spectra and water-soluble ions in the Mei-yu season. For all samples, a bi-modal aerosol mass spectra was found with modal diameters at 3.2 and 0.32 microm, respectively. The aerosol samples were able to be divided into different groups to show their mass and ion spectra according to the calculated 5-hr backward air trajectory. The utilization of enrichment factors showed that aerosol Cl-, Na+, and Mg2+ for all sizes, and super-micron SO4(2-) were related to the sea. Both the scheme of "chlorine loss" (Ohta and Okita, 1990) and a multivariate analysis (Thurston and Spengler, 1985) for categorizing water-soluble ions showed that sea-salts were major contributors in the prevalence of a sea breeze. In contrast, the secondary salts were significant for land breeze and a mix of land-sea breeze. In conclusion, the influence of local circulation on the distribution of aerosol mass and ionic species was found to be prominent.

Cloning of the genomic sequence encoding a processed adenylate kinase 2 pseudogene

A chromosomal DNA sequence harboring a processed AK2B pseudogene was isolated from a human genomic library. It was a variant of the AK2B gene sequence including several point mutations, deletions, and insertions. The nucleotide sequence of the ORF of the AK2B pseudogene predicted a truncated form of the AK2B mutant suggesting that the processed pseudogene is nonfunctional. A repetitive sequence, AAAAGAGAG, found in the 5' and 3' flanking regions of the pseudogene and the poly(A) tract in the 3' end junction suggest that a mRNA of AK2B may have been converted to the processed pseudogene by retrotransposition events. Previously, it was suggested that an adenylate kinase (AK) 2 related gene on chromosome 2, confirmed by Southern analysis using somatic cell hybrid cell lines, may be a processed pseudogene. It is proposed that the processed pseudogene isolated in this study may be the AK2 related nonfunctional gene localized on human chromosomes 2.

Unusual dental injuries following facial fractures: report of three cases

We report 3 cases of unusual dental injuries following facial fractures. The first patient sustained intrusion of a maxillary incisor into the nasal cavity following a mandibular fracture. The tooth dislocated into the pharynx and was found lodged in the piriform fossa during surgery. The second patient sustained intrusion of molars into the maxillary sinus following maxillary and mandibular fractures. His treatment was delayed due to life-threatening hemorrhage. The third case involved ingestion of multiple avulsed teeth into the alimentary tract following severe maxillofacial fractures. Although the diagnosis was made more than a week after the injury, the patient did not suffer any complications as a result of the dental avulsion. The aim of this report is to emphasize the possibility of associated dental injuries in patients with facial fractures. The trauma surgeon should be cognizant of the importance of carrying out a thorough intraoral examination during the initial evaluation. Any missing tooth should be considered as possibly displaced into other tissue compartments, and must be routinely searched for with x-rays of the skull, cervical spine, chest, and abdomen. If full intrusion injury is suspected, further diagnostic investigation with facial computed tomography scanning may be worth while.

Prenatal diagnosis of de novo interstitial deletion of proximal 4q by maternal serum screening for Down syndrome

Deletion of the proximal portion of chromosome 4q is apparently rare. To our knowledge, prenatal diagnosis of the interstitial deletion of 4q12-21.1 has never been reported. We present a prenatal case of 4q deletion in association with a positive Down syndrome screening test of an elevated maternal serum free beta human chorionic gonadotrophin (beta-hCG) level. The prenatal sonogram revealed intra-uterine growth retardation (IUGR) and shortening of the femur. Facial dysmorphism included micrognathia, depressed nasal bridge and low-set ears, these anomalies were evident at the postnatal examination. All of the anomalies were consistent with those described in proximal 4q deletion syndrome. Our case suggests that chromosome studies may be indicated for patients with high maternal serum free beta-hCG and IUGR in the early second trimester.

Survival advantages and complications of adjuvant therapy in early-stage cervical cancer with pelvic node metastasis

BACKGROUND

Patients with early-stage cervical cancer who have pelvic node metastasis usually need adjuvant therapy after surgery for improvement of the length of survival. We attempted to determine the survival advantages and complications associated with different adjuvant therapeutic modalities.

MATERIALS AND METHODS

Eighty-seven patients with clinical stage Ib and IIa cervical cancer were treated with radical hysterectomy from July 1986 through December 1994 were reviewed retrospectively. All had had lymph node metastasis. The patients were divided into three groups according to the different adjuvant therapeutic approaches utilized: radiation (group I, n = 43), chemotherapy (group II, n = 23), and chemoirradiation (group III, n = 21).

RESULTS

There was no significant difference among these three groups in the 5-year relapse-free survival rate (group I: 63%, group II: 62%, group III: 51%, p = 0.785). The recurrence rates among these three groups were found to be similar (group I: 32.6%, group II: 39.1%, group III: 47.6%, p = 0.331). However, most of the recurrence in patients who had received pelvic radiation was at a distant site (group I: 79%, group III: 80%) as compared to the patients who had received chemotherapy only (group II: 33%), and the differences were significant (p = 0.020). The rates of complications, such as severe leukopenia, lymphedema with cellulitis, proctosigmoiditis and ileus, were found to be lower in the chemotherapeutic group.

CONCLUSION

Although we failed to demonstrate the survival advantages of different adjuvant therapeutic approaches, we still favor chemotherapy as an adjuvant basis because it is the least toxic of the regimens.

Virological and immunological features of long-term human immunodeficiency virus-infected individuals who have remained asymptomatic compared with those who have progressed to acquired immunodeficiency syndrome

Infection with the human immunodeficiency virus (HIV) leads to a decrease in CD4(+) T cells and disease progression within a decade of seroconversion. However, a small group of infected people, despite being infected by HIV for 10 or more years, remain clinically asymptomatic and have stable CD4(+) cell counts without taking antiretroviral medication. To determine why these individuals, known as long-term survivors (LTS), remain healthy, the hematological profiles, viral load and properties, HIV coreceptor genotype, and anti-HIV immune responses of these people were compared with those of individuals who have progressed to disease (Progressors) over the same time period. Unlike Progressors, LTS have a low circulating viral load and a low number of HIV-infected cells. These differences in the levels of the viral load were not associated with a dominant biologic viral phenotype, varying growth kinetics of the virus, mutation in the cellular CCR5 gene, or the presence of neutralizing antibodies. Importantly, the difference in viral load could be explained by the enhanced ability of CD8(+) cells from LTS to suppress HIV replication.

