Benefit of in vitro fertilization treatment for endometriosis-associated infertility

OBJECTIVE

To evaluate the effectiveness of IVF treatment in endometriosis-associated infertility.

DESIGN

Nonrandom retrospective study.

SETTING

Department of Gynecology and Obstetrics, Akita University School of Medicine.

MAIN OUTCOME MEASURE(S)

Cumulative pregnancy rate.

PATIENT(S)

One hundred eighteen infertile patients in whom diagnosis of endometriosis was established by laparoscopic examination.

INTERVENTION(S)

The prognoses of 60 patients (IVF group) who started IVF treatment within 6 months after laparoscopy were compared with those of 58 patients who were managed expectantly without IVF treatment during the same period.

RESULT(S)

The cumulative conception rates at 36 months after laparoscopy were 62% in the IVF group and 43% in the control group, and the difference was not significant (a log-rank test). For patients > or = 32 years of age, the conception rates were significantly higher in the IVF group (59% versus 29%). A relatively large but nonsignificant difference in the conception rate between the two groups was observed in patients with endometriosis at stages III or IV (52% versus 27%).

CONCLUSION(S)

In vitro fertilization treatment provides better prognosis in patients > or = 32 years of age and is recommended for such patients. The benefits of treatment appear to be greater in patients with more advanced stages of endometriosis.

A pure, monolayer culture of Merkel cells from sinus hair follicles of the rat

Merkel cells, mechanoreceptor cells in the skin, were dissociated from sinus hair follicles of the whisker pads of newborn rats, and cultured in a serum-free medium. Based on the uptake of quinacrine, a specific fluorescence marking dye, more than 90% of the cells in culture were identified as Merkel cells. During monolayer culture on a poly-L-lysine-coated coverglass surface, Merkel cells exhibited a flat round morphology and often extended thin lamellae on their fringe. Small particles eliciting quinacrine fluorescence were present throughout these cells, with the exception of the lamellae or nuclei. Most Merkel cells died in 48-72 h in the serum-free medium. Fetal calf serum added to the medium protected Merkel cells from the cell death, and the Merkel cells had a fibroblast-like morphology in the serum-containing medium.

Status of the coagulation and fibrinolytic systems in ovarian hyperstimulation syndrome

OBJECTIVE

To elucidate characteristic changes of plasma hemostatic markers in ovarian hyperstimulation syndrome (OHSS) cycles.

DESIGN

Prospective study.

SETTING

The IVF-ET program of the Department of Obstetrics and Gynecology, The University of Akita, School of Medicine.

PATIENTS

Forty cycles of 40 IVF patients, including 12 cycles in which a severe form of OHSS occurred.

INTERVENTIONS

Blood samples were taken during IVF treatment to determine the levels of blood markers that reflect activation of the coagulation and fibrinolytic systems.

MAIN OUTCOME MEASURES

Thrombin-antithrombin III complexes, plasmin-alpha 2 antiplasmin complexes, and other hemostatic markers related to the coagulation and fibrinolytic system activation.

RESULTS

In the OHSS cycles, the levels of thrombin-antithrombin III and plasmin-alpha 2 antiplasmin complexes in the plasma began to rise within a few days after hCG administration and demonstrated significantly higher levels during the midluteal phase. In OHSS cycles with pregnancy, elevation of these markers continued for > or = 3 weeks after the onset of disease. There were some characteristic changes in OHSS cycles in other hemostatic markers, such as a decrease in the levels of antithrombin III and prekallikrein and shortened activated partial thromboplastin time.

CONCLUSION

These data demonstrate the status of the coagulation and fibrinolytic systems in OHSS cycles and provide insight into the mechanism of activation in the hemostatic system.

