Hysterosalpingography and selective salpingography in the differential diagnosis of chemical intrauterine versus tubal pregnancy.

OBJECTIVE: To determine the validity of hystersalpingography (HSG) and/or bilateral selective salpingography in the differential diagnosis of early (biochemical) intrauterine versus intratubal abortions. DESIGN: The study design involved the performance of HSG and selective salpingography in sequential patients with low declining beta-human chorionic gonadotropin (beta-hCG) values. SETTING: Medical School-affiliated Infertility Center. PARTICIPANTS: Four sequential pregnant infertility patients who demonstrated declining beta-hCG levels before pregnancy could be confirmed by ultrasound (chemical pregnancies). RESULTS: Three of four patients demonstrated a characteristic tubal opacification pattern in conjunction with a normally appearing endometrial cavity, considered diagnostic of an early tubal pregnancy. In contrast, a missed intrauterine pregnancy (IUP) demonstrated a characteristically abnormal endometrial cavity. CONCLUSIONS: Some early (chemical) pregnancy losses are intratubal rather than intrauterine. The correct differential diagnosis of early missed IUPs versus intratubal pregnancies is important because of its prognostic significance.

The limited value of hysterosalpingography in assessing tubal status and fertility potential.

DESIGN: To determine whether the diagnostic accuracy and prognostic value of hysterosalpingography (HSG) could be improved if routine spot films were replaced by an on-line recorded gynecoradiologic study. SETTING: Medical school-affiliated private infertility center. PATIENTS: In 1992, a review of 152 infertile women with infertility who demonstrated a normal HSG, by standard criteria of spot film evaluation, in 117 (77%). They were further investigated by gynecoradiologic study if the HSG revealed asymmetrical tubal filling, an increased perfusion pressure, and/or evidence for abnormal tubal spill. In 1993, 47 women with normal HSG by spot film criteria underwent bilateral selective salpingography and were subdivided into those with normal (group I, n = 23) and abnormal (group II, n = 24) tubal perfusion pressures. INTERVENTION: Patients in both study groups then were treated for their infertility independently of pressure perfusion measurements. MAIN OUTCOME MEASURE: Clinical pregnancy rates (PRs) over the ensuing 6 to 10 months. RESULTS: Among 117 women with apparently normal spot film HSG, 64 (55%) demonstrated asymmetrical tubal filling, 32 (27%) demonstrated abnormal spillage into the peritoneal cavity, and 55 (47%) demonstrated abnormally elevated injection pressures. Among 98 women who underwent bilateral selective salpingography, 43 (44%) demonstrated bilaterally normal tubal perfusion pressures and 55 (56%) showed an abnormally elevated pressure in at least one oviduct. Of 47 women that were followed prospectively in 1993, patients with normal perfusion pressure (group I) demonstrated a significantly higher PR than women with elevated tubal pressure (group II) from 2 months and on after the procedure. CONCLUSIONS: Routine spot film HSG is of limited value in assessing tubal status beyond the determination of tubal patency. Especially with regard to fertility potential, HSG should be replaced by gynecoradiologic study.

The association of antithyroid antibodies in euthyroid nonpregnant women with recurrent first trimester abortions in the next pregnancy.