Timed intercourse after intrauterine insemination for treatment of infertility

OBJECTIVE

To compare the pregnancy rates, between intrauterine insemination (IUI) followed by timed intercourse and IUI only for treatment of the infertile couples.

STUDY DESIGN

A prospective study of two different protocols of intrauterine insemination in two hundred and one infertile couples with a normal spermiogram was carried out. Of these, 101 couples were treated with IUI alone and 100 couples had both IUI and timed intercourse within a 12-18 h period. The pregnancy rates were compared between groups.

RESULTS

The characteristics of the two groups were similar in terms of the mean age, as well as the duration and causes of infertility. The cycle characteristics following follicular stimulation were also similar between two groups. The pregnancy rate per cycle increased with increasing numbers of total motile sperm per insemination in the IUI alone group (P=0.045). Timed intercourse increased pregnancy rate in patients with lower motile sperm number (<40x10(6)) (27.7% versus 10.5%, P=0.023), but not in patients with higher sperm number (> or =40x10(6)) (25.7% versus 22.7%, P=0.671).

CONCLUSIONS

In IUI with low number of motile sperm inseminated, timed intercourse significantly increases the pregnancy rates over IUI alone in infertile couples with a normal sperminogram. This alternative treatment appears to be a practical, simple, and inexpensive addition that improves the pregnancy rate in patients receiving ovulation induction and intrauterine insemination program.

The expression of mdr-1-related gp-170 and its correlation with anthracycline resistance in renal cell carcinoma cell lines and multidrug-resistant sublines

OBJECTIVES

To clarify the role of the membranous glycoprotein gp-170 in renal cell carcinoma (RCC) cell lines and their multidrug resistant (MDR) sublines. and to correlate gp-170 with the natural and acquired drug resistance of these cell lines to anthracyclines.

MATERIALS AND METHODS

The expression of gp-170 in five cultured RCC cell lines and serial RCC8701 MDR sublines was analysed by immunofluorescent flow cytometry. The chemosensitivity of these tumour cells to the anthracycline anticancer drugs adriamycin and epirubicin was measured using the microplate tetrazolium (MTT) cytotoxicity assay, and the results correlated with gp-170 expression.

RESULTS

All six natural RCC cell lines showed a variably increased expression of gp-170, with the A704 and Caki-1 cell lines the highest. In contrast, gp-170 expression increased and then was suppressed in acquired MDR sublines of RCC8701 cultured in increasing concentrations of adriamycin. The A704 and Caki-1 cells were much more resistant to adriamycin and epirubicin than the A498, ACHN and RCC8701 cell lines, in parallel with the expression of gp-170. The resistant cell line cultured long-term in 800 ng/mL adriamycin, RCC8701/ADR800, was 122 times more resistant to adriamycin and 238 times more resistant to epirubicin than the parent cell line: the pattern differed from that in native RCC cell lines and was unrelated to the expression of gp-170.

CONCLUSION

Membranous gp-170 plays an important role in MDR of native RCC cell lines, while acquired MDR cells have different mechanisms of obtaining drug resistance in addition to gp-170. This phenomenon may be applicable to the clinical treatment of patients newly diagnosed with RCC or those with disease refractory to chemotherapy.

Pathogenesis of ischemia reperfusion injury of the kidney after transient renal arterial clamping in rats

Renal function can be severely impaired through injuries sustained after both short and prolonged periods of complete ischemia. The magnitude of renal dysfunction resulting from these conditions and their reversibility depend on the duration of anoxia. In this study, we used a Sprague-Dawley rat model (5 to 7 rats in each group) to study the pathogenesis of short-term ischemia (30, 60, and 120 min)/reperfusion (2, 4, 24 h, 1 wk, and 3 wk) injury of the kidney under warm (room temperature) or cold (4 degrees C) conditions. Ischemia was induced by clamping the renal artery. Changes in kidney weight, histopathology, concentrations of serum thromboxane and leukotriene, and tissue malonyldialdehyde (MDA) concentration, numbers of apoptotic bodies, and p53 expression in the kidney were compared with those of sham-operated rats. The results showed that the immediate increase in kidney weight due to inflammatory swelling was associated with simultaneous elevation of serum thromboxane and leukotriene levels. The changes in mediator levels were closely related to the duration of ischemia and temperature. Histologic structures were preserved better when renal artery clamping was done at 4 degrees C. MDA peroxidation products from the ischemic tissue prominently increased 1 week following ischemia; this paralleled a secondary increase in leukotriene levels. Flow cytometric detection of p53 oncoprotein showed a marked increase at 1 week following ischemia, which was accompanied by the development of apoptotic bodies in ischemic tissues. These changes were also closely related to the ischemic time and temperature during ischemia. This animal model may be useful for future studies of the prevention of ischemia/reperfusion injury of the kidney and for selection of effective antioxidants.

Effect of postprepared sperm parameters and insemination specimen volume on the outcome of intrauterine insemination

BACKGROUND

The purpose of the present study was to identify the postprepared sperm parameters affecting the outcome of intrauterine insemination and to find out whether the volume of insemination specimen was a determinant factor in the rate of successful conception.

MATERIALS AND METHODS

A retrospective study including 306 couples was designed. The patients were inseminated with either 1.0 or 0.5 ml of prepared specimens. The pregnancy rates were compared using the chi-square test. Logistic regression was chosen for multivariant analysis of the parameters.

RESULTS

The only parameter significantly affecting the success rate was the postprepared sperm motility (p = 0.033). The pregnancy rate was 27.91% in cases with > or = 95% sperm motility. Only two patients with less than 75% sperm motility conceived. The pregnancy rates in cases with 0.5 ml and 1.0 ml inseminations were 12.12% and 16.13%, respectively. This difference was statistically insignificant (p = 0.427).

CONCLUSION

The postprepared sperm motility was the only parameter predicting the successful rate of intrauterine insemination. Seventy-five percent sperm motility can be used as a cut-off value for selecting patients. The volume of insemination specimen did not influence the outcome. Insemination with 1 ml of fluid was just as effective as insemination with 0.5 ml.

