Treatment Effect of Combined Surgical Maxillary Expansion and Mandibular Setback in Skeletal Class III

The purpose of this case report is to describe and discuss a combined surgical and orthodontic technique for the management of transverse maxillary deficiency and mandibular prognathism in the treatment of skeletal Class III malocclusion in a mature patient. Skeletal Class III malocclusion can present with maxillary deficiency or retrognathism, mandibular excess or prognathism, or a combination. The maxillary arch is narrow and often requires expansion. A 25-year-old patient presented with a constricted maxilla, a skeletal Class III malocclusion with a large mandible, Angle's Class III malocclusion, retroclined lower incisors, proclined upper incisors, crowding of maxillary and mandibular teeth, and bilateral posterior crossbite. The case report shows that an adult patient with Class III malocclusion (constricted maxilla and large mandible) can be treated with rapid maxillary expansion accompanied by bilateral maxillary osteotomies, followed by a reduction bilateral sagittal split osteotomy (BSSO). As the patient was 25 years old with a bilateral crossbite, a surgically assisted rapid maxillary expansion procedure was performed. As the diastema space was available at the end of expansion, it proved to be beneficial for the presurgical decompensation of Class III, thus creating a negative overjet, followed by which a BSSO setback was done.

Pediatric Facial Fractures: A 10-year Study

Aims and Objectives

The aim of the study is to retrospectively analyse the incidence of facial fractures along with age, gender predilection, etiology, commonest site, associated dental injuries and any complications of paediatric patients operated in Craniofacial unit of SDM college of dental sciences and hospital.

Materials and Methods

This retrospective study was conducted at the department of OMFS, SDM College of Dental Sciences, Dharwad from January 2003-December 2013. All the patients below 15 years of age were included in the study. Data were recorded for the cause of injury, age and gender distribution, frequency and type of injury, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, complications, concomitant injuries and different treatment protocols.

Results

A total of 68 cases of paediatric fracture were treated during these 10 years. Boys were commonly injured than girls with a ratio of 2.9:1, the commonest cause of trauma was fall (59 %), mandible was the commonest bone to be fractured (83 %), treatment protocols were dependant on the age, region and type of fracture but in most of the cases closed reduction was the choice of treatment, dental injuries were seen in 26 % patients and the commonest injury was avulsion.

Conclusion

This study was done not only to analyse the different types of facial fractures and the pattern of fracture of paediatric cases admitted at this centre, but also to act as a contributional data which will help us to take preventive measures to avoid such injuries and make the appropriate treatment plan and execute it to achieve the pre-injury status of form and function.

Accuracy of palpation, ultrasonography, and computed tomography in the evaluation of metastatic cervical lymph nodes in head and neck cancer

Introduction:

India accounts for the majority of oral cancer cases occurring worldwide. The metastasis of oral cancer to the regional lymph nodes and distant sites determines the prognosis and the survival rate of this disease.

Objectives:

The aim and objectives of this study were to evaluate the accuracy of preoperative clinical methods such as palpation, ultrasonography (USG), and computed tomography (CT) in comparison with postoperative histopathological findings in determination of metastatic cervical lymph nodes and also to assess whether combining these techniques increases the specificity and sensitivity of lymph node metastasis in oral squamous cell carcinoma (SCC).

Methodology:

Totally, 26 consecutive biopsy proven cases of oral SCC were included, and the nodal status was evaluated by palpation, CT and ultrasound (US) and confirmed by histopathological examination. The results were presented in terms of sensitivity, specificity, predictive values, accuracy, and P value.

Results:

Palpation, USG, and CT findings were compared with histopathologic findings by Fisher's exact test and the “P” value for palpation, US and CT were 0.003, 0.000, 0.000, respectively, which are statistically significant.

Conclusion:

US examination combined with CT gives a better assessment of the neck for nodal metastasis.

Peripheral calcifying epithelial odontogenic tumor - Case report

The calcifying epithelial odontogenic tumor (CEOT), Pindborg tumor is a benign, slow growing, but locally invasive neoplasm. It is known to have a common intraosseous variant and a very rare extraosseous variant. We report an unusual case of an extraosseous variant of CEOT of unusual large size and maxillary anterior location, the treatment was planned considering the clinical, radiological and histological features. Though peripheral types are less aggressive and had no recurrence, in our case regular follow up is required considering the aggressiveness of the lesion and its proximity to important adjacent structures.

