Combined application of Er:YAG and Nd:YAG lasers in treatment of chronic periodontitis. A split-mouth, single-blind, randomized controlled trial.

BACKGROUND: The aim of the present study was to compare the effectiveness of combined Er:YAG and Nd:YAG laser therapy to that of scaling and root planing with hand instruments in non-surgical treatment of chronic periodontitis. MATERIAL AND METHODS: Twenty-five systemically healthy patients with chronic periodontitis were selected for this study. The quadrants were randomly allocated in a split-mouth design to either combined Er:YAG (160 mJ/pulse, 10 Hz) and Nd:YAG laser (100 mJ/pulse, 20 Hz) therapy (test group) or scaling and root planing alone (control group). At baseline, 1 month and 3 months after treatment, plaque index, gingival index, probing depth, clinical attachment level and bleeding on probing (%), were recorded and gingival crevicular fluid and subgingival plaque samples were taken. The gingival crevicular fluid levels of interleukin-1ß and tumor necrosis factor-α were analyzed by enzyme-linked immunosorbent assay. Quantitative analysis of red complex bacteria was performed using quantitative real-time polymerase chain reaction. RESULTS: The clinical parameters had significantly improved for both groups after treatment. There were statistically significant differences in probing depth and clinical attachment level between the test and control groups only for deep pockets (≥7 mm) (P<.05). No significant differences between the two groups were observed for the biochemical and microbiological parameters at any time points (P>.05). CONCLUSIONS: The present study suggests that a combined course of Er:YAG and Nd:YAG laser therapy may be beneficial particularly in inaccessible areas such as deep pockets on a short-term basis. Further, well-designed studies are required to assess the effectiveness of the combination of these lasers.

Endometrium is not a reservoir for recurrent vaginal candidiasis.

The aim of this study was to determine whether the endometrium acts as a reservoir for Candida albicans in cases of recurrent vaginal candidiasis. Twenty-five women with documented history of recurrent vaginal candidiasis were enrolled in the study and endometrial samples were cultured for Candida albicans. Only two patients had positive cultures for Candida albicans. Therefore, we concluded that the endometrium is not a common reservoir for Candida albicans.

Effect of pentoxifylline on immotile testicular spermatozoa.

PURPOSE: A model for differentiating live and dead sperm cells during intracytoplasmic sperm injection (ICSI) is proposed. METHODS: We used pentoxifylline, a phosphodiesterase inhibitor known to enhance sperm motility, to initiate motility in testicular spermatozoa. Ten immotile testicular sperm samples were divided into two parts for examination of sperm motility with and without pentoxifylline treatment at 30, 60, and 90 min. RESULTS: The samples without pentoxifylline remained immotile even after 90 min of incubation: the addition of pentoxifylline initiated sperm motility in all samples: 51.8 +/- 10.2, 64.4 +/- 9.4, and 70.8 +/- 8.9% (mean +/- SD) at 30, 60, and 90 min, respectively. CONCLUSIONS: That pentoxifylline may be used to differentiate live testicular spermatozoa during ICSI, which may improve fertilization and pregnancy rates, is suggested.

Is long-protocol gonadotropin releasing hormone agonist administration superior to the short protocol in ovarian stimulation for in vitro fertilization?

OBJECTIVE: To compare the long and short protocols of gonadotropin releasing hormone agonist (GnRH-a) administration for ovarian stimulation. SETTING: University hospital. SUBJECTS: 90 patients on their first attempt at in vitro fertilization and embryo transfer (IVF-ET). METHOD: The results of two stimulation protocols were compared with respect to number of follicles greater than 17 mm, peak serum estradiol level, number of oocytes retrieved and fertilized, fertilization rate per oocyte, number of embryos transferred, and pregnancy rate per initiated cycle. RESULTS: The number of follicles greater than 17 mm and the peak estradiol level were significantly (P < .05) higher in the long protocol than those in the short protocol. The number of oocytes retrieved and fertilized, the number of embryos transferred, and the pregnancy rate per initiated cycle were also significantly (P < .001) higher in the long protocol than those in the short protocol. The fertilization rates per oocyte retrieved did not differ significantly between groups. CONCLUSION: The long protocol of gonadotropin releasing hormone agonist administration for ovarian stimulation in IVF-ET may be the preferred method when GnRH-a is used.

