Anatomical basis of antropyloric transposition for fecal incontinence in humans: the infrapyloric approach.

PURPOSE: Antropylorus transposition in the perineum for end-stage anal incontinence has shown to be feasible in humans. Vascular anatomy of the antro-pyloro-duodenal area is critical in preventing complications and increasing pyloric graft survival. This study was undertaken to examine the vascular anatomy of antro-pyloro-duodenal area in an attempt to safeguard the graft blood supply and improve its survival. METHODS: After obtaining preoperative CT angiography to delineate the infrapyloric artery (IP a.), bench dissection of resected pancreaticoduodenectomy specimens was performed in 12 patients. Ex vivo angiography of these specimens were also performed. Subsequent to the information obtained from these dissections, the method of antropylorus mobilization during transposition was modified in terms of the site of division of the right gastroepiploic a. (Rt GEA). Perioperative outcomes (graft related complications, fecal incontinence scores, Doppler flow studies, and manometry studies of the graft) were compared between the two groups. RESULTS: IP a. originated only from the Rt GEA in 8 cases (66 %) and from both the gastroduodenal a. and the Rt GEA in the rest. However, its origin solely from the gastroduodenal a. was not observed. The pyloric graft survival, pyloric valve pressures and Doppler flow velocities were significantly (p < 0.05) better when the infrapyloric a. was preserved following this refinement. However, no immediate significant difference in incontinence scores was observed. CONCLUSIONS: Careful preservation of the pyloric valve vascularity by preserving the IP a. by dividing the Rt GEA at its origin increases vascularity, survival and contractility of the pyloric graft in perineum.

Sperm function and structure and seminal plasma prostanoid concentrations in men with IDDM.

Semen from 18 men with insulin-dependent diabetes mellitus (IDDM) aged 20-40 yr was compared with that from 15 age-matched control subjects. Although semen volume, sperm count, and spermatozoal motility were similar in the two groups, semen from diabetic men had significantly greater numbers of abnormal spermatozoa and significantly lower ability to penetrate hamster eggs. Concentrations of prostaglandins E2, F2 alpha, and I2 and thromboxane A2 were significantly elevated in the seminal plasma from semen of diabetic subjects compared with control subjects. These observations indicate the need for a careful assessment of fertility in diabetic men, the mechanisms underlying the abnormalities in spermatozoa, and the relationship of these abnormalities to the increase in prostanoid concentrations in diabetic men.

Solvent extraction, spectrophotometric and inductively coupled plasma atomic emission spectroscopic (ICP-AES) determination of lanthanum(III) with crown hydroxamic acid.

A new crown hydroxamic acid, 5,14-N,N'-hydroxyphenyl-4,15-dioxo-1,5,14,18-tetraaza hexacosane (NHDTAHA) for the extraction and spectrophotometric determination of lanthanum(III) is described. Lanthanum(III) forms a yellow coloured complex with NHDTAHA, which is extracted with chloroform, having molar absorptivity 7.7 x 10(3) 1 mol(-1) per cm at 372 nm. The system obeys Beer's law in the range 1.2-20 ppm of lanthanum. The extract is directly aspirated for ICP-AES measurements, the limits for estimation are 5-140 ppb of lanthanum. Lanthanum has been determined in monazite sand and standard samples.

Application of chelate forming resin Amberlite XAD-2-o-vanillinthiosemicarbazone to the separation and preconcentration of copper(II), zinc(II) and lead(II).