High-performance liquid chromatography with a column-switching system and capillary electrophoresis for the determination of ibuprofen in plasma

Quantitative aspects of high-performance liquid chromatography with a column-switching system (CSS-HPLC) and capillary electrophoresis (CE) were investigated for the determination of ibuprofen in plasma. For CSS-HPLC, 100 microl of plasma was directly injected onto the column system for the three separation steps: (1) deproteinization and fractionation of plasma samples with a polymer-coated mixed-function phase column, (2) concentration with an intermediate column and (3) final separation with a main column. For CE, a mixture of 50 microl of plasma and 1 ml of acetonitrile was centrifuged and the supernatant was introduced onto the capillary (66 cmX50 microm I.D.; 62 cm to detector) at 20 degrees C. Run buffer was 250 mM sodium borate buffer (pH 8.5) and applied electric field was 379 V cm(-1). Linear dynamic ranges were 0.1-250 microg ml(-1) in CSS-HPLC and 1-1000 microg ml(-1) in CE. Intra-day and inter-day coefficients of variation were less than 5.6% and 6.5% for CSS-HPLC, 6.3% and 6.5% for CE, respectively. The limits of detection (S/N=3) for CSS-HPLC and CE were 25 ng ml(-1) and 300 ng ml(-1), respectively. CSS-HPLC was superior in simplicity and sensitivity, while CE was better in efficiency, rapidity, and cost.

Isolation of cDNA clones encoding human histone macroH2A1 subtypes

cDNA clones encoding two different subtypes of histone macroH2A1, macroH2A1.1 and macroH2A1.2, have been isolated from human liver tissue. The open reading frames in the isolated clones predicted proteins comprising 368 and 371 amino acids respectively. Estimated molecular masses of the two proteins were 39.0 kDa and 39.4 kDa. Human histone macroH2A1.1 and macroH2A1.2 showed about 98% identity with their counterparts isolated from rat. The features of the nucleotide sequences of the two macroH2A1 subtypes in human were the same as in the rat system. Northern blot analysis showed that the macroH2A1.1 and macroH2A1.2 subtypes were expressed as mRNA species with a size of 1.5 and 4.4 kb, respectively. They were expressed in all human tissues examined.

Transoral laryngeal surgery under flexible laryngovideostroboscopy

Although direct microlaryngoscopic surgery is universally accepted as the standard procedure for endolaryngeal surgery, general anesthesia and direct laryngoscopy are necessary during the procedure. Suspended laryngeal position also impedes intraoperative functional monitoring. Transoral laryngeal surgery under indirect laryngeal mirror or telescope has the advantage of sparing general anesthesia and direct laryngoscopy, but lower precision, difficult manipulation, and a high patient cooperation requirement make the procedure of limited application. Trying to overcome the above shortcomings, transoral laryngeal surgery under flexible laryngovideostroboscopy (FLVS) is undertaken at our institute. The surgery is performed at an outpatient office under topical anesthesia, with the help of high-resolution fiberoptic stroboscopy, high-quality CCD videocamera, and monitor. From October, 1993 to March, 1996, 157 patients with selected laryngeal problems were operated upon using this technique, and 150 patients smoothly completed the procedure with satisfactory results. The technique is highly effective, especially for limited-manipulation, lower precision procedures and for patients who are not candidates for general anesthesia. With proper patient selection, this is a cost-effective surgery of low invasiveness and high applicability.

Pregnancy after orthotopic liver transplantation in a Chinese patient: a case report

A 28-year-old woman who had undergone orthotopic liver transplantation due to decompensated liver cirrhosis conceived 2 years after the operation. Immunosuppressive treatment was maintained during the pregnancy. The case was managed as high risk. Although intrauterine growth retardation arose in the third trimester, the patient finally gave birth to a healthy male baby. To our knowledge, the present case is the first successful pregnancy of an Asian woman after liver transplantation. The related problems are also discussed.

Partial trisomy 13 [46,XY,dup(13)(q14-31)]: a case report

We report a fetus with partial trisomy 13 [46,XY,dup(13)(q14-31)] which was found during an amniocentesis performed due to the age of the mother. This duplication segment (13q 14-31) has not been reported in literature. The clinical features of our patient included cleft lip/palate, low set ears, depressed nasal bridge, hypertelorism, and epicanthal fold. After termination of the pregnancy, the fetus was sent for an autopsy. The autopsy report was compatible with the gross findings and no other abnormalities, including central nervous, cardiac, and renal system, were found. The level of maternal alpha-fetoprotein, 2.67 MoM, was opposite with the common phenomenon in complete trisomy 13.

Characterization and modulation of transitional cell carcinoma cell lines with acquired multidrug resistance

OBJECTIVES

To characterize in vitro drug-induced multidrug resistance (MDR) in transitional cell carcinoma (TCC) cell lines, and to elucidate the possible mechanisms of acquired MDR and their modulation.

MATERIALS AND METHODS

Two drug-resistant cell lines, TCC8702/A1000 (adriamycin 1000 ng/mL) and TCC8803/A200 (adriamycin 200 ng/mL), were established after long-term adriamycin treatment for at least 16 months. Their biological characteristics, including growth morphology, doubling time and cell cycle, were analysed. The drug-resistance pattern to various anticancer drugs was measured using a microplate cytotoxicity assay. The modulation of drug sensitivity by calcium-channel blockers and protein kinase C inhibitor was assessed among the different cancer cell lines.

RESULTS

Both MDR sublines had lower growth rates, lower saturation densities and higher nuclear/cytoplasmic ratios than the parent cell lines. DNA staining and cell cycle analysis revealed that both TCC8702/A1000 and TCC8803/A200 cells had a decreased S-phase fraction and the TCC8803/A200 cells a changed stem line; both sublines showed increased expression of membranous glycoprotein gp-170. The cytoplasmic content of glutathione and glucose-6-phosphate dehydrogenase were not related to the MDR development in the sublines. The drug-resistance index of TCC8702/A1000 to adriamycin was 121-fold higher than the native cell line and TCC8803/A200 was 189-fold higher. TCC8803/A200 also had a broader MDR to cisplatin, vinblastine and vincristine. Calcium-channel blockers (verapamil, quinidine) and protein kinase C inhibitors (tamoxifen) inhibited gp-170 activity and slowed the drug-efflux pump, with the acquired-MDR cells subsequently accumulating anticancer drugs. A calcium antagonist-based combination of modulators all presented synergistic cytotoxic enhancement of the anticancer drugs. Parent TCC cell lines had a poorer response to modulator treatment than their MDR sublines.

CONCLUSION

Different MDR mechanisms and subsequent modulator responses exist between native and acquired drug resistance in TCC cells. Acquired MDR seems strongly related to increased gp-170 expression and responds well to calcium antagonists. This phenomenon may be applicable in clinical conditions.

