Fertilization and embryonic development of human oocytes after cooling

Injury to living cells resulting from rapid cooling to temperatures at or near 0 degrees C has long been recognized, and the phenomenon, which is termed 'cold shock', has been known to occur in some mammalian gametes. Although human embryos have been successfully stored at low temperatures, cryopreservation of the human oocyte is proving to be more difficult. Whether or not this lack of success is a direct result of cellular injury brought about by 'cold shock' is the purpose of the current investigation. Human oocytes were cooled, in the absence of cryoprotectants, at two different cooling rates (-3 degrees C/min and -1000+ degrees C/min) to a temperature of 0 degrees C and rewarmed prior to insemination. In both cases fertilization after cooling was similar to the rates achieved in a routine in-vitro fertilization and embryo transfer procedure. After cooling at -3 degrees C/min, the rate of fertilization was 19/22 (86%) and after cooling at -1000+ degrees C/min, 9/9 (100%), with non-cooled control rates of 62/87 (71%) and 35/50 (70%) respectively. Fertilized oocytes from both groups were successfully cultured for a further 24 h before termination of the experiment.

The primary care research fellowship: an early assessment

BACKGROUND

To address the continuing need for research-oriented faculty in primary care, the Bureau of Health Professions in 1988 funded 10 National Research Service Award (NRSA) Primary Care Fellowship Program grants. We report an early evaluation of these programs.

METHOD

Descriptions of fellowship programs were obtained from grant proposals. Fellows with at least one year of training completed a mailed questionnaire that included both structured and open-ended items.

RESULTS

All programs emphasized research and gave mentorship explicit attention. Nine offered degree programs; six offered a third year of study. Twenty-seven of 32 eligible fellows returned the survey. They reported a median of three research projects during the fellowship. Sixty percent of fellows had extramural funding; 48% submitted manuscripts for publication; and 22% had work accepted for publication. In open-ended responses, fellows emphasized the importance of mentors' guidance on projects, accessibility, and emotional support; rarely did they mention help in establishing professional networks or in securing project funding. Fellows most appreciated the collegiality and protected atmosphere of fellowship programs, although they felt that both human and material resources were less than optimal.

CONCLUSIONS

Fellowship environments are generally conducive to productivity, and fellows undertake relevant primary care research. Programs should devote more attention to mentoring, especially regarding networking and obtaining funding. Funding agencies should increase support for training-related expenses in lieu of research grants that subsidize NRSA training in other specialties.

Exposure to LHRH agonists in early pregnancy following the commencement of mid-luteal buserelin for IVF stimulation

Exposure to buserelin in early pregnancy has been reported following its use in in-vitro fertilization treatment cycles. The number of reported cases is small. There are still no answers regarding embryotoxicity, and the need for luteal support is still unclear. A further six cases are reported here, five receiving luteal support and resulting in the delivery of healthy children, and one, without luteal support ending in a first trimester miscarriage. We propose that further data should be collected to allow adequate monitoring and follow-up of these pregnancies.

The role of partial colpectomy in the management of persistent vaginal neoplasia after primary treatment

OBJECTIVE

To describe and assess the technique of partial colpectomy for the treatment of persistent vaginal neoplasia.

SETTING

Gynaecological oncology unit of a London teaching hospital.

SUBJECTS

12 women with persistent vaginal intraepithelial neoplasia (VAIN) following hysterectomy for cervical intraepithelial neoplasia (CIN) or for benign disease.

TECHNIQUE

Partial colpectomy using a vaginal approach assisted by a Schuhardt incision to improve access.

RESULTS

Assessment of patients between 9 and 99 (mean 55) months after partial colpectomy for VAIN showed no recurrence of disease in ten patients (83%).

CONCLUSION

This technique of partial colpectomy is an effective procedure, associated with minimal morbidity which should be considered as primary treatment for patients suffering from persistent vaginal disease after hysterectomy or other procedures.

Assessment of the relevance of zona pellucida antibodies in serum and cervical mucus in patients who have fertilization failure during in vitro fertilization

OBJECTIVE

To assess whether antibodies to the zona pellucida can cause fertilization failure during in vitro fertilization (IVF).

DESIGN

Two methods for detecting zona pellucida antibodies were used to assess 20 women undergoing IVF. Nine patients had failed fertilization during the treatment cycle.

SETTING

Academic IVF department of a teaching hospital.

PATIENTS

Infertile patients previously assessed as requiring IVF.

INTERVENTIONS

Gonadotropin-releasing hormone analogue to achieve pituitary down regulation and human menopausal gonadotropin for superovulation. Transvaginal ultrasound directed oocyte recovery. Cervical mucus and serum samples were obtained.