Identification of the Fas antigen in human gingiva

The Fas antigen is a cell-surface glycoprotein that mediates apoptosis from the cell surface into the cytoplasm. Polyclonal antibody (Fas D) was raised against a synthetic polypeptide selected from the extracellular part of the human Fas antigen (amino acid residues 104-114) and was used to detect the Fas antigen in human gingiva. Biopsy specimens of human gingiva were prepared, and the paraffin sections were reacted with the Fas D antibody by an immunohistochemical method. The antibody localized to the prickle-cell layer and to granular layer keratinocytes of human gingiva. Proteins were also prepared from human gingiva and subjected to SDS-PAGE, followed by Western-blotting analysis with the Fas D antibody. The antibody interacted with a band corresponding to an estimated molecular weight of 35 kDa. The incidence of the immunoreactive 35-kDa protein was detected in the gingiva of 90% of the 20 individuals examined. The Fas antigen detected in human gingiva may be related to the physiological turnover of oral mucosa.

[A case of AIDS with bronchial tuberculosis]

A case is 48 years-old Japanese man who had a history of frequent sexual contact with prostitutes in Thailand and the Philippines. He presented with chief complaint of chest discomfort in April 1995. His chest X-ray film showed right mediastinal lymph node swelling in other hospital and the sputum smear was strongly positive for acid fast bacilli. In May 1995, he was admitted to our hospital and serological tests for HIV were positive both by EIA and Western blot methods. The CD4 lymphocyte count was 167/microliters. He was diagnosed as a case of AIDS according to the criteria proposed by the AIDS surveillance committee of the Japanese Ministry of Health and Welfare. Although numerous tubercule bacilli were detected in sputum, the chest X-ray did not show abnormal shadow in lung fields. So the diagnosis of bronchial tuberculosis was suspected by these apparently contradictory findings and the bronchoscopy was performed. Biopsy specimen of the bronchial mucous membrane obtained by bronchoscopy confirmed the presence of acid fast bacilli by Ziehl-Neelsen's staining method, however, histological findings were atypical of tuberculosis. A month after the initiation of treatment with isoniazid, rifampicin and ethambutol and AZT, his clinical symptoms improved and the sputum smear and the culture tests for tubercule bacilli converted to negative. Complications of AIDS, (Pneumocystis carinii infection, Cytomegalo virus infection, Kaposi's sarcoma, etc) other than tuberculosis have not developed to date. In the past reports, we could not find reports of bronchial tuberculosis with AIDS. Tuberculous granuloma formation was scarce in this case, and it was suspected that bronchial tuberculosis with AIDS would show characteristic sign as same as pulmonary tuberculosis with AIDS.

Sperm immobilization antibodies in infertile male sera decrease the acrosome reaction: a possible mechanism for immunologic infertility

OBJECTIVE

To study the effect of sperm-immobilizing antibodies from male sera on spontaneous and A23187-induced acrosome reactions (AR).

DESIGN

Swim-up spermatozoa obtained from three fertile donors were incubated with 13 sera with sperm-immobilizing antibodies obtained from infertile men and three control sera obtained from healthy fertile males. Sperm acrosomes were examined by staining with pisum sativum agglutinin labeled with fluorescein isothiocyanate (30 micrograms/ml; Sigma Chemical Co., St. Louis. MO) as spontaneous and A23187 (used at a final concentration of 10 microM; Sigma Chemical Co.) induced.

RESULTS

The incidence of spontaneous AR of spermatozoa incubated with antisperm antibody positive male sera (6.2 +/- 0.7) was significantly (P < 0.001) lower than that of spermatozoa incubated with control sera (10.7 +/- 0.5). And the incidence of A23187-induced and -inducible (incidence of induced minus spontaneous) ARs of spermatozoa incubated with sperm antibody-positive male sera (12.4 +/- 1.9 and 6.2 +/- 1.9) was significantly lower (P < 0.001) than that of spermatozoa incubated with control sera (31.0 +/- 0.5 and 20.3 +/- 0.9). Sperm-immobilizing antibody-positive sera decreased spontaneous, A23187-induced, and inducible ARs.

CONCLUSIONS

Sperm-immobilizing antibodies from male sera interfere with fertilization by inhibiting the AR.

