Intracytoplasmic sperm injection combined with preimplantation genetic diagnosis for the prevention of recurrent gestational trophoblastic disease

A strategy for the prevention of repeated molar pregnancies by using intracytoplasmic sperm injection (ICSI) coupled with preimplantation genetic diagnosis (PGD) with fluorescence in-situ hybridization (FISH) was developed. In this approach, complete moles which arise from dispermic fertilization are avoided by the use of ICSI. ICSI is followed by preimplantation selection against the transfer of 46,XX embryos, thus preventing complete moles resulting from a fertilization of an inactive oocyte, by a haploid X-bearing spermatozoon which subsequently duplicates. Triploid partial moles which arise mainly from dispermic fertilization may also be prevented by ICSI. The preimplantation confirmation of diploidy by FISH guards against triploid partial moles which may result from mechanisms other than dispermic fertilization. The employment of this strategy in an attempt to prevent a repeated event of molar pregnancy in a patient with a history of two previous episodes of gestational trophoblastic disease is reported.

Fertility of dairy cows in Northern Ireland

A comprehensive database was established on the milk production and reproductive performance of dairy cows in 19 selected herds in Northern Ireland, varying in size, management system and genetic merit. Data were obtained for 2471 cows, 1775 of which calved in a second year, and 693 were culled from the herd for specific reasons. The estimated mean rate of heat detection (assessed by the interheat interval during the main breeding season) in all the herds was 71 per cent, with a range from 53 to 92 per cent The average conception rate to first insemination was 37.1 per cent (range 21 to 66 per cent). The average calving interval for the retained cows was 407.2 days (range 359 to 448 days). Twenty-eight per cent of the cows that calved were culled, with infertility being the largest single reason (26.8 per cent of the cows culled). There were major differences in reproductive performance between the herds, but heat detection rate, conception rate and calving interval did not appear to be affeded by a herd's genetic merit. The herds with shorter calving intervals were characterised by better heat detection efficiency (83 v 61 per cent, P<0.01), a shorter interval from calving to first insemination (74 v 97 days; P<0.05), a higher conception rate to first insemination (45 v 34 per cent, P>0.10) and a lower removal rate (23 v 37 per cent, P<0.01). Furthermore, the cows in these herds had lower body condition scores (BCS) in the dry period (3.0 v 3.3; P<0.05) but lost less body condition in early lactation (0.3 v 0.6 BCS units, P<0.05). These results show that dairy herd fertility in Northern Ireland is generally low and similar to that previously reported for England and the USA, but that in some herds changes in herd management practices improved the cows' fertility.

Milk progesterone profiles and their relationship with fertility, production and disease in dairy cows in Northern Ireland

A detailed investigation was conducted to identify the main factors influencing the current poor reproductive performance in dairy herds in Northern Ireland. Nineteen herds were selected and a comprehensive database was established, comprising detailed information collected over a 2-year period. Milk progesterone monitoring (no.=1423 cows), based on twice weekly sampling, was included in this on-farm investigation. The mean interval from calving to commencement of luteal activity was 30·1 days and 13·4% (184/1378) of these cows had not commenced luteal activity by day 50post partum. In addition, there was a high incidence of abnormal progesterone profiles: delayed ovulation type I; 15·6% (242/1388), delayed ovulation type II; 11·7% (125/965), persistent corpus luteum type I; 19·4% (212/1121) and persistent corpus luteum type II; 11·9% (70/619). Delayed commencement of luteal activity and abnormal profiles were associated with reduced fertility performance manifested as increased interval to first AI service and ultimately prolonged calving interval. Delayed commencement of luteal activity and abnormal progesterone profiles, with the exception of ‘delayed ovulation type II’ profiles, were not associated with lower conception rates. Assistance at calving was associated with delayed commencement of luteal activity. Delayed commencement of luteal activity and delayed ovulation types I and II profiles were associated with indicators of nutritional stress and poorer production performance in early lactation. Retained foetal membranes were strongly associated with prolonged luteal phases (persistent corpus luteum types I and II profiles). While hormonal therapy may prove useful in treating cows with abnormal milk progesterone profiles, the prevention and treatment of associated diseases and the implementation of good management practices are likely to be more rewarding.