MAIN OUTCOME MEASURES

The presence of antizona pellucida antibodies in serum or cervical mucus in relation to fertilization.

RESULTS

Seven of 20 patients had antizona antibodies in serum and 7 of 20 patients had antibodies in mucus. Only 1 patient had antibodies in both samples. No correlation between the presence of antibodies in either sample and failure of fertilization was found.

CONCLUSION

Detection of antizona pellucida antibodies by the methods described have no role in the prediction of IVF.

Evaluation of the risk of pelvic infection following transvaginal oocyte recovery

The risk of introducing infection into the peritoneal cavity at the time of transvaginal ultrasound-guided recovery of oocytes in assisted reproduction techniques was assessed by culturing peritoneal fluid samples from 25 women with unexplained infertility. The samples were collected laparoscopically at the time of zygote intra-Fallopian transfer (ZIFT), 24-48 h after oocyte collection. High vaginal and endocervical specimens from 25 women treated by in-vitro fertilization (IVF) and transcervical embryo transfer were cultured for comparison. The peritoneal cultures were negative in all but one patient. High vaginal swabs grew Candida albicans in three cases and endocervical specimens were all negative. Seven and three pregnancies occurred in the ZIFT and IVF groups respectively. No pelvic damage was noted at laparoscopy in those women who had had previous treatment cycles with transvaginal oocyte recovery. This method of oocyte recovery, using prophylactic metronidazole and chlorhexidine for preoperative vaginal preparation, appears to be safe for treatment of women with no previous pelvic damage.

A pilot study of the prevalence of herpes genitalis among selected groups of patients seeking care in a family practice center

Herpes genitalis is typically studied in patient panels identified at specialized sexually transmitted disease clinics or with information obtained from herpes self-help groups. This article reports the results of a descriptive pilot study of the prevalence of herpes genitalis in family practice. The feasibility of obtaining psychosexual information on sexually transmitted diseases from more than 600 patients from five family practice practices was assessed. These initial data show that in the family practices participating in this study: 1) genital herpes is a low prevalence disease; 2) psychosocial adjustment to the disease among infected persons is usually reported as good, apart from sexual effects; and 3) close to 30% of the study population reported having prior sexually transmitted diseases. Problems involved in generalizing the results of this research and the limitations of conducting collaborative clinical research in family practice settings are reviewed.

Expert testimony based on decision analysis: a malpractice case report

OBJECTIVE

Expert testimony in malpractice cases is often subjective and biased. Decision-analytic techniques might provide an objective basis for such testimony.

DESIGN

Case report. This article reports the case of a patient with chest pain that resulted in a malpractice suit alleging a delay in diagnosis of coronary artery disease.

SETTING

The case occurred in a private practice; the expert witnesses and the decision analysis originated from a university teaching hospital.

METHODS

A decision tree and threshold analysis were used to define the thresholds of disease probability at which either testing or treatment should be implemented. The expert testimony of two witnesses that exercise stress testing was the standard of care was compared with the results of the decision analysis.

MAIN RESULTS

Decision analysis supported the view that cardiac catheterization would have been the more appropriate test.

CONCLUSIONS

Techniques of decision analysis provide a structured and quantitative basis for empirical judgment and may help to minimize current problems with expert testimony.

Infant care: the value of the six week check

A review of the routine six week post-natal examination of the well-baby was performed. Eighty-one percent of infants born in the Rotunda attended for a hospital based review during the study period and 42% of these had experienced some problem during the six weeks from birth (rashes 20%, snuffles 10.7%, irritability 7.6% and eye infections, constipation, diarrhoea, vomiting, cyanotic/breath holding episodes). These problems were dealt with by the hospital outpatient department (55%), the mothers themselves (30%), general practitioners (12.5%) and public health nurses (2.5%). Significant problems not detected at birth were present in 12 infants (3%) and eight infants (2%) required hospital admission. This review illustrates a relatively low rate of problems not previously detected and that the majority of problems arising in the first six weeks of life require advice alone. There is also clearly scope for improving the community based services and increasing their involvement in this aspect of infant health.

Physical and mechanical properties of anterior and posterior composite restorative materials

The physical and mechanical properties of two photo-cured anterior filling materials and a photo-cured posterior filling material have been compared with those of a conventional-cure resin composite. The properties of these materials were found to be dependent on their matrix resin compositions, filler contents, and filler particle sizes. One material with a low (50%) inorganic filler content of small particle size (0.04 micron) was found to have a lower mechanical strength with significantly higher water sorption and solubility characteristics than more heavily filled materials. A new hybrid photo-cured anterior composite with a smaller filler particle size was found to have comparable sorption and solubility behavior but a tensile strength superior to that of a conventional-cure composite. The superior properties of the new photo-cured systems are thought to result from their hybrid composite structures and the smaller filler particle sizes.