Assessment of masticatory function using bite force measurements in patients treated for mandibular fractures

Bite force measurements are excellent criteria for assessment of masticatory efficiency. The purpose of this study was to assess the effect of mandibular fractures on the bite forces of patients treated for such fractures. Patients who were surgically treated for isolated mandibular fractures in the Department of Oral and Maxillofacial Surgery from January 2006 to December 2007 were included in the study. Patients were asked to bite on a bite force transducer on the first, fourth, sixth, and ninth postoperative weeks. The bite force values were compared with those of age, sex, and weight-matched controls. A total of 60 patients were included in the study. It was found that maximum bite forces in patients were significantly less than in controls for several weeks after surgery. After the ninth postoperative week, the maximum bite force measured < 65% the normal in patients with isolated angle fractures and > 80% the normal in patients with isolated parasymphysis fractures. The same values reduced to < 60% in patients with fractures of angle and parasymphysis and < 70% in patients with fractures of parasymphysis and condylar complex. An inverse relationship was found between the bite force values and the number of fractures of the mandible. We also found lower bite forces and longer period for normalization in patients who had fractures in those regions of the mandible which are more significantly associated with the masticatory apparatus for example angle or condyle of the mandible.

Oral eumycetoma of infancy: a rare presentation and a brief review

Mycetoma is a chronic granulomatous infection of skin and subcutaneous tissue, which may involve bone. The disease is caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Both types of organism are important soil saprophytes, and therefore infection is normally acquired by traumatic inoculation of the skin by contaminated material. Clinically, mycetomas are characterized by tumefaction, draining sinuses and discharging grains. The grains are aggregates of fungal hyphae or bacterial filaments, and grain size, colour and consistency provide the initial clue to the causative organism. To our knowledge, this probably is the first case report of oral eumycetoma of infancy. Review of literature shows only ten cases of eumycetoma involving the head and neck, including the present case. Histological examinations of the biopsies were the cornerstone in the diagnosis of mycetoma. The distinction between eumycetoma and actinomycetoma is essential for treatment. Direct microscopic examination of the grain and histopathological examination, using histochemical staining will distinguish between the two. Treatment consists of long courses of antifungals and antibacterials agents, often combined with surgery.

Inflammatory pseudotumor of maxillary sinus: Mimicking as an aggressive malignancy

Inflammatory pseudotumor is a rare entity in the head and neck region. Clinically it behaves as an aggressive lesion with extensive destruction but considered to be a benign reactive process. Because of its extensive involvement and infiltrative nature, it is confused as a malignancy. Most of them respond very well to corticosteroid and surgical excision.

Epidermal inclusion cyst of the mandible after extraction of a third molar: case report

Epidermal inclusion cysts of the head and neck are rare. We report the case of a non-traumatic epidermal inclusion cyst in the submandibular region, with both intraosseous and extraosseous components, which communicated with the socket of a third molar extracted 12 years previously.

Osteomyelitis of maxilla in poorly controlled diabetics in a rural Indian population

OBJECTIVES

To retrospectively analyze all patients who were diagnosed with Osteomyelitis of jaws in our unit.

STUDY DESIGN

31 patients with Osteomyelitis of jaws were analyzed retrospectively from 2002 to 2008 at the Department of Oral & Maxillofacial Surgery, S.D.M College of dental sciences and hospital, Dharwad, India. Parameters considered were age, gender, jaws involved, clinical features, surgical management & complications.

RESULTS

Of the 31 patients, maxilla was involved in 16 patients and mandible was involved in the remaining 15. 11 out of the 16 patients with maxillary osteomyelitis were immuno-compromised. The predominant etiology noted was odontogenic infection. With the treatment protocol we have adopted, all our patients showed satisfactory resolution of the condition by 6 weeks.

CONCLUSION

Incidence of maxillary osteomyelitis & their association with diabetes mellitus was higher in our series compared to others. The cause for this high incidence was analyzed in our study. Based on our results we conclude that a conservative surgical method with an attempt to preserve vital bone and an appropriate antibiotic therapy with the correction of the underlying medical problems is adequate to treat Osteomyelitis of jaws.

Cyclic neutropenia in a cleft lip and palate patient: a case report

Cleft lip and palate is the most common congenital anomaly. Its association with hematologic disorders is rarely reported. Cyclic neutropenia is a rare blood disorder that may occur spontaneously or has a genetic predisposition. Periodicity/recurrence of cyclic neutropenia has a cyclical pattern reoccurring in multiples of 7 days, usually at 21- or 28-day intervals between attacks, with the patient being fairly asymptomatic. There is no case in the literature that has reported the presence of cyclic neutropenia in cleft patients. We report a case of cleft patient associated with cyclic neutropenia. The clinical features, diagnosis, and course of management are described.

Non-syndromic recurrent multiple odontogenic keratocysts: a case report

Odontogenic keratocysts (OKCs) are one of the most frequent features of nevoid basal cell carcinoma syndrome (NBS). It is linked with mutation in the PTCH gene. Partial expression of the gene may result in occurrence of only multiple recurring OKC. Our patient presented with nine cysts with multiple recurrences over a period of 11 years without any other manifestation of the syndrome.