An internal control for routine diagnostic PCR: design, properties, and effect on clinical performance

We constructed internal controls (ICs) to provide assurance that clinical specimens are successfully amplified and detected. The IC nucleic acids contain primer binding regions identical to those of the target sequence and contain a unique probe binding region that differentiates the IC from amplified target nucleic acid. Because only 20 copies of the IC are introduced into each test sample, a positive IC signal indicates that amplification was sufficient to generate a positive signal from targets present at the limit of test sensitivity. The COBAS AMPLICOR Chlamydia trachomatis, Neisseria gonorrhoeae, Mycobacterium tuberculosis, and human hepatitis C virus tests exhibited inhibition rates ranging from 5 to 9%. Approximately 64% of these inhibitory specimens were not inhibitory when a second aliquot was tested. Because repeatedly inhibitory specimens were not reported as false negative and because additional infected specimens were detected during retesting, test sensitivities were 1 to 6% greater than they would have been if the IC had not been used.

Monoclonal antibodies against renal tumors: the potential application in discrimination of ambiguous adenocarcinoma or transitional cell carcinoma of kidney

PURPOSE

We tested the discrimination ability of 2 monoclonal antibodies, mAB 90 and 2-2, in renal carcinomas, including renal cell carcinoma and transitional cell carcinoma of the kidney.

MATERIALS AND METHODS

Two monoclonal antibodies raised in renal adenocarcinoma (mAB 90, IgG3 subclass and mAB 2-2, IgG1 subclass), have been generated in our laboratory by hybridoma technique. The tumor associated antigens recognized by these IgG subclass monoclonal antibodies are located in the cell membrane of tumor cells. Antibodies were purified from mice ascites through protein A-Sepharose 4B affinity column and then conjugated with fluorescein isothiocyanate fluorescence by dimethyl sulfoxide method. The binding activity of these antibodies was measured by direct immunofluorescence method and analyzed in a flow cytometer. Forty-five cases of renal cell carcinoma and 16 cases of transitional cell carcinoma of the renal pelvis were collected, and the recognition power of these 2 antibodies was tested. Frozen tumor tissues were prepared and allocated into single cell suspensions in phosphate buffered saline before adding diluted (1:10) conjugated antibodies. Irrelevant antibody and negative tumor cell lines without any reaction with these antibodies were used as background fluorescence control.

RESULTS

Reactivities of mAB 90 and mAB 2-2 for renal cell carcinoma tissues were 80 and 91%, respectively. On the contrary the reactivities of mAB 90 and mAB 2-2 for transitional cell carcinoma of renal pelvis tissues were 0 and 69%, respectively. mAB 90 (+)/mAB 2-2 (-) expression pattern had 76% accurate diagnostic rate for renal cell carcinoma and mAB 90 (+)/mAB 2-2 (+) pattern had 69% accurate diagnostic rate for transitional cell carcinoma of the kidney.

CONCLUSIONS

When facing pathologically ambiguous kidney tumors, the binding specificity of mAB 90 and mAB 2-2 may be useful for discrimination between renal cell carcinoma tumors and transitional cell carcinoma of the renal pelvis.

Bilateral multicystic kidney dysplasia in a fetus with neonatal pulmonary hyaline membrane disease: a case report

Multicystic kidney disease is the most common cause of neonatal renal mass and either the most or second most common neonatal abdominal mass. This disease is a congenital dysplasia of the kidney characterized by large nonhomogeneous dilations of the collecting tubules. It may occur unilaterally or bilaterally, and the incidence is about 1 out of 5,000 to 10,000 births. Severe bilateral defects are lethal. Partial dysplastic involvement of both kidneys eventually leads to renal function impairment. This is a case of bilateral multicystic kidney dysplasia diagnosed prenatally at 34 weeks of gestation. Hyaline membrane disease was found in both lungs after delivery. The antenatal diagnostic criteria for multicystic kidney disease and treatment after diagnosis are also discussed.

Spectrally weighted twisted projection imaging: reducing T2 signal attenuation effects in fast three-dimensional sodium imaging

A scheme for the reduction of T2 signal attenuation effects in three-dimensional twisted projection imaging is presented. By purposely reducing the sample density at the high spatial frequencies, a considerable reduction in readout time is achieved. The reduction in readout time leads to decreased T2 signal attenuation which translates into improved signal-to-noise ratio (SNR). The SNR improvement is achieved without decreasing the image's resolution since the point spread function depends on the sample weighting as well as the T2 attenuation. The results indicate that SNR improvements of up to 40% can be achieved using the proposed scheme.

Establishment of ANSI N13.11 X-ray radiation fields for personal dosimetry performance test by computation and experiment

This paper describes establishment by computational and experimental methods of the American National Standard Institute (ANSI) N13.11 X-ray radiation fields by the Korea Atomic Energy Research Institute (KAERI). These fields were used in the standard irradiations of various personal dosimeters for the personal dosimetry performance test program performed by the Ministry of Science and Technology of Korea in the autumn of 1995. Theoretical X-ray spectra produced from two KAERI X-ray generators were estimated using a modified Kramers' theory with target attenuation and backscatter correction and their spectral distributions experimentally measured by a high-purity germanium semiconductor detector through proper corrections for measured pulse height distributions with photopeak efficiency, Compton fraction, and K-escape fraction. The average energies and conversion coefficients obtained from the computation and experimental methods, when compared with ANSI N13.11 and the recently published National Institute of Standards and Technology X-ray beams, appeared to be in good agreement--(+/-)3% between corresponding values--and thus, could be satisfactorily applied in the performance test of personal dosimeters.

High-performance liquid chromatographic assay for the quantitation of irbesartan (SR 47436/BMS-186295) in human plasma and urine

A selective, accurate, precise and reproducible high-performance liquid chromatographic assay was developed for the quantitation of irbesartan, an angiotensin II antagonist, in human plasma and urine samples. The method involved solid-phase extraction of irbesartan and internal standard (I.S.) using a 100-mg Isolute CN cartridge. A portion of the eluate was injected onto an ODS analytical column connected to a fluorescence detector that was set at an excitation wavelength of 250 nm and an emission wavelength of 371 nm. The mobile phase consisted of 50% acetonitrile and a 50% weak phosphate-triethylamine solution, pH 3.5, at a flow-rate of 0.8 ml/min. The assay was linear from 1 to 1000 ng/ml with both plasma and urine. In either matrix, the lower limit of quantitation was 1 ng/ml. The analyses of quality control samples indicated that the nominal values could be predicted with an accuracy >95%. The inter- and intra-day coefficients of variation for the analyses in both matrices were <8%. Irbesartan was stable in both human plasma and urine for at least seven months at -20 degrees C. The application of the assay to a pharmacokinetic study is described.