Alternative treatment for bacterial vaginosis in pregnant patients; restoration of vaginal acidity and flora.

PIP: In Turkey, physicians treated 22 first-trimester pregnant women aged 20-34 exhibiting signs and symptoms of bacterial vaginosis with commercially available yogurt containing more than 100 million Lactobacillus acidophilus per ml and at a pH of less than 4.5. The treatment involved vaginal douching with a 10-ml syringe daily for 7 days and was repeated after a 1-week interval. The signs and symptoms used as criteria for bacterial vaginosis included subjective symptoms of foul-smelling discharge, vaginal pH more than 4.7, presence of clue cells in the vaginal discharge, and foul odor caused by the addition of 10% potassium hydroxide to the vaginal discharge (i.e., positive amine test). Cure was defined as the disappearance of 3 of the 4 criteria 4-6 weeks after completing the 2nd treatment and clinical improvement (i.e., patients' subjective feelings on 3rd day of treatment). All the women were considered clinically improved on the 3rd day of treatment. 4 weeks after the 2nd treatment, 20 (90%) women exhibited none of the criteria for bacterial vaginosis. At 6 weeks, 19 (86.4%) had no criteria. These findings suggest that commercially available yogurt may restore the microenvironment and pH of the vagina, thus representing a viable treatment of bacterial vaginosis. This treatment may be preferable during pregnancy, since the use of any drug during pregnancy should be minimized. It will reduce the likelihood of a premature delivery.^ieng

Changing epidemiology of measles in Turkey: need for reassessment of measles vaccination policy?

Changing epidemiology of measles in Turkey and in Izmir city, since the introduction of measles vaccine was examined in order to evaluate the need for new strategies to control measles infection. After the National Vaccination Campaign in 1985, the rates of incidence and mortality dropped to 4.2/100000 and 0/million, respectively, in 1987. When the epidemics in 1989 and 1993 were examined it was seen that more measles cases occurred in age groups 5-9 and > 15 years, and most of the cases seen in children in primary and secondary schools were in those previously immunized against measles. Future strategies for control of measles should aim at increasing the coverage rate and introducing a two-dose regimen to reduce vaccine failure.

Pentoxifylline-enhanced acrosome reaction correlates with fertilization in vitro.

To evaluate the possible effect of pentoxifylline on the acrosome reaction (AR) and its correlation with in-vitro fertilization (IVF), sperm samples obtained from 51 patients who underwent IVF treatment were studied. Acrosome reactions were evaluated as spontaneous, pentoxifylline-treated and calcium ionophore (A23187) induced, before and after treatment. The correlation of AR with fertilization in vitro in spermatozoa pre-treated with pentoxifylline was sought. In cases with failure or very low fertilization rate (< or = 10%) in their previous trials, spermatozoa after swim-up were treated before insemination. Spontaneous acrosome loss remained low even after treatment (mean +/- SD: 8.18 +/- 1.74%). Response to A23187 was enhanced significantly (P < 0.001) by pre-treatment with pentoxifylline in 33 control cases (group A) in which fertilization in vitro was previously successful without this treatment. Patients with at least two episodes of failed fertilization were divided into two groups. In 11 cases (group B), the IVF rate was improved significantly (P < 0.001) by the treatment. This was not observed in seven cases (group C) in which the treatment induced no increase in IVF rate. We achieved nine (27.3%) pregnancies in group A and five (45.4%) pregnancies in group B. This study demonstrated that pentoxifylline enhanced A23187 induced the acrosome reaction and this effect was correlated with improvement in IVF rate.

Effect of peritoneal fluid from infertile women with endometriosis on ionophore-stimulated acrosome loss.