OBJECTIVE: To evaluate the prognostic value of antithyroid antibodies in euthyroid women with a history of recurrent first trimester abortions on future pregnancy loss. DESIGN: The sera of 42 euthyroid women with a history of three or more consecutive first trimester abortions were evaluated for the presence of antibodies to thyroglobulin and thyroid peroxidase before pregnancy and again as soon as the diagnosis of pregnancy was made. SETTING: Medical school-affiliated private infertility center. PATIENTS: Forty-two women with a history of three or more consecutive first trimester abortions who were planning to conceive again. MAIN OUTCOME MEASURE: The presence of antithyroid antibodies in the nonpregnant state and their association with pregnancy loss in the next gestation. RESULTS: Thirteen of 42 women (31%) were positive for the presence of antithyroid antibodies at the initial screening before pregnancy. All 13 maintained positivity by the time their next pregnancy was diagnosed. Only 12 of those 42 women (29%) experienced a first trimester abortion. Eight of these 12 women (67%) were positive for one or more antithyroid antibody. In contrast, among 30 nonaborting women, only 5 of 30 (17%) exhibited thyroid antibody positivity. The detection of thyroid antibodies before conception carried an increased risk of pregnancy loss in the next pregnancy (8 of 13, 62% versus 4 of 29, 14%). CONCLUSION: The presence of antithyroid antibodies in nonpregnant women with a history of recurrent abortion identifies a subgroup of women at significantly increased risk for yet another pregnancy loss in their next gestation. Because organ-specific autoantibodies thus demonstrate similar prognostic significance to nonorgan-specific autoantibodies, it is tempting to conclude that peripheral autoantibody abnormalities seen in habitual aborters only reflect an underlying T-lymphocyte defect, which may be the actual cause of pregnancy loss.

Transvaginal intratubal insemination by tactile sensation: a preliminary report.

Transvaginal catheterization of the fallopian tube has gained increased popularity for transfer of embryos and gametes. Forty-five ITIs were performed on 32 patients using the novel approach of tubal transfer via tactile sensation. This group of patients had undergone an average of 5.2 IUIs before ITI. There were a total of 11 pregnancies, 6 occurring with hMG stimulation and 5 with CC-stimulated cycles (34% PR per patient). Three pregnancies ended with spontaneous abortion, and one patient developed acute salpingitis necessitating laparotomy. These data suggest ITI may be effective in assisted reproduction but, as other invasive procedures, is not without risk.

Elevated tubal perfusion pressures during selective salpingography are highly suggestive of tubal endometriosis.

OBJECTIVE: To investigate the possible etiologies of elevated tubal perfusion pressures. DESIGN: Analysis of 48 consecutive female patients with infertility who underwent laparoscopy and a gynecoradiological investigation as part of their infertility work-up. SETTING: Academically affiliated infertility center. INTERVENTIONS: A gynecoradiological investigation was performed using a previously reported standardized contrast injection system. Laparoscopy was performed routinely. RESULTS: Patients who demonstrated by laparoscopy to have endometriosis showed a significantly increased incidence of tubal blockage during initial hysterosalpingography (HSG) (12/26, 46.1%) compared with controls (2/14, 14.3%). Patients with endometriosis also demonstrated significantly more frequently elevated tubal perfusion pressures (22/26; 84.6%) than women without disease (2/14, 14.3%) and significantly higher mean tubal perfusion pressures than women with normal pelvises (576 +/- 264 versus 450 +/- 268 mm Hg). CONCLUSION: Tubal blockage during initial HSG and elevated tubal perfusion pressures during selective salpingography are highly suggestive of tubal endometriosis. These data are the first evidence that tubal involvement with endometriosis may be more frequent than previously suspected. They also suggest that the performance of a gynecoradiological investigation, inclusive of selective salpingography, can greatly contribute to a presumptive diagnosis of endometriosis.

What is the radiation exposure to patients during a gynecoradiologic procedure?

OBJECTIVE: To evaluate the risk of radiation exposure to infertility patients during a gynecoradiologic procedure. DESIGN: Retrospective clinical study. SETTING: Medical school-affiliated infertility center. PATIENT(S): Three hundred thirty-two consecutive infertility patients undergoing a gynecoradiologic procedure. INTERVENTION(S): Patients underwent a gynecoradiologic procedure as part of their infertility workup and the fluoroscopic exposure time was analyzed. MAIN OUTCOME MEASURE(S): The fluoroscopic exposure (rad time) during gynecoradiologic procedures, including hysterosalpingogram (HSG), selective salpingography, tubal catheterization, and others. RESULT(S): The rad time (mean +/- SD) was 63 +/- 54 seconds for normal HSG (n = 94, range 17 to 404 seconds), 100 +/- 61 seconds for abnormal HSG (n = 53, range 28 to 272 seconds), 111 +/- 57 seconds for unilateral selective salpingography (n = 36, range 31 to 324 seconds), 142 +/- 74 seconds for bilateral selective salpingography (n = 87, range 40 to 430 seconds), 176 +/- 77 seconds for unilateral tubal catheterization (n = 27, range 70 to 342 seconds), and 239 +/- 82 seconds for bilateral tubal catheterization (n = 30, range 110 to 381 seconds). Five patients had other procedures, such as lysis of intrauterine adhesions (n = 2) and resection of an uterine septum (n = 3), for which the rad time was in a range of 180 to 300 seconds. CONCLUSION(S): The radiation exposure of patients during a gynecoradiologic procedure, using previously described standard techniques, is well within established margins of safety.