The techniques of nonmuscular closure of hypopharyngeal defect following total laryngectomy: the assessment of complication and pharyngoesophageal segment

The usual method of reconstructing a hypopharyngeal defect during total laryngectomy includes pharyngeal muscle layer closure, which may result in high pharyngoesophageal pressure. We hypothesize that nonclosure of the pharyngeal muscle can reduce the pressure of the pharyngoesophageal segment which can reduce the chances of the formation of pharyngocutaneous fistulae. A technique of nonmuscular closure of a hypopharyngeal defect is presented. The differences in the rate of fistula formation and swallowing function between patients with usual and nonmuscular closure were also studied. Sixty consecutive laryngectomees were enrolled in this study. Thirty patients received usual closure after total laryngectomy, whereas the other 30 patients underwent non closure of their pharyngeal muscles. One patient (3.3 per cent) in the nonmuscular closure group and three patients (10 per cent) in the usual closure group developed a pharyngocutaneous fistula. The pharyngoesophageal pressures of the nonmuscular closure group were significantly lower than those of the usual closure group. We conclude that the technique of nonclosure of the pharyngeal constrictor muscle after total laryngectomy is relatively more simple and is not associated with a higher rate of fistula formation. Furthermore, nonclosure of the pharyngeal constrictor muscle is preferable to muscular closure because it reduces the spasm of the pharyngoesophageal segment which limits voice rehabilitation.

Cloning of the human cDNA sequence encoding the NADH:ubiquinone oxidoreductase MLRQ subunit

A cDNA clone encoding human NADH:ubiquinone oxidoreductase (complex I of mitochondrial respiratory chain) MLRQ subunit was isolated from human fetal liver cDNA library. The clone contained an open reading frame of 246 by which predicted a protein comprising 81 amino acids with a calculated molecular weight of 9,370 Da. The deduced amino acid sequence exhibited 95% homology (88% identity and 7% favored substitution) to that of bovine MLRQ subunit. Northern analysis revealed that the cDNA clone hybridized with a 0.7 kb mRNA species which was present in all tissues examined. The expression level of the 0.7 kb mRNA in heart, skeletal muscle, and brain was higher than in other organs. Human MLRQ cDNA could cross-hybridize with the genomic DNAs from various species.

Transoral Teflon injection under flexible laryngovideostroboscopy for unilateral vocal fold paralysis

Intracordal Teflon injection is a widely accepted method for the treatment of glottic incompetence due to unilateral vocal fold paralysis. It can be performed transorally via direct or indirect laryngoscopy, as well as transcutaneously under laryngovideoscopy. However, these procedures still have their disadvantages. The technique we introduce is to perform the procedure transorally while using a curved injection needle under flexible laryngovideostroboscopic monitoring. With topical anesthesia, the patient can phonate naturally during the procedure. The surgeon can visualize the needle and injection site clearly under high-resolution flexible laryngovideostroboscopy. Stroboscopic examination during surgery enables the surgeon to monitor the improvement of vocal fold vibration. Twenty consecutive patients treated with this technique were studied. The preliminary results are satisfactory. The technique we introduce is an outpatient procedure with high applicability and low morbidity. This technique is a good, cost-effective alternative to standard operative direct laryngoscopy with injection.

Conservative management of early endometrial adenocarcinoma with repeat curettage and hormone therapy under assistance of hysteroscopy and laparoscopy

We report a rare case of early-stage endometrial adenocarcinoma in a 22 year old nullipara with polycystic ovaries undergoing conservative treatment. Pretreatment evaluation including tumour grade, depth of myometrial invasion, tumour size, hormone receptor status and flow cytometric analysis indicated a favourable prognosis. The patient underwent repeat endometrial curettage and a 6 month period of therapy with megestrol acetate and tamoxifen. A combination contraceptive pill was then prescribed to ensure withdrawal of the menstrual cycle thereafter. Now, 1 year after the last curettage, there is no evidence of disease. During the treatment period, hysteroscopy allowed for a more precise approach in panoramically examining the tumour nest in the endometrial cavity, and the subsequent endometrial response to hormone therapy. Laparoscopy using bulldog clamps applied to the isthmic portion of the Fallopian tubes prevented i.p. spread of endometrial tissue from retrograde regurgitation during hysteroscopy. Laparoscopic ovarian electrocautery resulted in the reduction of abnormal hypervascularization on the surface of polycystic ovaries postoperatively but caused a peri-ovarian adhesion complication. It is interesting that this case posed a unique opportunity to demonstrate the tumour regression under the assistance of laparoscopy and hysteroscopy.

Morphology and vibration pattern of the vocal cord after intracordal Teflon injection: long-term results

BACKGROUND

Intracordal Teflon injection has been the mainstream management for unilateral vocal cord palsy over the past three decades. In recent years, some investigators concerned about its possible adverse effects on the vibration of the injected vocal cords. It is therefore necessary to clarify the clinical significance of these concerns if Teflon injection will stay as a viable treatment.

METHODS

Twenty-one patients with unilateral vocal cord palsy, who had received Teflon injection for more than one year, were evaluated by flexible laryngovideostroboscopy, basic voice function evaluations and the patient self-assessment.

RESULTS

The morphological and vibratory patterns of the post-injection vocal cords were categorized into seven types according to the videostroboscopic findings. Type I and type II cases had relatively normal morphology and vibration (assorted as group I). Type III through type VII cases showed various kinds of morphological and vibratory abnormalities (assorted as group II). Group I and group II were significantly different in the results of basic voice function evaluations and the patient self-assessment. Group I cases who showed relatively normal morphology and vibration had mean values closer to the normal ranges. For all the patients recruited, their voices were quite stable after injection. None with initial improvement of the voice suffered deterioration.

CONCLUSIONS

The results showed that some patients had nearly normal vibration of the vocal cords years after Teflon injection. True (delayed onset, not due to improper injection) and voice-disturbing Teflon granuloma was not seen in the present study. The majority of cases with disturbed vibration were due to either improper location or an improper amount of injected Teflon. The problems were mostly induced by technical difficulties, not by Teflon-related foreign body reaction. Efforts should be made to avoid these technical errors to increase the predictability of the outcome.