[Primary intramedullary melanocytoma of medulla oblongata: a case report]

A case of intramedullary melanocytoma of the medulla oblongata; which has not been hitherto reported, is presented. The tumor ran on a slow progressive course. The patient died of pneumonia seven months after the operation. MRI findings did not specify this tumor as they were not distinct from those of malignant melanoma. The tumor was totally black and was not attached to the dura. Microscopically, the neoplastic cells were uniform in size and possessed abundant melanin granules in their cytoplasm. Mitosis was very rare. The ultrastructure of the tumor cells showed many melanosomes at varying stages of maturation. The melanocytoma in the eloquent region has an unfavorable outcome.

Short protocol of gonadotropin releasing hormone agonist administration gave better results in long protocol poor-responders in IVF-ET

OBJECTIVE

To determine the effectiveness of a short protocol (SP) of gonadotropin-releasing hormone agonist (GnRH-a) administration in patients who already had undergone at least one in vitro fertilization (IVF) and embryo transfer (ET) treatment cycle with the long protocol (LP) and had shown poor results.

METHODS

One hundred and twelve patients were studied. The E2 levels, the number of preovulatory follicles, the number of oocytes retrieved and fertilized, the number of embryos cleaved, the fertilization rate and the number of embryos transferred were calculated.

RESULTS

The values for the mentioned parameters were significantly higher in the SP than those in the LP. So were the pregnancy rates per cycle and per ET (23.2% and 24.1%, respectively) in the SP significantly (p < 0.0001) higher than those in the LP (12.5% and 13.5%, respectively).

CONCLUSION

In cases who showed poor results to the LP, instead of repeating the same protocol the SP may be substituted. This strategy may not only improve the results, but also decrease the total cost of the IVF-ET treatment.

In vitro fertilization of in vitro matured oocytes obtained from the follicles without hCG exposure for prevention of severe ovarian hyperstimulation syndrome: a case report

We aspirated ovarian follicles of an infertile patient who encountered a great risk of ovarian hyperstimulation (OHSS) during her ovulation-induction cycle, which had been stimulated with gonadotropins, in order to avoid OHSS without interrupting the treatment. If this action were to yield a considerable number of immature oocytes, some of which were to achieve in vitro maturation and subsequent fertilization, this method could be an alternative to conventional ovulation-induction methods for patients who repeatedly present imminent signs of hyperstimulation. However, the number of oocytes collected from the patient was disappointingly low, even though a large number of follicles were thoroughly aspirated. One of these oocytes was matured in vitro in a medium containing 30% follicular fluid and granulosa cells of mature follicles, fertilized, cryopreserved, and transferred in a later artificial cycle; but pregnancy was not achieved. A low number of recovered oocytes from patients in this situation might be a factor that greatly limits the clinical applications of this method.

[An autopsy case of microscopic polyarteritis nodosa resembling Schoenlein-Henoch purpura]

A 86 year-old woman was re-admitted because of purpura of her upper and lower extremities, abdominal pain and blood stools. Seven weeks previously, she underwent a gastrectomy for gastric cancer. After re-admission, proteinuria and hematuria were noted, and the serum creatinine level increased. Two months, after the onset of purpura, she died of pneumonia. On autopsy examination, fibrinoid vasculitis of acute inflammatory stage (II) at small arteries and/or arterioles in the bladder, rectum, lungs, spleen and crescentic glomerulonephritis without immune deposits were observed. A diagnosis of microscopic polyarteritis nodosa (M-PN) was made based on these clinical and histological findings. M-PN refers to systemic vaculitis with segmental necrotizing glomerulonephritis. However, this condition may be difficult to diagnose because vasculitis such as Scholein-Henoch purpura (SHP) and/or hypersensitivity angitis, diseases in which the small arteries and arteroles are mainly affected, occasionally bears a clinical and histological resemblance to M-PN. Because differential diagnosis from SHP was required, this case provided abundant suggestions with regard to the entity of M-PN.