A randomized prospective comparison between intrauterine insemination and fallopian sperm perfusion for the treatment of infertility.

OBJECTIVE: To determine if the pregnancy rates (PRs) in infertile women could be improved with fallopian sperm perfusion in comparison with IUI. DESIGN: Randomized prospective analysis. SETTING: Academically affiliated infertility center. PATIENTS: Consecutive patients undergoing controlled ovarian hyperstimulation (COH). INTERVENTIONS: After hCG administration, patients were randomized to either IUI or fallopian sperm perfusion. MAIN OUTCOME MEASURES: Pregnancy rates with the two treatment modalities. RESULTS: Of 240 COH cycles, those randomized to IUI included 44 clomiphene citrate (CC) (group I) and 76 gonadotropin (group III) cycles. Patients receiving fallopian sperm perfusion included 44 cycles of CC (group II) and 76 cycles of gonadotropin (group IV) treatment. The overall PRs per cycle (10.8% versus 10.8%) were similar for IUI and fallopian sperm perfusion, respectively. The PRs were also similar when compared for ovulation induction with CC (6.8% versus 9.1%) and gonadotropins (13.2% versus 11.8%). CONCLUSION: We conclude that fallopian sperm perfusion offers no advantage over IUI. Because the process of fallopian sperm perfusion is more time consuming and more costly (because of increased media usage), fallopian sperm perfusion does not seem indicated as a routine infertility therapy and should not replace IUI.

A spectroscopic study of nickel(II)-bovine serum albumin binding and reactivity.

The pH dependence of the uv/visible and CD spectra of the 1:1 Ni(BSA) complex in aqueous solutions is interpreted in terms of a major square-planar form and an octahedral form. At pH 7.4, the two forms, respectively, account for ca. 70% and 30% of the total Ni(II). The two forms are in rapid equilibrium with each other and so both probably involve Ni(II) binding to the N-terminal region of the albumin protein. The kinetics of the equilibrium reaction of Ni(BSA) with His were studied at 37 degrees C in buffered media of pH 7.4 and 9.3. In line with predictions, the two Ni(BSA) forms show markedly different reactivities, with the square-planar form being the more thermodynamically stable and the less reactive. The octahedral form reacts with an observed zero-order dependence on His concentration while the square-planar form shows both zero-order and first-order dependence, the latter being the more dominant. The significance of the slow equilibrium rate at pH 7.4 to the possible physiological role of Ni-albumin in blood serum is discussed.

Lipid analysis of a frozen egg substitute.

The lipid composition of an egg substitute and fresh eggs was conpared. The total lipid was divided into fractions on a silicic acid column. Thin-layer-chromatographic analysis demonstrated that the egg substitute was practically void of cholesteryl esters. Gas-liquid-chromatographic analysis were used to ascertain the fatty acid composition of the various fractions. Eggs contained considerably higher concentrations of saturated and mono-unsaturated fatty acids than did the substitute. The polyunsaturated fatty acid concentration in the substitute was approximately three times that of eggs. In all fractions, the eggs contained several more individual fatty acids than did the egg substitute.

Isolation and identification of rutin as the major mutagen of red wine.