High-resolution echo-planar fMRI of human visual cortex at 3.0 tesla

Known specialized properties of the human visual cortex have been used to investigate the role of spatial resolution on fMRI using blood oxygenation level dependent (BOLD) echo-planar MRI at 3.0 tesla. The magnitude of BOLD signal changes has been examined at low (3.1 x 3.1 x 3.0 mm3) and high (0.8 x 1.6 x 3.0 mm3) resolution using both gradient-echo and spin-echo EPI. Paradigms were designed to activate primary visual cortex (V1/V2) and more specialized areas associated with detection of color (V4) and motion (V5). Sensitivity of activation maps increased at higher resolution despite the decreased total signal intensity at the smaller voxel size, presumably from reduced partial volume averaging. The greater microvascular selectivity of high-resolution spin-echo imaging enabled distinct activation patterns sensitive to motion to be detected in V1/V2 that were not apparent with gradient-echo imaging. The spatial resolution at 3.0 tesla was constrained by the size of physiological head motion relative to the voxel dimensions rather than SNR or the hemodynamic response of BOLD contrast. The higher spatial resolution at 3.0 tesla with more selective spin-echo EPI can further refine functional mapping within the cerebral cortex.

Fast three dimensional sodium imaging

An efficient scheme for fast three dimensional acquisition of sodium MR images is described. This scheme relies on the use of three dimensional k-space trajectories with constant sample density to achieve significant (60-70%) reductions in total data acquisition time over conventional projection imaging schemes. The performance of this data acquisition scheme is demonstrated with acquisition of sodium data sets on phantoms and normal human volunteers at 1.5 and 3.0 Tesla. The experimental results demonstrate that high quality three dimensional sodium images (0.2 cc voxel size, 10:1 signal-to-noise ratio) can be acquired at clinical field strengths (1.5 Tesla) in under 10 min.

The outcome of in vitro fertilization and embryo transfer therapy in women with endometriosis failing to conceive after laparoscopic conservative surgery

STUDY OBJECTIVE

To compare the outcome of in vitro fertilization and embryo transfer (IVF-ET) after laparoscopic surgery in women with endometriosis with that of patients with tubal factor infertility.

DESIGN

Retrospective survey of hospital and office charts using a computerized worksheet.

SETTING

Lin-Kou medical center of Chang Gung Memorial Hospital.

PATIENTS

Sixty-seven women with minimal to mild or moderate to severe endometriosis. Women with tubal factor infertility without other associated disorders (60 cycles) made up the control group.

INTERVENTIONS

Seventy-five consecutive cycles of IVF-ET were performed in these patients who failed to conceive after laparoscopic conservative surgery.

MEASUREMENTS AND MAIN RESULTS

The concentration of serum estradiol on the day of human chorionic gonadotropin (hCG) injection, the day of hCG injection, clinical pregnancy rates per transfer, number of follicles larger than 14 mm, number of embryos transferred, and implantation rate were not significantly different between women with endometriosis and those with tubal factor infertility. The number of oocytes retrieved and number fertilized were decreased, and the basal level of follicle-stimulating hormone on cycle day 3 was higher in women with both degrees of endometriosis. Women in both endometriosis groups received more follicle-stimulating hormone and human menopausal gonadotropin than those with tubal factor infertility.

CONCLUSIONS

The outcome of IVF-ET in patients with endometriosis after laparoscopic surgery did not differ from that in the group with tubal factor infertility, but the former required more ampules of gonadotropin to achieve the same response. The advantages of laparoscopic surgery in women with endometriosis should be probably correlated with success of IVF-ET.

Wide opening method for vocal fold retention cyst

BACKGROUND

Vocal fold cyst is a common cause of dysphonia. In our reported series, most cases were retention cysts. Enucleation of the cyst under microlaryngoscopy is usually considered to be an ideal treatment despite the fact that cyst rupture is frequently encountered with this procedure. In this report, we present a wide opening method for vocal fold retention cyst.

METHODS

Twenty consecutive patients with vocal fold retention cysts larger than 2 mm in diameter were operated upon using the wide opening method (marsupialization). The medial cyst wall was excised along with the overlying mucosa, while the lateral cyst wall was preserved on the vocal fold. The cyst was widely opened following this procedure.

RESULTS

Perceptual voice improvement was noted postoperatively. Videostroboscopy and acoustic analysis were also applied to confirm the perceptual results.

CONCLUSIONS

The wide opening method has the advantages of simplicity, minimal tissue injury, rapid functional recovery and low recurrence. This technique can be considered another standard treatment of choice for medium- or large-sized vocal fold retention cysts.

Subsequent reproduction and obstetric outcome after methotrexate treatment of cervical pregnancy: a review of original literature and international collaborative follow-up

The case reports of 22 patients with cervical pregnancies treated by methotrexate (MTX) administration and published in English literature between 1983 and 1995 were reviewed, by either original paper review or follow-up under international collaboration, to determine the subsequent reproductive performance and obstetric outcomes. Out of 22 cases, 18 (78%) MTX chemotherapy attempts succeeded with complete remission and four (22%) failed. Of the 13 women who wished to conceive and could be followed for at least 3 years, nine succeeded in having live births without congenital malformations, one spontaneously aborted and three suffered infertility. In general, MTX chemotherapy alone or combined with adjuvant methods such as subsequent cervical curettage or cervical tamponade, or intracervical potassium chloride injection, appears to be a convenient and effective method for the treatment of the majority of cervical pregnancies before 12 weeks gestation, and has not been shown to have detrimental effects on subsequent reproductive capacities, obstetric outcomes and progeny health for those cases with successful preservation of the uteri.

Vulvovaginal tuberculosis: a case report

A rare case of vulvovaginal tuberculosis is reported. A 76-year-old woman presented with a painful ulcer at the posterior fourchette and lower vagina for 6 weeks. Direct biopsy for histologic examination revealed mycobacterial infection. Anti-tuberculosis treatment was effective for this patient. We suggest prompt biopsies for suspicious vulvar or vaginal lesions.

Color Doppler energy in prenatal diagnosis of meconium peritonitis: a case report

Meconium peritonitis is an uncommon chemical peritonitis of a fetus resulting from antenatal bowel perforation. We reported a case of meconium peritonitis with pseudocystic formation diagnosed by color Doppler energy (CDE) at 34 gestational weeks. An echogenic substance inside a fetal abdominal mass was detected using ultrasound. By conventional color Doppler, there was minimal blood flow in the cystic wall or septums of the mass. Using CDE, bowel hyperperistalsis was observed in multiple small bowel loops and the region of intestinal loops into the mass was easily detected. Therefore, the angle independent nature of CDE will play a significant role in the early and accurate diagnosis of meconium peritonitis before birth.