The effect of peritoneal fluid (PF) from endometriosis patients was studied in spontaneous and stimulus-induced (Ca-ionophore; A23187) acrosome reactions. PF samples were obtained from 21 infertile women with endometriosis and five normal women (controls). Sperm acrosomes were examined by staining with Pisum sativum agglutinin labelled with fluorescein isothiocyanate. The incidence of spontaneous acrosome reaction after 1 and 6 h of incubation (6.7 +/- 1.6 and 6.9 +/- 1.4 respectively) was significantly (P < 0.001) lower when the incubation was performed with PF from endometriosis patients in comparison with spermatozoa incubated in PF from the control group (12.8 +/- 1.1 and 12.8 +/- 0.8). Similarly, the incidence of A23187-induced acrosome reaction after 1 and 6 h of incubation (19.8 +/- 2.7 and 20.0 +/- 2.4) was significantly (P < 0.001) lower when spermatozoa were incubated with PF from endometriosis patients in comparison with spermatozoa incubated with PF from the control group (34.6 +/- 9.8 and 34.4 +/- 1.1). The incidence of A23187-inducible acrosome reaction was also significantly (P < 0.001) lower when the incubation was performed with PF from endometriosis patients (13.1 +/- 2.8 and 13.1 +/- 2.4) when compared with that from the control group (21.8 +/- 2.6 and 21.6 +/- 1.5). No relationship was found between the stage of endometriosis and the incidence of acrosome loss. In conclusion, the PF from endometriosis patients decreased both spontaneous and stimulus-induced acrosome reaction. This may represent a mechanism for the detrimental effect of the PF from endometriosis patients on the spermatozoa-oocyte interaction and partially explain the aetiology of infertility in patients with endometriosis.

The expanding spectrum of a disease. Behçet's disease associated with amyloidosis.

In this report, we present a series of 6 patients with Behçet's disease (BD) associated with amyloidosis whose illnesses date back at least 4 years. In all the cases, nephrotic syndrome heralded the onset of amyloidosis, which was diagnosed by percutaneous kidney biopsies. After the diagnosis of amyloidosis, all subjects received colchicine, and steroids were discontinued. Three patients have benefited from treatment. It was suggested that amyloidosis may be an intrinsic feature of BD or that the suppurative lesions may play a role in the accumulation of amyloid in the tissues. The literature was reviewed and discussed.

Intestinal protection against Strongyloides ratti and mastocytosis induced by administration of interleukin-3 in mice.

Information about interleukin-3 (IL-3) effects in vivo is limited compared with the in vitro effects. We found that a repetitive injection of a low dose of recombinant IL-3 induced protection against intestinal worms of Strongyloides ratti in C57BL/6 mice. When mice were injected i.p. with different doses of recombinant IL-3 twice a day from day -5 to day -1 and infected orally with larvae recovered from the head of infected rats on day 0, worm recovery from the small intestine was markedly reduced by a total of 10(4) U IL-3 or more on day 2 post-infection. The number of intestinal mucosal mast cells (MMC) was increased by the protective dose of IL-3. The IL-3 treatment, however, was ineffective in protecting mice against tissue migrating larvae, as assessed by recovery from the head. The protective effect of IL-3 on intestinal worms was observed within 6 hr post oral infection, suggesting little concern with antigen-specific immune responses. The effective dose of IL-3 treatment increased the number of MMC progenitors five times in the spleen and the mesenteric lymph nodes. An MMC-specific protease, MMCP-1, was secreted 200 times more than in controls in the intestinal lumen by the IL-3 treatment. The IL-3 treatment induced no protection or mastocytosis in mast cell-deficient W/Wv mice. These results suggest that the IL-3-induced intestinal protection against S. ratti is mediated by MMC.

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

OBJECTIVE: To study the effect of sperm-immobilizing antibodies from male sera on spontaneous and A23187-induced acrosome reactions (AR). DESIGN: Swim-up spermatozoa obtained from three fertile donors were incubated with 13 sera with sperm-immobilizing antibodies obtained from infertile men and three control sera obtained from healthy fertile males. Sperm acrosomes were examined by staining with pisum sativum agglutinin labeled with fluorescein isothiocyanate (30 micrograms/ml; Sigma Chemical Co., St. Louis. MO) as spontaneous and A23187 (used at a final concentration of 10 microM; Sigma Chemical Co.) induced. RESULTS: The incidence of spontaneous AR of spermatozoa incubated with antisperm antibody positive male sera (6.2 +/- 0.7) was significantly (P < 0.001) lower than that of spermatozoa incubated with control sera (10.7 +/- 0.5). And the incidence of A23187-induced and -inducible (incidence of induced minus spontaneous) ARs of spermatozoa incubated with sperm antibody-positive male sera (12.4 +/- 1.9 and 6.2 +/- 1.9) was significantly lower (P < 0.001) than that of spermatozoa incubated with control sera (31.0 +/- 0.5 and 20.3 +/- 0.9). Sperm-immobilizing antibody-positive sera decreased spontaneous, A23187-induced, and inducible ARs. CONCLUSIONS: Sperm-immobilizing antibodies from male sera interfere with fertilization by inhibiting the AR.