Evaluation of Parental Nasomaxillary Asymmetry as a Risk Factor for Development of Palatal Clefts in their Offsprings

Background and Objectives : It has been suggested previously that increased width of midfacial structure is associated with the development of palatal clefting. One of the most important heritable characteristics predisposing towards the development of orofacial clefting in an embryo is craniofacial morphology. The aim of the study was to compare nasomaxillary width of parents of children with unilateral complete cleft lip alveolus and palate with parents of noncleft children. Methods : 25 biologic parent sets of children with unilateral complete cleft lip alveolus and palate and 25 biologic parents of noncleft children were included in this study for PA cephalometric analysis. Results : There was no statistically significant difference between study and control groups. An association was found between the side of the cleft in the affected children and the parents in the same side with narrower nasomaxillary width. Interpretation and conclusion : The result of this study was in contrast with other previous studies. We observed a narrower nasomaxillary width, which suggested that this feature may be of morphogenetic importance in the etiopathogenesis of orofacial clefting in this geographic and ethnic group.

Poor quality of sperm as it affects repeated early pregnancy loss

A study was carried out to determine whether males contribute to repeated early pregnancy loss. Semen samples were analyzed from proven-fertile men (n = 51 group I) and from men whose partners presented with early pregnancy loss (>3 first trimester abortions, n = 32 group II). Routine analysis, sperm function tests, and ultrastructural studies of sperms were carried out. Female factor could be identified in 25 (78%) couples, and in 7 (22%) no cause either male or female could be identified and the semen analysis was normal. Percent morphologically normal did not differ significantly between the groups, but increased sperm head abnormalities were seen. The functional tests were all normal except for a significant decrease in the capacity of nuclear chromatin to decondense in vitro. The ultrastructural studies showed defects of chromatin condensation and irregular nuclei with vacuoles. This study points to the loss of chromatin integrity as a possible contributing factor from males to early pregnancy loss.

Does seminal fluid viscosity influence sperm chromatin integrity?

A retrospective study was undertaken to investigate whether viscosity alters sperm chromatin integrity. Semen samples were obtained from 269 men attending the infertility clinic. The viscosity was measured quantitatively by needle and syringe method and the viscosity ratio was calculated against distilled water. The chromatin integrity was evaluated by in vitro decondensation test using 1% SDS and 6 mM EDTA. According to the viscosity ratios the samples were divided into 2 groups: I, normal (ratio < 9, n = 239): and II, abnormal (ratio > 9, n = 30) viscosity. Chromatin integrity was significantly lower in the group with higher viscosity. Significant decrease in sperm count and motility were seen in group II as compared to group I. Thus, hyperviscosity of seminal fluid alters the sperm chromatin integrity.

Constraints in the development of contraceptives for men

Considerable efforts have been made to develop a male contraceptive and the studies have provided very useful information in this field. At least five different strategies to develop a male contraceptive have been pursued, namely: inhibition of sperm production, interference with sperm function, interruption of sperm transport, prevention of sperm deposition, and prevention of sperm-egg interaction. Of all these approaches, inhibition of sperm production by using androgens either alone or in combination with progestins have given the most encouraging results. A number of clinical trials substantiate that it is indeed possible to have a reversible, effective and safe hormonal method of contraception. A postmeiotic and epididymal approach to interfere with sperm function or the secretory and metabolic processes of the epididymis is another attractive option of male contraceptive development. A number of chemical compounds have been identified which interfere with sperm function in the epididymis without affecting sperm production, however, the compounds evaluated so far were found to be toxic. Interruption of sperm transport through the vas either by vasectomy or percutaneous intravasal injection of liquids which form cure-in-place plugs is also an attractive option. However, reversibility of the methods is of concern in their wide scale use. The major constraint in developing a long-acting male contraceptive seems to be the need for greater investment for product development. The clinical trials for evaluating the efficacy and safety of the new products and formulations stretch over several years and require enormous financial commitment. Nevertheless, the long-term gain of having a long-acting reversible contraceptive for men is far greater than the financial commitments over few years. Male attitude towards using methods of family planning is much more favourable than originally believed. The pharmaceutical industry as well as the health care providers therefore have a greater responsibility. For early development of a contraceptive for men, it is essential to increase investment and simplify the drug regulatory procedures. The advent of newer technologies coupled with the convergent efforts of scientists will certainly make it possible to have an effective, safe and reversible male contraceptive in the near future.