Frequent involvement of the internal cuff segment in CAPD peritonitis and exit-site infection - an ultrasound study

BACKGROUND

The extent of involvement of the subcutaneous Tenckhoff catheter tract in CAPD peritonitis and catheter-related infections is of major therapeutic importance. By definition, both peritonitis and exit-site infections do not involve the catheter tract. However, diagnosis of these infections as well as the more sinister tunnel infection is based mainly on clinical signs.

METHODS

We examined the usefulness of ultrasound examination (US) of the catheter tract in delineating catheter-related (exit-site and tunnel) infections, and their relationship to each other and to peritonitis. CAPD patients with no evidence of peritonitis or catheter-related infections for 6 months prior to examination served as controls. US were performed by one of two experienced radiologists using the Acuson 128XP/10 scanner with a 7-MHz linear transducer. A positive US was defined as an area of hypoechogenicity (indicative of fluid collection) >2 mm in width along any portion of the catheter tract. Findings were localized into segments(S) as follows: S1, limited to external cuff; S2, intercuff segment adjacent to the external cuff; S3, intercuff segment adjacent to the internal cuff; S4, limited to the internal cuff; and S5, involvement extending throughout the catheter tract.

RESULTS

Between March 1993 and January 1995, 39 CAPD patients, all with a double-cuff straight Tenckhoff catheter with the exit site situated above the point of entry into the peritoneum were studied. A total of 56 US were performed divided among 26 episodes of peritonitis, four tunnel infections, 13 exit-site infections,and 13 controls. There were 30 positive US distributed among 16 peritonitis, four tunnel, eight exit site infections and two control patients. The two positive controls went on to develop peritonitis within 1 month of the US. The majority of the US findings (13/16 in episodes of peritonitis and 5/8 exit site infections were localized to segment 4, that is, to the internal cuff region. Apart from a significant increase in width in all infected segments versus a normal tunnel, no differences in size were seen between peritonitis, exit-site, or tunnel infections, nor were there any differences in size and localization in these infections when comparing the offending organism (Gram-positive, negative, or culture negative).

CONCLUSIONS

We conclude that peritonitis and exit-site infections are frequently accompanied by involvement of the catheter tract. The localization of infection to the internal cuff region in cases of exit-site infection probably occurred as a result of downward migration along the catheter tract. This supports the notion that ideally the exit site should be pointing caudally or that the peritoneal catheter have a swan-neck configuration. With regard to peritonitis, infection within the peritoneal cavity appears to extend and involve the internal cuff region. Thus both the internal and external cuffs do not seem to pose an effective barrier against the spread of infection.. Based on our data, we recommend that US be performed as a routine investigation in all cases of exit-site infection and in cases of refractory or relapsing peritonitis.

Role of imaging in the diagnosis of acute appendicitis in children

The aim of the study was to investigate the place of imaging in the diagnosis and treatment of acute appendicitis. The files of 2,427 children with suspected acute appendicitis were reviewed for clinical management and operative findings. The sample was divided into 3 groups at time of admission: (1) before diagnostic imaging was available in our department (1991-1994); (2) after the introduction of imaging studies on a random basis in equivocal cases (1995-1998); and (3) after a policy was formulated for ultrasound use in all equivocal cases followed by computed tomography if necessary (1999-2000). Results showed that the rate of misdiagnosis decreased from 13.2% in group 1 to 6.5% in group 2 and 6.1% in group 3. False-positive findings (normal appendix with positive scan) were noted in 16.7% of group 2 and 25% of group 3; false-negative findings (appendicitis at surgery with negative scan) in 23.8% and 9.5%, respectively. Computed tomography was performed in 8 children and prevented unnecessary surgery in 4 of them. We conclude that in equivocal cases of acute appendicitis, imaging studies performed by skilled operators can improve the accuracy of diagnosis, saving patients unnecessary surgery, and identifying other conditions that mimic appendicitis.

Birth weight discordance, DNA methylation, and cortical morphology of adolescent monozygotic twins

BACKGROUND

Several studies have shown that the in utero environment, which can be indexed by birth weight (BW), is associated with cortical morphology in adolescence and adulthood. Work in monozygotic (MZ) twins suggests that this association is driven by non-shared environmental factors. This correlation could be the result of in utero impacts on DNA methylation. The aim of the present study with MZ twins is to replicate the association between discordance in BW and brain morphology and test whether discordance in DNA methylation mediates this relationship.