The polyphenolics of a red wine were concentrated by salt-induced phase separation into acetone-alcohol and fractionated by Sephadex LH-20 and multi-layer counter-current chromatography. The mutagenicity of each fraction was evaluated by the Salmonella mutagenesis assay. The mutagen of red wine required activation by both rat-liver microsomal enzymes and human-fecal enzymes (fecalase). The mutagenic component of red wine was purified to homogeneity by reverse-phase high-performance liquid chromatography (RPHPLC) on Lichrosorb C18 and was identified as rutin by UV spectrometry, co-chromatography with authentic standard on RPHPLC and gas-liquid chromatography/mass spectrometry.

Palatability of prerigor cooked boar meat.

Cooking reduces odor intensity in boar meat but also may induce lipid oxidation unless the meat pH is above approximately 6.0. This research was designed to determine the feasibility of cooking boar meat in the prerigor state to overcome boar odor and lipid oxidation problems. Prerigor and postrigor triceps brachii muscle samples from 40 boars (20 Duroc and 20 Yorkshire) were cooked to 60 degrees C, frozen and stored at -20 degrees C, reheated in a 60 degrees C water bath for 1 h, and then subjected to pH, thiobarbituric acid (TBA), and sensory analyses. Boar odor intensity and skatole concentration in backfat samples were determined by olfactory test and HPLC, respectively. Cooked (initial cooking) prerigor meat was found to have higher (P < .05) pH and lower (P < .05) TBA values than comparable postrigor meat (6.44 vs 6.09 and 2.15 vs 3.23, respectively). Regression analysis indicated an inverse relationship between pH and TBA values (r = -.52; P < .01). No appreciable changes in TBA values were noted after frozen storage for 14 to 98 d, but reheating increased TBA values (P < .05) in both prerigor and postrigor samples (3.45 vs 4.32, respectively). Sensory evaluation scores indicated that prerigor cooked meat was less tender with more pronounced rancid flavor than postrigor cooked meat (P < .05), but panelists may have allowed the toughness of the prerigor samples to adversely affect their flavor scores. No difference in boar odor was detected between rigor states or breeds. Mean skatole concentration in backfat was .12 micrograms/g and no difference was detected between breeds.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of five cycle rapid freeze-thaw treatment in conjunction with various chemicals for the reduction of Salmonella typhimurium.

A five cycle rapid freeze-rapid thaw process was used in conjunction with chemicals to reduce numbers of Salmonella typhimurium cells on poultry meat. The second portion of chicken wings consisting of ulna and radius with attached skin and muscle was inoculated with 400 to 900 colony forming units (CFU/g) of a nalidixic acid resistant strain of S. typhimurium. Chemicals used were 20 ppm chlorine, 5% potassium sorbate, 5% lactic acid, and 5% calcium propionate. The wings were either sprayed with or dipped into all chemicals before the freeze-thaw process. Wings were also chemically treated and not subjected to the freeze-thaw process. Numbers of S. typhimurium were determined by the most probable number procedure. The relative effectiveness of combinations of chemicals and the freeze-thaw process was compared to a control with the following percentage reductions of numbers of S. typhimurium cells: lactic acid, 98%; calcium propionate, 96%; potassium sorbate, 96%; chlorine, 95%; and freeze-thaw process without chemicals, 95%. There were no statistically significant differences among the treatments. In pilot plant study simulating commercial conditions, a carbon dioxide freezer was used for the rapid freeze and a microwave oven was used for the rapid thaw. Treatment of wings with 5% lactic acid plus freeze-thaw process resulted in statistically significant fewer numbers of S. typhimurium cells when compared to the freeze-thaw process without chemical treatment or to wings chemically treated without the freeze-thaw process.

Copper-albumin: what is its functional role?

The small copper fraction in animal blood that is bound to albumin protein is generally considered to have a transport role for the metal. However, several studies have concluded that copper ion incorporation into copper-enzymes requires caeruloplasmin to act as the transport form. The kinetic rates of Cu(albumin) reactions are also not in keeping with a general transport function. Only in the portal bloodstream does the Cu(albumin) appear to have a well-established transport role, i.e. in delivering the metal ions from the intestine to the liver. Thereafter the evidence as to its function is less certain; it could act as a storage form of the metal or have no role at all. Similar considerations apply to other metal-albumin fractions e.g. those of zinc and nickel.