An enhancement of inpatient diagnosis clusters: applications to residency training

The diagnosis cluster method has recently been used effectively to compare inpatient and outpatient clinical experiences across data sets for practicing physicians and family practice residents. This paper describes the use of the diagnosis cluster method to study the three-year experience of a class of family practice residents in one university program and three community hospital programs. A group of 10 additional clusters based on the criteria of frequency, clinical homogeneity, and educational importance were identified covering 14.3% of the diagnoses not falling within the established 52-cluster method. These residency-specific clusters require review and validation by further analysis of clinical data and peer review by faculty involved in residency education.

The effects of gamma radiation on the properties of composite restorative resins

The effects of gamma radiation at therapeutic dosage levels on the physical properties of three anterior (two light-cured and one autocure) composites and a light-cured posterior composite were studied. Gamma radiation had no effect on the autocured composite but had varied effects on the light-cured systems. The diametral tensile strength and dimensional stability were unaffected, water sorption and solubility were reduced but surface and bulk hardnesses were increased with the hardness increases linearly related to the radiation dosage. These effects may arise from continued polymerization of the air-inhibited surface layer and possibility of low molecular weight entities within the matrix. Overall, therapeutic levels of gamma radiation had no detrimental effects on the physical properties of the composite resins.

The mouse carbonic anhydrase I gene contains two tissue-specific promoters

We report the isolation and characterization of the mouse carbonic anhydrase I (CAI) gene. Direct RNA sequence analysis of the 5' nontranslated regions of CAI mRNA from mouse colon and mouse erythroleukemia cells demonstrated tissue specificity in the lengths and sequences of CAI transcripts. Analysis of several mouse CAI genomic clones showed that the transcripts arose from a single CAI gene with two tissue-specific promoters and eight exons. CAI transcripts in the colon were found to initiate just upstream of the erythroid exon 2 of the CAI gene region sequence. Erythroid transcripts originated from a novel promoter upstream of exon 1, which was located more than 10 but less than 250 kilobases upstream of exon 2. Erythroid exon 1 contained only a nontranslated sequence, which was spliced to exon 2 via a cryptic splice acceptor site located in the region that encoded the colon mRNA 5' nontranslated sequence. The remaining exon-intron junctions were conserved in comparison with those of the CAII and CAIII genes.

The development of an information resource center for academic family medicine

The discipline of family medicine covers a broad area of interests which often leads to duplication of information and lack of awareness of useful information resources. In an era of limited financial and time resources, it is in the best interest of large departments to consolidate departmental and scholarly information and to educate faculty members, residents, and medical students in the effective use of information retrieval systems and other sources of information. This paper presents the development of a small departmental center to organize and manage family medicine related information and resources and implementation of that information in the activities of an academic family medicine department to support teaching, research, and patient care.

Patterns of uterine contractions and prolonged uterine activity using three methods of breast stimulation for contraction stress tests

The contraction patterns in 378 breast-stimulated contraction stress tests administered to 213 women are described. The subjects were assigned sequentially to one of four intervention groups: bilateral manual breast massage, unilateral pump stimulation, heating pad stimulation, and placebo. There was a marked increase in the proportion of tests with three to four contractions in 5-minute intervals after the interventions occurred. Twenty-five percent of all tests showed prolonged uterine activity, occurring most frequently in women with postdate gestations using manual massage or breast pump stimulation. The duration of prolonged contractions ranged from 1.5-8 minutes, with 19% lasting from 4.5-8 minutes. There was no difference in the incidence of fetal heart rate abnormalities between tests with and without prolonged uterine activity, and no late decelerations occurred in tests with tachysystole.

Doctor-patient communication on the telephone

Since its invention, the telephone has been an important tool in medical practice, particularly for primary care physicians. Approximately half the calls made to a physician's office during regular consulting hours are for clinical problems and most are handled effectively over the phone without an immediate office visit. Telephone encounters are generally very brief, and managing such calls requires a pragmatic approach that is often quite different from the approach taken in the office visit. The telephone encounter should be recognized and recorded as a specific medical interaction in the medical chart for both clinical and legal reasons. Effective telephone encounters depend on good communication skills; decision making regarding disposition is a major goal. The physician's perception of a medical problem may be different from the patient's; patients are frequently seeking advice and reassurance rather than diagnosis and treatment, and may call because of anxiety and psychological stress. For physicians and their families who are not prepared for after-hours telephone encounters, calls that interrupt more "legitimate" activities may result in anger or frustration for the physician and dissatisfaction for the patient.