Characteristics of blood hemostatic markers in a patient with ovarian hyperstimulation syndrome who actually developed thromboembolism

OBJECTIVE

To investigate whether a patient with ovarian hyperstimulation syndrome (OHSS) demonstrated characteristic changes in the blood hemostatic markers before she developed thromboembolism.

DESIGN

Patients with OHSS had blood drawn to determine hemostatic markers and related factors.

PATIENTS

Twenty-three OHSS patients, including a case complicated with thromboembolism.

SETTING

The IVF-ET program of the Department of Obstetrics and Gynecology, The University of Akita, School of Medicine.

MAIN OUTCOME MEASURES

Blood hemostatic markers and related factors.

RESULTS

The patient with thromboembolism demonstrated marked leukocytosis and higher levels of activation in the blood markers related to fibrinolytic system, such as alpha 2 plasmin inhibitor, plasmin-alpha 2 antiplasmin complexes, and D-dimers, before the onset of this episode.

CONCLUSION

Marked leukocytosis and higher levels of activation of the fibrinolytic system may be the signs of imminent thromboembolism in OHSS patients.

Prospective evaluation of simple morphological criteria for embryo selection in double embryo transfer cycles

Preventing the occurrence of high-rank multiple pregnancies without reducing the pregnancy rate remains a high priority of in-vitro fertilization and embryo transfer programmes. Our previous study demonstrated that, if there is at least one embryo with a good morphological grade, then the transfer of two (a double embryo transfer) instead of three embryos does not result in a lower pregnancy rate, and that the influence of the number of embryos transferred becomes significant only when poor-quality embryos are transferred. This result allowed us to employ the simple policy of systematically selecting double embryo transfer cycles without affecting the pregnancy rate. Since January 1994, when patients < 37 years of age had more than two embryos available for transfer, only two instead of three embryos were transferred if at least one of the embryos demonstrated a good morphological grade. After a 1 year application of this policy, of the 147 cycles (group A) that fulfilled the above criteria, two embryos were transferred in 92 cycles, while three embryos were transferred in the other 55 cycles. The results of these cycles were compared to those of the control 144 cycles (group B) in which three embryos were transferred, prior to the application of this policy. The on-going pregnancy rates and the incidence of multiple and triplet pregnancies were 24% and 28%, 22% and 23%, and 2% and 9% in groups A and B respectively. The rates were not significantly different. In conclusion, although our prospective trial demonstrated a tendency of decreasing pregnancy rate and an invariable incidence of multiple pregnancies, the very low occurrence of triplets during this period indicated that this policy provided a practical compromise between achieving a high pregnancy rate and an acceptable incidence of triplet pregnancies.

The role of pulse oximetry. Its use as an indicator of severe respiratory disease in Peruvian children living at sea level. Respiratory Group in Peru

OBJECTIVE

To evaluate pulse oximetry as a technique for diagnosing pneumonic and nonpneumonic acute lower respiratory tract infection (ALRI) in Peruvian children.

DESIGN

Children with acute respiratory infection were diagnosed with hypoxemia by pulse oximetry, with ALRI by the World Health Organization (WHO) algorithm and clinical examination, and with pneumonia by radiographic examination. Diagnoses were compared using kappa analysis.

SETTING

Pediatric emergency department.

PATIENTS

Peruvian pediatric patients with acute respiratory infection (n = 269) and well children (n = 162).

MAIN OUTCOME MEASURES

Hypoxemia (arterial oxygen saturation < 96.6% of the mean arterial oxygen saturation of well children -2 SD).

RESULTS

Children with pneumonic and nonpneumonic ALRI (59%, 160/269) had a mean (+/- SD) arterial oxygen saturation significantly lower than well children (93.8% +/- 3.5% vs 98.7% +/- 1.51%; P < .01). Pulse oximetry detected 88% and the WHO algorithm 90% of cases of pneumonic ALRI. The WHO algorithm and pulse oximetry detected 72% of radiologic pneumonia. Pulse oximetry misclassified notably fewer well children than did the WHO algorithm (4% vs 35%). Pulse oximetry and the WHO algorithm together (SATWHO) detected 99% and 87% of pneumonic ALRI and radiologic pneumonias, respectively, and both methods detected 94% of all cases of pneumonic and nonpneumonic ALRI diagnosed clinically.