Immunohistochemical analysis of insulin-like growth factor I, insulin-like growth factor I receptor and insulin-like growth factor II in endometriotic tissue and endometrium

BACKGROUND

The purpose of this study was to investigate unprecedentedly immunohistochemical localization of insulin-like growth factor I, insulin-like growth factor I receptor and insulin-like growth factor II in endometriotic tissue, and to compare staining intensity with that of endometrium obtained simultaneously.

METHODS

Endometriotic and corresponding endometrial tissue samples were obtained during operative laparoscopy from eighteen infertile patients for the problem of infertility. Semiquantitative scoring was used for analysis of results.

RESULTS

It was demonstrated that insulin-like growth factor I and insulin-like growth factor I receptor were present in both endometriotic and endometrial tissues. In contrast, there was little insulin-like growth factor II present in either ectopic or eutopic endometrial tissue. For insulin-like growth factor I and insulin-like growth factor I receptor, the immunostaining score was similar between ectopic and eutopic endometrial tissues. There was no significant difference in immunostaining score between glandular epithelium and stromal cells.

CONCLUSIONS

insulin-like growth factor I and insulin-like growth factor I receptor could be demonstrated immunohistochemically in both endometriotic and endometrial tissues.

Life table analysis of pregnancy rates in women with moderate or severe endometriosis comparing danazol therapy after carbon dioxide laser laparoscopy plus electrocoagulation or laparotomy plus electrocoagulation versus danazol therapy only

STUDY OBJECTIVE

To assess the effectiveness, in terms of pregnancy rates, of isotopic 13CO2 laser laparoscopy versus traditional laparoscopy or laparotomy in the treatment of infertile women with moderate or severe endometriosis.

DESIGN

Prospective 5-year study.

SETTING

Medical school-affiliated hospital.

PATIENTS

Three hundred nine infertile women with moderate to severe endometriosis.

INTERVENTIONS

The patients were treated with one of four options: operative laparoscopy with the 13carbon dioxide (13CO2) laser vaporization and/or resection, operative laparoscopy with simple electrocoagulation and sharp dissection, laparotomy with electrocoagulation and sharp dissection, and medical treatment with danazol. Estimated cumulative pregnancy rates using life table analyses were indicators of treatment of success and compared among treatments. A subgroup of 192 women considered to have endometriosis as the only infertility factor was also evaluated.

MEASUREMENTS AND MAIN RESULTS

Pregnancy rates in the laparoscopy group were equal to or higher than those of the laparotomy group, for both the entire population and the endometriosis-only subset. When the CO2 laser was used as an adjuvant option, the rates were better, especially in patients with advanced disease and with endometriosis as the only infertility factor.

CONCLUSION

In women with endometriosis as the only infertility factor, laparoscopic surgery with the 13CO2 laser was more effective than nonlaser treatment.

The correlation of membranous glycoprotein-gp-170, cytoplasmic glutathione and glucose-6-phosphate dehydrogenase levels with multidrug resistance in transitional cell carcinoma cell lines of the urinary tract

The expression of membranous glycoprotein gp-170, cytoplasmic glutathione (GSH) and energy-related glucose-6-phosphate dehydrogenase (G-6-PD) in cultured normal urothelial cells and transitional cell carcinoma (TCC) cell lines was analyzed by flow cytometric and enzymatic methods. The chemosensitivity of these tumor cells to four major types of anticancer drugs, including cisplatin, thiotepa, methotrexate, 5-fluorouracil, adriamycin and vinblastine, was correlated with biological activities in TCC cell lines. The TCC cell lines displayed a general sensitivity to anticancer drugs with a low incidence of highly resistant cell lines (23%). The expression of multidrug resistance was not related to cellular differentiation or invasiveness of cancer cells. Only 24% of TCC cell lines had an elevated expression of gp-170, but their expression was not related to drug resistance. Increased cytoplasmic GSH and G-6-PD was observed in over 90 per cent of TCC cell lines, but no correlation with drug resistance and cellular differentiation was observed. The biological activities of GSH and G-6-PD were not related to the drug resistance of TCC. The low expression rate of gp-170 in TCC cells indicates that other mechanisms should be involved in the development of MDR in TCC cells.

Leiomyomatosis peritonealis disseminata (LPD) with acute ascites induced by gonadotropin-releasing hormone (GnRH) agonist: a case report

Leiomyomatosis peritonealis disseminata (LPD) is a rare disorder characterized by the development of numerous leiomyomata throughout the peritoneal cavity. We present a case of a 29-year-old woman who had LPD with acute ascites induced by a GnRH agonist (Supremon; buserelin acetate nasal solution 400 micrograms/per day). We found abdominal wall leiomyomata under the left rectus muscle. Because the disorder tended to recur with acute ascites in this patient, castration was performed to eliminate the hormonal stimulation of tumor growth. We suggest postponing hormone replacement therapy post-operatively for 6 months, and we recommend close follow-up to prevent tumor recurrence and hypoestrogenism.

T cell recognition and cytokine production elicited by common and type-specific glycoproteins of herpes simplex virus type 1 and type 2

T cell recognition of common and type-specific herpes simplex virus (HSV) glycoproteins was measured in 72 subjects. T cells were stimulated with whole HSV-2 antigen and glycoproteins gB2, gD2, and gG2. T cell proliferation in response to HSV-2 antigen and gG2 was significantly higher in subjects with HSV-2 infection than in those with HSV-1 infection only; responses to gB2 and gD2 were the same. T helper (Th) type 1 and Th2 cytokine production in response to whole HSV-2 antigen, gB2, and gD2 was evaluated in 33 subjects. Interleukin (IL)-2 and interferon-gamma responses to most antigens were significantly higher among HSV-2-seropositive subjects than among seronegative subjects. IL-4 synthesis was negligible; IL-10 was produced in seronegative and seropositive persons, but HSV-2 antigen responses were significantly higher in HSV-2-seropositive persons. Naturally acquired immunity to HSV involves T cell recognition of common and type-specific glycoproteins, prominent Th1 responses, and discordant Th2 responses with little IL-4 but substantial IL-10 production.

Comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in taiwan

In order to clarify the feasibility of laparoscopically assisted vaginal hysterectomy (LAVH) using a not-for-extra charge instrument and to determine its cost-effectiveness in the Taiwan national health care system, we designed a prospective comparison which recruited candidates with nonmalignant uterine tumors prepared for hysterectomy to assess treatment by the laparoscopic versus the laparotomic approach. There were 144 patients in the laparoscopic group and 157 patients in the laparotomic group. The two groups were similar in characteristics. A total of 138 LAVHs were completed with six conversions (4.2%) to abdominal hysterectomy. Intraoperatively, the mean operating time in the LAVH group was longer than in the laparotomic group (134 vs 112 minutes, p < 0.001). No statistically significant differences were found between the two groups in mean estimated blood loss (260 vs 259 mL) and complications (5.8 vs 4.5%). Postoperatively, mean flatulence-relief time (27.4 vs 31.3 hours) and intramuscular meperidine requirements (1.6 vs 2.5 ampoules, 1 ampoule = 50 mg) were significantly less with LAVH. There were no differences in mean hemoglobin levels (10.7 vs 10.9 g/dL), complications (9.4 vs 13.4%, p = 0.288), or hospital stay (4.9 vs 5.2 days, p = 0.058). The mean total hospital charges (NT$48,390 vs 41,649) and insurance-paid costs (NT$43,992 vs 38,389) were significantly greater in the LAVH group. In conclusion, LAVH when performed by an experienced laparoscopist and for adequately selected patients, permits a better short-term convalescence, but is more expensive compared with conventional abdominal hysterectomy.

Multivariate analyses of the relationship between umbilical cord length and obstetric outcome

To investigate the clinical significance of umbilical cord length in human pregnancies, 1087 deliveries at Kaohsiung Chang Gung Memorial Hospital from May 1995 to August 1995 were studied. Our data showed that male fetuses had longer cord length than female and vertex presentation had longer cord length than breech presentation. The cord length and placental weight were significantly related to the birth weight. We found that: 1) only intrauterine growth retardation was associated with the increased risk of fetal distress; 2) secondary arrest of labor and advanced gestational age were correlated with meconium stain; and 3) birth weight and presence of meconium stain were correlated with the secondary arrest (p < 0.05). However, there was no significant correlation between umbilical cord length and fetal well-being. As a result of multivariate analyses, we conclude that the umbilical cord length does not significantly correlate with either maternal age, gestational age (> or = 28 weeks), parity fetal outcome or intrauterine fetal well-being. Birth weight is the only characteristic that is correlated with cord length.

The effects of Vero cell co-culture on human zygotes resulting from in vitro fertilization and oocytes following subzonal insemination

A variety of co-culture systems have been devised to enhance the human embryo development in vitro. Vero cells were selected because they can be highly controlled and are easy to handle. To evaluate the embryotrophic effects of Vero cell monolayers, when they were co-cultured with human in vitro fertilized zygotes or subzonal inseminated oocytes. Total 1695 two-pronuclear embryos resulting from in vitro fertilization were cultured with Vero cells or medium alone for 24 hours. Similarly, sixty-six two-pronuclear embryos resulted from subzonal insertion of sperm (SUZI) with co-culture starting immediately following SUZI were compared with fifty-two two-pronuclear embryos resulted from SUZI, without co-culture. The numbers of blastomere and morphology of embryos were compared between the co-culture group and control group using student's t-test. Cell numbers in each embryo were greater in the IVF/co-culture group than in the control group (4.01 +/- 1.32 vs. 3.86 +/- 1.45, p < 0.05). The rates of poor quality embryo with major fragmentation were lower in the co-culture group than in the control group(11.5% vs. 19.9%, p < 0.001, for IVF embryos; 9% vs. 27%, p < 0.005, for SUZI oocytes). Co-culture SUZI oocytes on Vero cells prior to fertilization did not positively influence embryo cleavage, but improved embryo quality. We conclude that Vero cells can enhance human embryo development; however, the period for one-day or two-day co-culture is too short to provide a maximal support. Short term co-culture did not increase implantation rates. Immediate co-culture following SUZI might somewhat rescue the microinseminated oocytes. However, a longer duration of co-culture is necessary to exert the maximal effects on embryo development and implantation.

Second trimester diagnosis of thanatophoric dysplasia

Thanatophoric dysplasia is one of the most common skeletal dysplasia, with an incidence from 1:6,400 to 1:100,000 births. While the etiology is unknown, either autosomal recessive or polygenic transmission with 0.2% recurrence risk had been suggested. It is a lethal disorder characterized by extremely short ribs, tubular bones and macrocephaly. Death is often secondary to pulmonary hypoplasia caused by the small thoracic cavity. We present a fetus with shortening of four limbs, typical thanatophoric dwarfism, diagnosed by sonography at the 25th week of gestation. The second trimester diagnosis by ultrasound was crucial, because it gave an alternative option of pregnancy termination when the affected fetus was discovered.

Child malnutrition in China--present status and changing trend

Halving the malnutrition of under five of years has been set as one of the goals to be achieved by the year of 2000 by Chinese government. So it is important to know the present status of child malnutrition and its trend of changing, in order to predict the possible outcome of the achievement of the goal. According to the Child Survey carried out by the State Statistic Bureau (SSB) in 26 provinces and autonomous regions and 3 municipalities in 1992, the prevalence of malnutrition of under five was: moderate and severe underweight, stunting and wasting were 17.9%, 34.7% and 4.7% respectively. But there are significant differences among urban and rural children and between different provinces. The highest prevalence rate usually occurred in the second year of life of the children, and this may be the result of inadequate weaning food provided to the children. As compared with the data collected in 1987 by SSB in 9 provinces and autonomous regions, an impressive improvement in underweight has occurred within these 5 years. The average declined prevalence was 20.5%. It is specially true for urban children. To stunting, there was also improvement for urban children but not in the rural, resulting and over all increasing of prevalence by 5.9%. To wasting, the prevalence for urban children was low and remained at the same level while there was some what increase in the rural. So, according to these results, with constant economic development and more attempt made in areas and groups at risk, the goal to decrease malnutrition in half in terms of underweight could be reached by the year of 2000.

Relationship of uterine perfusion to outcome of intrauterine insemination

This prospective study was undertaken to evaluate the prognostic value of uterine perfusion on the day of human chorionic gonadotropin administration in patients who were undergoing intrauterine insemination. Uterine perfusion was evaluated by measuring the pulsatility index of the ascending branch of the uterine arteries on the day of administration of human chorionic gonadotropin. No pregnancy occurred when the pulsatility index of the ascending branch of the uterine arteries was more than 3. The fecundity rate was 18% when the pulsatility index was less than 2 and was 19.8% when the pulsatility index was between 2 and 3 (not significant). The continuing pregnancy rate was 18% when the pulsatility index was less than 2, compared with 12.1% when the pulsatility index was between 2 and 3 (P < 0.05). Our data suggest that the measurement of uterine perfusion on the day of human chorionic gonadotropin administration may have predictive value regarding fecundity and the continuation of pregnancy in intrauterine insemination.