METHODS

One hundred and four adolescent MZ twins (52 pairs, of which 42% were male pairs) who have been followed regularly since birth underwent T1 weighted structural MRI, and epigenome-wide assessment of DNA methylation from saliva at age 15.

RESULTS

Co-twins had very similar measures of DNA methylation and cortical morphology. Higher BW members of a twin pair had increased total cortical surface area, and decreased cortical thickness compared to their lower BW sibling. BW Discordance was positively associated with both cortical surface area and cortical volume discordance. Genes involved in neurodevelopment were tentatively identified as mediators of both the BW - cortical volume, and BW- cortical surface area relationships.

CONCLUSIONS

The association between BW and cortical morphology in adolescence appears to be attributable to in utero environmental effects, and DNA methylation may play a role in mediating this relationship. Hum Brain Mapp 38:2037-2050, 2017. © 2017 Wiley Periodicals, Inc.

[A comparison of operative invasiveness in minimally invasive anterolateral hip replacement (MIS-AL) and standard hip procedure, using biochemical markers]

PURPOSE OF THE STUDY

The aim of this prospective randomized study was to compare, by means of biochemical markers, the operative invasiveness of the standard total hip replacement with that of the minimally invasive anterolateral (MIS-AL) approach.

MATERIAL

Twenty-six randomly assigned patients with standard and 22 patients with MIS-AL total hip replacement were included in the study. Patients with elevated pre-operative levels of the markers evaluated or patients taking medication that might affect marker levels were not included.

METHODS

Creatine phosphokinase (CPK) and C-reactive protein (CRP) were chosen as markers of muscle damage and post-operative inflammatory changes, respectively. Blood samples were drawn before surgery (less than 24 hours) and after surgery at 24, 48 and 96 hours, which respected biological half-lives of the markers and permitted us to study their dynamics. The results were evaluated and statistically analyzed at the department of biochemistry, using the two sample t-test.

RESULTS

Statistically significant differences between the two groups of patients were found for both markers. The average CRP values differed significantly (p < 0.05) at 48 and 96 hours post-operatively, being higher for the standard than MIS-AL total hip replacement by 28% and 44%, respectively. The average CPK values showed the most marked difference at 48 hours after surgery, when the level was higher by 62.5% in the standard than MIS-AL total hip replacement (p < 0.05).

DISCUSSION

Our objective evaluation of the invasiveness of surgery in total hip replacement was based on the most frequently recommended markers for assessment of muscle tissue damage and post-operative inflammatory changes. The study was focused on the invasiveness of surgery only and neither subjective nor objective outcomes of implantation were evaluated. The use of the muscle sparing approach MIS-AL results in minimal damage to muscle tissue and, consequently, a lower degree of post-operative inflammation than is recorded in traditional hip replacement surgery.

CONCLUSIONS

In the patients undergoing MIS-AL total hip replacement, post-operative levels of CPK and CRP were significantly lower than in the patients with standard total hip replacement. The MIS-AL technique evidently provides a more sparing approach to soft tissues.

[The EDEC curriculum-the path to advanced echocardiography in the intensive care unit]

Good knowledge of echocardiography is essential for modern intensive care medicine. A standardized curriculum for acquiring the expertise to perform TTE and TEE is a good way to strengthen one's own diagnostic skills.The EDEC curriculum from ESICM, which has been established for years, offers a good opportunity for structural further training at the advanced level in combination with gaining a high level of professional competence.

[Influence of antenatal administration of corticoids on heart activity--case report]

OBJECTIVE

to draw attention to possible influencing of cardiotocographic recording of antenatal administration of corticoids, on the use of Doppler ultrasonographic parameters in the diagnostics of hypoxia-endangered fetus.

DESIGN

Case report.

SETTING

Mother and Child Care Institute of Prague.

METHOD

Case report.

CONCLUSION

Antenatal administration of corticoids is presently an inherent part of therapeutic management of premature delivery. This administration significantly diminishes morbidity and mortality of immature newborns. Nevertheless, their administration results in changing intrauterine behavior of the fetus and his/her heart activity. These changes may be mistakenly diagnosed as signs of evolving hypoxia. For the evaluation of acute condition of the fetus and obtaining help in decision making how the further management of delivery should be done, Doppler ultrasonographic examination of maternal, fetus-maternal and fetal circulation may prove useful.