Effect of abnormal sperm head morphology on the outcome of intracytoplasmic sperm injection in humans.

The present study was designed to determine the efficacy of intracytoplasmic sperm injection (ICSI) using spermatozoa with abnormal head morphology in 17 cases with total teratozoospermia. A total of 160 oocytes were retrieved and 144 metaphase II oocytes were injected. The fertilization and cleavage rates were 50.7 and 93.2% respectively. Fertilization failure occurred in two couples. A total of 54 embryos were transferred and pregnancy rates per initiated and per embryo transfer cycle were 17.6 and 20.0% respectively, while the clinical pregnancy rates per initiated and embryo transfer cycle were 11.8 and 13.3%. The implantation rate was 3.7% (2/54). Out of two pregnancies achieved, one resulted in abortion in the first trimester. The ongoing pregnancy rates per initiated and embryo transfer cycle were 5.88% (1/17) and 6.6% (1/15) respectively. Although the implantation and ongoing pregnancy rates are very low, ICSI seems to be the only treatment modality in cases where teratozoospermia was total with 100% abnormal head morphology.

Effects of nitrendipine on blood pressure and blood ciclosporin A level in patients with posttransplant hypertension.

In order to evaluate the antihypertensive effectiveness and interaction with ciclosporin A (CS-A) nitrendipine, a dihydropyridine derivative calcium entry blocking agent, was used in 16 (13 men, 3 women) hypertensive renal posttransplant patients followed by the Nephrology Department of Hacettepe University Hospital. The patients did not receive any antihypertensive drug for a 7-day period. They were then given 20 mg/day nitrendipine for 3 weeks. At the end of this period, mean (+/- SE) supine blood pressure fell from 163/108 +/- 3.6/1.87 to 141/87 +/- 3.8/2.2 mm Hg (p less than 0.01), while the heart rate was unchanged. 14 of 16 patients achieved full control of blood pressure levels with 20 mg/day nitrendipine, and only 2 patients needed a higher dosage of 30 mg/day (20 + 10 mg). After 3 weeks of treatment no significant variations in blood chemistry or renal functional parameters were noticed. There was also no difference between blood CS-A levels before and after treatment with nitrendipine (218.06 +/- 33 vs. 222.68 +/- 26 ng/ml, p greater than 0.05). We conclude that short-term therapy with nitrendipine in renal post-transplant patients does not appear to be harmful and longer term studies are needed to fully evaluate safety and efficacy of this drug. Because it influences neither blood chemistry nor renal functional parameters and blood CS-A level, it may be preferable to other calcium channel blocking agents in this group of patients.

Two instead of three embryo transfer in in-vitro fertilization.

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

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

OBJECTIVE: To study the effect of sperm-immobilizing antibodies on spontaneous and A23187-induced acrosome reactions. MATERIAL AND METHODS: Swim-up spermatozoa obtained from a fertile donor were incubated with 16 sera containing sperm-immobilizing antibodies obtained from infertile women and 3 control sera obtained from healthy females. The acrosome loss, either occurring spontaneously or induced by 10-microM A23181, were examined by staining sperm with Pisum sativum agglutinin labeled with fluorescein isothiocyanate. RESULTS: The incidence of the spontaneous acrosome reaction of spermatozoa incubated with anti-sperm antibodies (6.25 +/- 1.4%) was significantly (P < .001) lower than that of the spermatozoa incubated with control sera (12 +/- 0.8%). The incidence of A23187-induced and inducible (incidence of induced minus spontaneous) acrosome reactions of spermatozoa incubated with sera-positive for sperm antibodies (10.4 +/- 1.3% and 4.2 +/- 1.5%) was also significantly lower (P < .001) than that of spermatozoa incubated with control sera (30.7 +/- 0.5% and 18.7 +/- 1.2%). CONCLUSION: Sperm immobilizing antibodies interfere with fertilization by inhibiting the acrosome reaction.