Use of acridine orange to evaluate chromatin integrity of human spermatozoa in different groups of infertile men

To study the sperm chromatin compactness various methods, such as acidic aniline blue or acridine orange staining, have been applied. Due to its metachromatic properties, acridine orange dye fluoresces green with double- and red with single-stranded DNA. Samples (n = 181) were evaluated and grouped as follows: group I, normal recently fertile; group II, male having female partner with repeated early pregnancy loss; group III, male with varicocele; and group IV in-vitro fertilization and intrauterine insemination failures. Routine semen analyses were carried out in all the cases. Amorphous particulate matter as observed under phase contrast microscope was graded on the scale of nil to +4. Fixed smears were stained with an aqueous solution of acridine orange and viewed under a fluorescence microscope. Two hundred cells were counted and the percentage of fluorescence calculated. Groups II, III and IV exhibited significantly low green fluorescence compared with the control group. The study also indicates that increased amorphous particulate matter (indicating infection) might be one of the contributing factors to lower acridine orange stainability. Thus acridine orange staining can be used to evaluate the integrity of the nucleus, disorders of which can cause unexplained infertility or lower fertilization potential that may go undetected by routine analysis.

Tamoxifen-induced light and electron microscopic changes in the rat testicular morphology and serum hormonal profile of reproductive hormones

The effects of oral administration of tamoxifen at doses of 40 and 200 micrograms/kg/day on testicular histology, testicular ultrastructure and serum hormonal profile were studied. The drug was administered to adult male rats over a period of 90 days and the effect was assessed at 10-day intervals. The morphometry, microscopic structures of the testis, including ultrastructure and daily sperm production rate, were evaluated. The hormone profiles of luteinizing hormone (LH), follice-stimulating hormone (FSH), testosterone, and estradiol were studied. The testes from treated animals showed disorganization of tubular elements with increased intercellular space. At day 50, the changes were extensive including presence of phagosomes. Morphometric studies showed a reduction in the spermatid and spermatozoan population (69.3%) with no changes in tubular diameter. The mean Leydig cell area was significantly lowered at day 50, at both doses. The daily sperm production rate was reduced as compared with controls. An array of degenerative changes were revealed by ultrastructural studies. The changes were extensive at day 50 at both doses. The characteristic features were lost in most of the cells with phagolysosomes becoming abundant. The cytoplasm of the cells was dense with poorly defined cytoplasmic organelles. Circulating LH levels were not modified at the 40 micrograms/kg/day dose but at 200 micrograms/kg/day, LH levels were significantly decreased. Initial transitory rise in FSH was seen with both doses. Both doses of tamoxifen decreased testosterone levels. Changes in the circulating estradiol levels were inconsistent, and no apparent relationship between dose and days of treatment was observed. Thus, this study supports our thesis of tamoxifen as a potential male contraceptive agent.

Efficiency of routine semen analysis to predict functional and structural integrity of human spermatozoa

The study is to examine the ability of routine semen analysis to predict the functional and structural integrity of spermatozoa in in vitro conditions. Since large number of subjects were evaluated over a long period of time, the value of routine analysis to prognosticate the functional and structural integrity in the same sample was assessed. Routine semen analysis was done on 354 subjects. In the same sample, functional tests were carried out. The functional tests applied were hypoosmotic swelling test, test for acrosome intactness, nuclear chromatin decondensation test and sperm mitochondrial activity index. A scoring system was adopted for both routine and functional analysis. According to the scores obtained, the samples were categorized into fertile, subfertile and infertile. Analysis of the data indicated that efficiency of routine semen analysis was 38.13%. Prediction of functional integrity by routine analysis of semen specially in subnormal cases is only partly fulfilled. The study also indicates that functional tests are definitely indicated in cases with subnormal score.

Onapristone (ZK 98.299): a potential antiprogestin for endometrial contraception

OBJECTIVES

The effects of the antiprogestin onapristone (ZK 98.299) on fertility; menstrual cycle length; duration of menses; serum estradiol, progesterone, and cortisol concentrations; and endometrial morphologic features were studied in adult bonnet monkeys.

STUDY DESIGN

Five animals were treated subcutaneously with the vehicle and another nine with either 2.5 (n = 4) or 5 mg of onapristone per animal (n = 5). Treatment was initiated on day 5 of the first treatment cycle, and thereafter onapristone was administered every third day for four to seven consecutive cycles. The females were placed with adult males during the periovulatory period, which was assessed by frequent analysis of serum estradiol concentrations. In the final treatment cycle an endometrial biopsy was performed on day 8 after a midcycle estradiol peak in the ovulatory cycle, or around day 20 if the cycle was anovulatory. Blood samples for estradiol, progesterone, and cortisol measurement were collected every third day, except for the periovulatory period when sampling was more frequent.