CONCLUSIONS

Pulse oximetry and the WHO algorithm are practical, helpful, and appropriate for use in developing countries to identify children with pneumonic and non-pneumonic ALRI who require treatment. The SATWHO is highly sensitive for detecting children with ALRI.

Nasal natural killer (NK) cell lymphoma: report of a case with activated NK cells containing Epstein-Barr virus and expressing CD21 antigen, and comparative studies of their phenotype and cytotoxicity with normal NK cells

Malignant lymphomas arising from the nasal cavity have been considered to be derived from T cells, but recent surface marker studies suggest that more than half of the lymphomas are derived from natural killer (NK) cells. Here we describe a case of nasal lymphoma whose lymphoma cells were identified as NK cells by morphological, phenotypic, immunogenotypic, and functional studies. We believe this is the first study with functional evidence of NK activity. When compared with normal freshly isolated NK cells or activated NK cells, the surface phenotypes and NK activity of the patient tumour cells were those of the activated, but not resting, NK cells. Also, Epstein-Barr virus (EBV) was detected in the tumour cells and the lymphoma cells were found to be monoclonally expanded. The patient's lymphoma cells also expressed EBV receptor CD21 (CR2) and CD30 (Ki-1) that have not been described on normal NK cells. We therefore examined highly enriched NK cells of normal donors, and found that some resting and/or activated NK cells express these antigens.

High incidence of embryo transfer cancellations in patients with polycystic ovarian syndrome

This study was aimed at assessing the outcome of in-vitro fertilization (IVF) and embryo transfer in patients with polycystic ovarian syndrome (PCOS). The results of IVF and embryo transfer in PCOS patients (PCOS group, 78 cycles of 26 patients) were compared with those of a control group (423 cycles in 202 patients without male factor; age and ovarian stimulation protocol were matched). Although the pregnancy rate per transfer was not different in the two groups of patients (25 versus 34%, PCOS versus control group), the PCOS group had a significantly lower pregnancy rate per follicle aspiration (19 versus 31%, P < 0.05). A notable result was a significantly higher incidence of embryo transfer cancellations in the PCOS group (22 versus 8%, P < 0.01), which resulted from unpredictable failure of either oocyte recovery or fertilization. The incidence of unexplained complete failure of fertilization was significantly higher in the PCOS group (18 versus 5%, P < 0.01). These results may reflect a reduced quality of the oocytes in the PCOS group, and there was a subgroup of PCOS patients who repeatedly produced poor results of treatment. Although the ovarian stimulation regimen best suited to PCOS patients remains to be determined, special care should be taken during ovarian stimulation, especially when the PCOS patients had experienced unexplained failure of oocyte recovery or fertilization in the previous treatment cycle(s).

Two instead of three embryo transfer in in-vitro fertilization

The rational of transferring two instead of three embryos was studied through 468 in-vitro fertilization (IVF) treatment cycles in 287 couples. The quality of 1224 embryos was determined according to the fragmentation rate and the morphology as good (A) and poor (B). The influence of the number of embryos transferred (two or three) on the pregnancy rate when the same quality or combinations of good and poor quality embryos transferred was examined. When only good quality embryos were transferred the pregnancy rates in double (AA) and triple (AAA) embryo transfer were 40.5 (17/42) and 42.9% (30/70) respectively (not significant). When only poor quality embryos were transferred, the pregnancy rates in double (BB) and triple (BBB) embryo transfers were 11.0% (11/100) and 22.9% (16/70) respectively (P < 0.001). On the other hand, when good and poor quality embryos were transferred together as AB in double and as AAB and ABB in triple embryo transfer, the pregnancy rates were 36.8 (14/38) and 39.9% (59/148) respectively (not significant). There was no difference in the miscarriage rate between double and triple embryo transfers; 16.7 and 18.1% respectively. The multiple pregnancy rate was 14.3% for double embryo transfers and 32.4% for triple embryo transfers (P < 0.001). This study demonstrates that if there is at least one good quality embryo available for transfer, then double instead of triple embryo transfer will not yield a significantly lower pregnancy rate. The influence of the number of embryos transferred on the pregnancy rate became significant when only poor quality embryos were transferred.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect on sperm-immobilizing antibodies on the spontaneous and calcium-ionophore (A23187)-induced acrosome reaction