Relationship of chlamydial infection to male infertility: sperm parameters / antisperm antibodies.

PIP: This study included 124 men from infertile couples who were referred to the Department of Obstetrics/Gynecology, Akita University Hospital, Japan. All the patients had a history of involuntary infertility lasting for at least 2 years. Serum antichlamydial antibodies were measured by indirect immunofluorescence technique. The antigen used for testing was cycloheximide treated McCoy cells infected with the broad reacting L2 strain of C. trachomatis. The sera were examined for the presence of antichlamydial IgG at a starting dilution of 1:10. Heat inactivated serum specimens were analyzed for presence of sperm immobilization antibodies (SIA) by the method of Isojima et al. Semen was collected and examined directly after liquefaction, and analysis included sperm volume, pH, sperm count, progressive motility, morphology, and number of round cells. 21 of 124 men (16.9%) had IgG antibody titers or= 40 to C. trachomatis. The sperm parameters of the males who had C. trachomatis IgG antibody titers or= 40 were compared with the parameters of the males who had C. trachomatis IgG antibody titers 40, and no significant difference was found. The incidence of patients with IgG antibody titers or= 40 to C. trachomatis was 17.6% (3/17) and 16.8% (18/107), respectively, in males with sperm counts less than 20 x 10-6/ml and males with sperm counts more than 20 x 10-6/ml. There was no significant difference between the 2 groups. When sperm motility was 20% C. trachomatis IgG antibody titers or= 40 were found in 15.4% (2/13) of patients compared with 17% (19/111) in patients with 20% sperm motility. No significant difference was found for the tested variables. SIA titers were positive in 11 of 124 patients (89.9%). The incidence of SIA was 9.5% (1/21) and 8.7% (9/103) in patients with C. trachomatis IgG antibody titers or= 40 and in patients with C. trachomatis IgG antibody titers 40, respectively. The difference was not significant. These data show that Chlamydial IgG antibody titers in serum are of questionable value in predicting possible correlation between male infertility and C. trachomatis infection.^ieng

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

OBJECTIVE: To determine the effectiveness of a short protocol (SP) of gonadotropin-releasing hormone agonist (GnRH-a) administration in patients who already had undergone at least one in vitro fertilization (IVF) and embryo transfer (ET) treatment cycle with the long protocol (LP) and had shown poor results. METHODS: One hundred and twelve patients were studied. The E2 levels, the number of preovulatory follicles, the number of oocytes retrieved and fertilized, the number of embryos cleaved, the fertilization rate and the number of embryos transferred were calculated. RESULTS: The values for the mentioned parameters were significantly higher in the SP than those in the LP. So were the pregnancy rates per cycle and per ET (23.2% and 24.1%, respectively) in the SP significantly (p < 0.0001) higher than those in the LP (12.5% and 13.5%, respectively). CONCLUSION: In cases who showed poor results to the LP, instead of repeating the same protocol the SP may be substituted. This strategy may not only improve the results, but also decrease the total cost of the IVF-ET treatment.

Effect of chlamydial antibodies on the outcome of in vitro fertilization (IVF) treatment.

OBJECTIVE: Our objective was to study the relationship between the presence of Chlamydia trachomatis antibodies and the success of IVF treatment. DESIGN: We evaluated 118 in vitro fertilization and embryo transfer (IVF-ET) treatment cycles from 51 couples with a history of infertility lasting for at least 2 years. All women starting a treatment cycle had their serum chlamydial antibody titers measured by indirect immunofluorescent technique. All patients received similar ovarian stimulation regimens and the oocytes collected were inseminated with similar concentrations of motile sperm. Clinical data from couples where the female partner had C. trachomatis ab titers > or = 40 have been compared with the equivalent data from couples where the female partner had C. trachomatis ab titers < 40. RESULTS: There was no statistically significant difference between the two groups concerning age, infertility period, oocytes collected, oocytes fertilized, and fertilization rate, and the pregnancy rates were comparable. CONCLUSION: Previous exposure to C. trachomatis did not alter the success rate of IVF-ET.