RESULTS

Each of the five animals treated with the vehicle became pregnant: one in the first, three in the second, and one in the third mated cycle, whereas only one of nine treated with onapristone became pregnant. Four animals treated with 2.5 mg of onapristone for 17 cycles and another four treated with a 5 mg dose for 21 cycles did not conceive. In eight animals that did not conceive the first three treatment cycles of six were ovulatory, and in the remaining two animals two cycles of each were ovulatory. During treatment the mean menstrual cycle length was not altered significantly; however, in one it was shortened and in another two it was prolonged. Similarly, the mean duration of menses was not significantly affected, but in some cycles it was reduced. Moreover, there was only slight bleeding in some treatment cycles. Ovulation occurred in 30 of 45 treatment cycles, including the final treatment cycle during which the biopsy was taken, as indicated by serum estradiol and progesterone concentrations. In some of the ovulatory cycles prolonged treatment suppressed luteal activity; however, in the ovulatory cycles the duration of follicular and luteal phases was not significantly affected. In the anovulatory cycles there was a delayed increase in serum estradiol concentrations, suggesting a partial inhibition of folliculogenesis. In treated animals endometrial growth and development was retarded and rendered out of phase. In animals treated with the higher (5 mg) onapristone does the endometrial glands had partially regressed, the secretory activity was blocked, and stromal compaction was evident. The treatment had no significant effect on serum cortisol levels.

CONCLUSIONS

This study demonstrates that low-dose onapristone treatment throughout the menstrual cycle prevents pregnancy without disturbing the menstrual cycle and ovulation in the majority of cycles. However, anovulation and luteal insufficiency occurred in some animals during prolonged treatment. The contraceptive effect in the ovulatory cycles seems primarily related to the retardation of endometrial development resulting in the inhibition of endometrial receptivity. It appears likely that a dose or treatment regimen of onapristone that will inhibit endometrial receptivity and prevent implantation without affecting the menstrual cycle even on prolonged treatment could be identified.

Severe asthenozoospermia: a structural and functional study

Ejaculates from 25 patients with severe asthenozoospermia (all spermatozoa immotile or only non-progressively motile) were studied to identify individually the cause of impaired motility. Multiple tests were performed, viz. light and electron microscopic studies and sperm function tests. An objective scoring was applied to both the routine and the functional analyses. Three categories of samples were identified: (1) necrozoospermia (n = 9), where sperm viability was very poor; (2) structural tail abnormality as seen by light microscopy (n = 4); and (3) ultrastructural abnormality (n = 12). In the last category, one case showed absence of dynein arms; this was associated with mitochondrial abnormalities. Mitochondrial abnormality with normal tail components was observed in the majority (n = 7) and accessory fibre abnormality in four cases. The scoring system revealed that, functionally, all samples were abnormal whereas routine analysis showed 15 samples to be subnormal and 10 to be abnormal, which indicates the need for functional analysis. Because of the multiple defects seen in these samples, there is a need for a battery of sperm function tests. This study indicates that mitochondrial defects are one of the causes that may account for the loss of sperm motility in the patient population.

Alteration of semen characteristics and regulatory factors in human semen with bacterial infection

Semen samples (n = 40) obtained from males attending an infertility clinic were subjected to bacteriological culture and categorized as bacteriologically negative (group I) and bacteriologically positive (group II) depending on the culture positivity. Semen samples from both groups were simultaneously analyzed for routine parameters such as volume, count, motility, viability, morphology, pH, and hypoosmotic swelling. Seminal plasma was assayed for levels of prolactin (PRL), prolactin-suppressing factor (PSF), prostatic inhibin peptide (PIP) and zinc (Zn). Patients in group II (n = 25) showed statistically significant alteration (p < .01) in semen parameters such as motility, percent normal morphological forms, and percent normal HOS test as compared to group I (n = 15). There was a negligible change in the sperm concentration between the two groups. The semen volume, viability, and pH did not show any variation. Among the regulatory factors assayed, there was a significant change in the Zn, PSF (p < .05), and PIP (p = .01), while no such alterations were seen for PRL. The results suggest that bacterial infection affects fertility either by affecting the seminal characteristics directly or by acting on the regulatory systems.

Effects of tamoxifen on the fertility of male rats

The effects of oral administration of tamoxifen (a synthetic non-steroidal anti-oestrogen) at doses of 40, 200 or 400 micrograms kg-1 day-1 on the circulating concentrations of LH, FSH, prolactin, testosterone and oestradiol, weights of pituitary, testes, secondary sex organs and the fertility of adult male rats were determined. The drug was administered per os daily, for up to 90 days. The fertility of rats treated with tamoxifen for 60, 70, 80 or 90 days was assessed by allowing them to mate with normal female rats of proven fertility. Tamoxifen at 40 micrograms kg-1 day-1 reduced concentrations of testosterone in plasma but had no affect on LH, FSH, prolactin and oestradiol concentrations, and the weights of pituitary, testes, epididymides, ventral prostate and seminal vesicles. Tamoxifen at 40 micrograms kg-1 day-1 reduced potency, fecundity, the number of implantation sites, the fertility index and litter size. Tamoxifen at 200 and 400 micrograms kg-1 day-1 reduced the concentrations of LH and testosterone in plasma and the weights of testes and secondary sex organs compared with controls. Tamoxifen at 400 micrograms kg-1 day-1 was most effective in reducing the number of viable pups, the litter size (< or = 1) and the fecundity (20%). The potency of treated rats (a measure of the presence of an ejaculate) was significantly decreased when compared with controls, but copulation was apparently not affected as mated female rats showed a constant dioestrous phase. Histology of the testes revealed disorganization of the cytoarchitecture of the tubules with obliterated lumen.(ABSTRACT TRUNCATED AT 250 WORDS)