OBJECTIVE

To study the effect of sperm-immobilizing antibodies on spontaneous and A23187-induced acrosome reactions.

MATERIAL AND METHODS

Swim-up spermatozoa obtained from a fertile donor were incubated with 16 sera containing sperm-immobilizing antibodies obtained from infertile women and 3 control sera obtained from healthy females. The acrosome loss, either occurring spontaneously or induced by 10-microM A23181, were examined by staining sperm with Pisum sativum agglutinin labeled with fluorescein isothiocyanate.

RESULTS

The incidence of the spontaneous acrosome reaction of spermatozoa incubated with anti-sperm antibodies (6.25 +/- 1.4%) was significantly (P < .001) lower than that of the spermatozoa incubated with control sera (12 +/- 0.8%). The incidence of A23187-induced and inducible (incidence of induced minus spontaneous) acrosome reactions of spermatozoa incubated with sera-positive for sperm antibodies (10.4 +/- 1.3% and 4.2 +/- 1.5%) was also significantly lower (P < .001) than that of spermatozoa incubated with control sera (30.7 +/- 0.5% and 18.7 +/- 1.2%).

CONCLUSION

Sperm immobilizing antibodies interfere with fertilization by inhibiting the acrosome reaction.

Phase-contrast radiographs of nonstained rat cerebellar specimen

Phase-contrast radiography using an x-ray interferometer is presented for observing organic matter. High sensitivity of phase-contrast radiography is demonstrated with a rat cerebellar specimen without staining it with a contrast medium. The layer structure of the cerebellum can be observed in the obtained image while there is no clear structure in the corresponding absorption-contrast image. Quantitative image analysis is made possible by converting an x-ray interference pattern to an x-ray phase shift distribution. The lipid distribution in the cerebellum is discussed by evaluating x-ray phase shifts before and after lipid removal.

The effect of insulin and insulin-like growth factor-1 on the expression of calretinin and calbindin D-28k in rat embryonic neurons in culture

In a primary culture of rat embryonic neurons, insulin (5 mg/ml) promoted neurite formation between neuron clusters in serum/glial-free simplified medium with a high concentration of transferrin (100 micrograms/ml). Insulin growth factor-1 (IGF-1) exerted a similar effect in the same culture system at a lower dose (100 ng/ml) of insulin. Calretinin has recently been identified as a calcium binding protein expressed predominantly in sensory neurons, which has six calcium binding domains and shows molecular similarity to calbindin D-28k, an intestinal calcium transporter protein also found in the CNS. The effects of insulin and IGF-1 on the expression of calretinin and calbindin D-28k were investigated in rat embryonic neuronal cell culture. When cells were cultured for 2 days, insulin and IGF-1 promoted the expression of both proteins; when cultured for more than 2 days, IGF-1 still exerted a growth factor effect, but insulin decreased the expression of calretinin. Using the present culture system, we demonstrated that the effects of closely related molecules, insulin and IGF-1 which share receptors reciprocally, differed in calretinin and calbindin D-28k expression. Therefore, these two calcium binding proteins may play different physiological roles in the nervous system based either on different molecular mechanisms or switching roles at different stages of CNS development. Amplification based on Western blot employing the streptoavidin-horseradish peroxidase method was applied to detect calretinin and calbindin D-28k in the culture system by an immunoblotting technique.