Volume of semen as a parameter of its quality

A total of 1655 semen samples obtained from men who underwent initial semen analysis before enrolling for IVF-ET programme were analysed. The semen samples were categorized arbitrarily on the basis of volume as high (> 4.5 ml), normal (1.5-4.5 ml) and low (< 1.5 ml). The semen parameters studied vis-a-vis volume of the sample were viscosity, osmolality, motility, sperm count and morphology. The different volume groups were also compared to the overall quality of the sample. The study showed that high and low volume semen were associated with high incidence of spermatozoa exhibiting subfertile characteristics. Normal volume per se did not indicate the quality of the sample, however high and low volumes were indicators of semen of subfertile quality. There was an inverse correlation between osmolality and volume of semen sample. Thus the parameter 'volume' gives a rough estimate of the quality of the sample.

Antifertility effects in rats actively immunized with 80 kDa human semen glycoprotein

A 80 kDa human sperm antigen has been identified using the serum of an infertile woman having circulating antisperm antibodies. The antigen was then purified to homogeneity by gel permeation chromatography using HPLC (protein PAK-125 column) system and on FPLC (superose-12 column) system. The antigen was found to be a glycoprotein. The antigen was mainly localized in the postacrosomal region of the human sperm, while it was localized in the head region of the rat sperm as demonstrated by immunofluorescent staining. The presence of this antigen was also demonstrated in the human prostate and endometrium and in the rat testis; epididymis and the prostate by immunocytochemical staining. The purified protein upon active immunization in female rats caused infertility in 100 percent animals. While in male rats it caused infertility in 90 percent animals. On morphometric analysis of testicular tissue it was observed that there was no significant change in spermatogonia and spermatocytes, but significant decrease in spermatids and sperm number as well as daily sperm production in the immunized male rats. The epididymal spermatozoa were markedly reduced in number and were largely found to be agglutinated. The results suggest that 80 kDa human sperm antigen appears to be a suitable candidate for immunocontraception both in male and female.

Morphometric and ultrastructural studies on the rat testis following administration of antiserum to human seminal plasma inhibin

A study was undertaken to see the effects of antiserum to human seminal plasma inhibin (hSPI) on the morphology of rat testis. Morphometric, light microscopic, and ultrastructural studies were done on rat testis after 4, 8, and 12 weeks of administration of antiserum to hSPI. Daily sperm production rate was also estimated by histometric method. The light microscopic analysis showed a slight decrease in tubular diameter which was not significant. The degenerative changes in the tubules were marked after 12 weeks of treatment. The daily sperm production rate was reduced by 50% after 12 weeks of treatment. The ultrastructural study revealed phagocytosis of elongated spermatids and spermatozoa enclosed in a vacuole surrounded by Sertoli cells. The Sertoli cells were dedifferentiated into an immature type. The spermatogonia were not affected. The treatment with antiserum to hSPI alters testicular morphology at the spermatid and mature spermatozoa level. Since treatment with AshSPI is known to elevate the FSH level it appears that the morphological changes correlate with the endocrine status.

Incidence of abnormalities in sperm morphology as an indicator of its fertilizing potential

A retrospective analysis was carried out to assess the correlation of sperm morphology with the occurrence of fertilization in vitro of human oocytes. Seventy women who were subjected to in vitro fertilization procedure were taken up for this study. The cytological smears of semen were evaluated for the morphological characteristics of spermatozoa. Instances where in vitro fertilization did not occur (group II) had significantly (P less than 0.001) higher morphological abnormalities (head defects) when compared with those where fertilization occurred in vitro (group I). The results indicate that evaluation of sperm morphology with special reference to head abnormalities has diagnostic potential in human in vitro fertilization.

Passive immunization against prostatic 'inhibin' peptide as a male contraceptive

Passive immunization of adult male hamsters for 12 weeks against peptide (As-PIP), a sperm coating antigen, resulted in selective elevation of the blood levels of FSH, impairment of spermatogenesis, and complete infertility when males were mated with normal cycling females. Passive immunization of male marmosets with As-PIP for 8 weeks was also effective and was reversible, without causing any obvious change in mating behaviour. These preliminary studies in hamsters and marmosets indicate that antibodies to a prostatic 'inhibin' peptide represent a promising new approach to male contraception.

Comparison of four different ovarian stimulation protocols in an in vitro fertilisation & embryo transfer programme

Four different ovarian stimulation protocols were evaluated in an in vitro fertilisation and embryo transfer programme in 208 women (228 treatment cycles). In the rigid protocol (RP), 100 mg of clomiphene citrate (CC) was given from day 3 to day 7 of the menstrual cycle and 300 IU of human menopausal gonadotropin (hMG) was given from day 5 of the menstrual cycle. In the individualised protocol (IP) the same drugs and doses were used as in RP, but the day of initiation of CC depended on the length of the individual's menstrual cycle and hMG was administered from the last day of CC. In the programmed protocol (PP), ovarian function was suppressed with oral contraceptive pills (ethinyl estradiol 30 micrograms and norethisterone 1 mg) started on day 5 of the menstrual cycle for 45 to 70 days. Considering the last day of pill intake as day 0, CC was given for 5 days from day 5 and hMG (300 IU) from day 7. In the alternate day protocol (ADP), 100 mg of CC was administered from day 2 to day 6 and hMG (300 IU) was given on alternate days from day 2 to day 8 or day 10 of the cycle. In all the women, hCG (5000 IU) was administered when the diameter of at least 2 follicles was greater than or equal to 16 mm and estradiol levels were 300 pg/ml/dominant follicle. Patients not showing such a response were not treated further. The cardinal events of IVF-ET such as number of good responders, incidence of oocytes harvested, fertilised and embryos transferred per cycle were compared and it was concluded that the pregnancy rates were highest in women treated by the PP.

Effects of intranasal administration of norethisterone on folliculogenesis, cervical mucus, vaginal cytology, endometrial morphology and reproductive-endocrine profile in women

The effects of intranasal administration of norethisterone (NET) on menstrual cycle length, folliculogenesis, serum levels of estradiol, FSH, LH and progesterone, vaginal cytology, cervical mucus and endometrial morphology were studied in 8 volunteers (age 28 to 39 years, weighing between 46 and 54 kg). The study period comprised 4 consecutive menstrual cycles. In the first cycle (pretreatment cycle), only the vehicle (alcohol, propylene glycol, water; 3:3:4) was sprayed intranasally (100 microliters in each nostril), using a metered nebulizer, once daily from day 3 to the last day of menstrual cycle. In the next two cycles (treatment cycles), NET (300 micrograms/day) was administered once daily, starting from day one of menstrual cycle, between 9 and 10 a.m. The fourth cycle was a post-treatment cycle in which the volunteers were monitored for recovery. Blood samples (about 5 ml each) were collected once daily from day 8 to 24 and thereafter on alternate days until the last day of cycle during all the 4 cycles. Levels of estradiol, FSH, LH and progesterone were measured in the serum samples by radioimmunoassay methods. Cervical mucus samples and vaginal smears were collected once daily starting from day 7 or 8 of each cycle until the mucus was very scanty. Serial pelvic ultrasonography was performed starting from day 7 or 8 until the growing follicle disappeared or throughout the cycle in case a growing follicular cyst was observed. Endometrial aspirates were collected once around day 22 in each cycle and processed for routine histological examination.

In vitro decondensation of nuclear chromatin of human spermatozoa: assessing fertilizing potential

Spermatozoan nuclear chromatin is in a highly condensed state prior to fertilization. In vivo decondensation occurs in the ooplasm and is essential for successful fertilization and the formation of male pronucleus and the zygote to occur. The chromatin of spermatozoa and nucleus can undergo in vitro decondensation with sodium dodecyl sulfate (SDS) and 6 mM ethylene diamine tetraacetic acid (EDTA). The ability of sperm to decondense in vitro was compared with their ability to fertilize human oocytes in vitro. Spermatozoa from normal samples were studied for their decondensation ability as regards their fertilizing performance in an in vitro fertilization (IVF) program. Fertilization occurred when the decondensation percentage of sperm nuclear chromatin was more than 70%. The effective sperm count was significantly (p less than 0.05) lower in the unfertilized group. This is a new diagnostic technique to assess sperm-fertilizing potential at the initial evaluation of the male.

Gamete intrafallopian transfer: A preliminary experience

BACKGROUND

After in vitro fertilizationand embryo transfer for tubal infertility, gamete intrafallopian transfer has been introduced for patients with non-tubal infertility. However, the gametes need to be transferred in 2 to 5 minutes and the distance between the operating theatre and tissue culture laboratory delayed its introduction at our hospital.

METHODS AND PATIENTS

To overcome this problem we designed a box in which gametes could be stored. Using gametes taken from this box and employing the standard technique, we achieved 5 pregnancies in 39 infertile women.

RESULTS

From 41 treatment cycles, 39 women underwent oocyte retrieval. Five pregnancies were achieved of which 4 delivered live births at full term and 1 ended in abortion. Our first gamete intrafallopian transfer baby was born on 6 January 1988.

CONCLUSION

The gamete intrafallopian transfer technique can be successfullyadapted for India.

Semen characteristics of asymptomatic males affected by Trichomonas vaginalis

Trichomonas vaginalis is a sexually transmitted anaerobic parasite which causes vaginitis and cervicitis. The present study was carried out to determine the incidence of Trichomonas infection in semen samples of asymptomatic men and also to understand the changes of semen characteristics in the infected individuals before treatment and after treatment with metronidazole (Flagyl, 400 mg x 3x a day for 10 days). The semen obtained from 1131 men was examined for different characteristics and Trichomonas were detected in wet smear preparations in 50 cases (4.42%). The characteristics of semen in them was compared with 52 normal semen samples. Statistical analysis showed that the seminal fluid viscosity and percentage particulate debris was increased significantly in the infected group (P less than 0.001). There was no significant change in the pH of semen. Spermatozoan motility and morphologically normal forms were decreased significantly (P less than 0.001), spermatozoan viability was altered, and there was a significant change in membrane integrity (P less than 0.001) as indicated by the hypoosmotic swelling test. The significant improvement in semen characteristics were seen in 25 cases after a single course of treatment. Therefore, it is possible that in some cases, the infertility seen in asymptomatic individuals may be due to infection by Trichomonas.

Effect of antibodies to human seminal plasma inhibin on spermatogenesis and sperm agglutination in adult male rats

In vitro incubation of rat epididymal sperm with antiserum to human seminal plasma inhibin (As hSPI) caused agglutination of the sperm. In vivo administration of As hSPI to adult male rats resulted in a significant decrease in testicular as well as epididymal sperm counts. Furthermore, the majority (almost 90%) of the epididymal sperm were agglutinated. When these animals were mated with normal cycling females, significant reduction in fertility was observed.

Ultrastructure of spermatozoa & non spermatozoal cells in human semen in genital tract infections

With a view to ascertain the possible etiology fo the morphological abnormalities seen in spermatozoa of semen from genital tract infections, 16 semen samples were studied. Samples were selected on the basis of each of them having 10-12 pus cells per high power field. Apart from routine semen analysis, the sperms were subjected to electron microscopic studies. Alterations in the ultrastructure of spermatozoa and non-spermatozoal constituents of the infected semen samples were studied. The possible etiology of a wide spectrum of abnormalities in semen found to be associated with genital infection is discussed.

Presence of sperm antibodies and association with viscosity of semen

Semen characteristics were studied in 96 men from an in-vitro fertilization and embryo transfer programme. Along with the routine semen analysis, the presence of sperm antibodies in seminal plasma was measured by an ELISA technique. Antibodies to spermatozoa (IgA and/or IgG) were present in 19 cases and 15 of these (78.95%) had abnormally high viscosity, often associated with a high percentage of particulate debris and an increased number of morphologically abnormal spermatozoa.

Modulation of prolactin release by a 25 kD peptide of human seminal plasma

Prolactin-regulating factor (PRF) of molecular size of 25 kD has been isolated from human seminal plasma. This 25 kD factor inhibits circulating PRL levels in intact adult male rats to the extent of about 48% at dose level of 10 micrograms. Furthermore, in vitro incubation of pituitary demonstrated that PRF inhibits the release of PRL in the medium. PRF also interferes with the binding of I125 PRL to its receptors in liver, prostate, and spermatozoa. However, I125 PRF itself does not bind to these receptors. PRF seems to modulate PRL release as well as its binding to receptors. A sensitive, specific RIA was developed for PRF. Using the RIA, levels of PRF in seminal plasma were measured. PRF levels were low in vasectomized subjects as compared with controls. A negative correlation was noted with seminal plasma PRF levels and sperm count.

Antibodies to human seminal plasma inhibin cause sperm agglutination and impairment of cervical mucus penetration and sperm-egg attachment

Inhibin isolated from human seminal plasma which has 94 amino acids has been shown to be structurally similar to a sperm coating antigen of prostatic origin. Specific antibodies generated against this peptide caused agglutination of human sperm. Using FITC-labeled antibody, antigen was localized on the post-acrosomal head region of sperm. Antiserum to inhibin could also impair the penetration of human spermatozoa into cervical mucus. After 10 and 30 minutes, the depth and density of penetration as well as the motility of the sperm were inhibited. The treatment of sperm with antiserum to inhibin caused an inhibition of sperm attachment to the egg as well as inhibition of penetration.