A very stable chelating resin matrix was synthesized by covalently linking o-vanillinthiosemicarbazone (oVTSC) with the benzene ring of the polystyrene-divinylbenzene resin Amberlite XAD-2 through a -NN- group. The resin was used successfully for the separation and preconcentration of copper(II), zinc(II) and lead(II) prior to their determination by atomic absorption spectrophotometry. The total sorption capacity of the resin was 850, 1500 and 2000 mug g(-1) of the resin for Cu(II), Zn(II) and Pb(II), respectively. For the quantitative sorption and recovery of Cu(II), Zn(II) and Pb(II), the optimum pH and eluants were pH 2.5-4.0 and 4 M HCl or 2 M HNO(3) for Cu(II), pH 5.5-6.5 and 1.0-2.0 M HCl for Zn(II) and pH 6.0-7.5 and 3 M HCl or 1 M HNO(3) for Pb(II). Both, the uptake and stripping of these metal ions were fairly rapid, indicating a better accessibility of the chelating sites. The t (1 2 ) values for Cu(II), Zn(II) and Pb(II) were also determined. Limit of tolerance of some electrolytes like NaCl, NaF, NaNO(3), Na(2)SO(4) and Na(3)PO(4) have been reported. The preconcentration factor for Cu(II), Zn(II) and Pb(II) was 90, 140 and 100 respectively. The method was applied for the determination of Cu(II), Zn(II) and Pb(II) in the water samples collected from Sabarmati river, Ahmedabad, India.

Sequential liquid-liquid extraction graphite furnace atomic absorption spectrometric (GFAAS) and spectrophotometric determination of zirconium(IV) with calixarene hydroxamic acid.

A new calixarene hydroxamic acid, 25,26,27,28-tetrahydroxy-5,11,17,23-tetrakis (N-p-chlorophenyl) calix[4]arene hydroxamic acid (CPCHA) is synthesized and used for the extraction and graphite furnace atomic absorption determination of zirconium(IV). The extract is also determined spectrophotometrically as CPCHA-SCN complex having maximum absorbance at 447 nm with molar absorptivity 9.4x10(3) l mol(-1) cm(-1). The Beer's law obeys in the range of 1.0-9.5 ppm of zirconium. The graphite atomic absorption (GFAAS) increases the sensitivity by about 50 folds. The method is applied to the trace determination of zirconium(IV) in standard samples.

Selective screening for cancer of the cervix uteri in South Indian women.

In India, the need exists for a scheme of selective screening for women at high risk of developing cervical carcinoma. In this study, the incidence of abnormal cervical cytology amongst 500 pregnant south Indian women (gravida 3, para 2 or more) who were booked under the Post Partum Programme of the Government of India was compared to that of 200 primi and second gravidas from the same out patient clinic population. Abnormal cytology was detected in 3.6% of the women in the study group which was significantly higher (P less than 0.05) than that in the control (0.5%), indicating that the former are at higher risk of developing cervical cancer. Within the study group, abnormal cytology was not found to correlate with increasing age and gravidity or with any clinical parameter. The study and follow up could be carried out using existing facilities and manpower. Using existing personnel involved in the Post Partum Programme, a follow up rate of 67% could be achieved from among women with abnormal cervical cytology. The cost-effectiveness of this scheme of selective screening is borne out by the extremely modest additional cost incurred.

Antioxidative and cytoprotective effects of andrographolide against CCl4-induced hepatotoxicity in HepG2 cells.

This article describes antioxidative and cytoprotective property of andrographolide, a major active component of the plant Andrographis paniculata (A. paniculata). High yields (2.7%) of andrographolide was isolated from the aerial parts of this plant via silica column chromatography. The purity of the compound was determined by high-performance thin-layer chromatography (HPTLC) and reversed phase high-performance liquid chromatography (HPLC) analysis. The structure was elucidated using techniques such as UV-visible spectrophotometry, elemental analysis, Fourier transform infrared (FT-IR), (1)H nuclear magnetic resonance ((1)H NMR), (13)C nuclear magnetic resonance ((13)C NMR) and mass spectral analysis and the data obtained were comparable with reported results. It was observed that andrographolide exhibited significant antioxidative property (IC50 = 3.2 µg/ml) by its ability to scavenge a stable free radical 1,1-diphenyl-2-picrylhydrazyl (DPPH) as compared to known antioxidants like ascorbic acid, butylated hydroxy toluene (BHT) and the plant extract. The cytoprotective role of andrographolide against carbon tetrachloride (CCl4) toxicity in human hepatoma HepG2 cell line was assessed using trypan blue exclusion test, 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay, by estimation of various leakage enzymes and by measuring the glutathione levels. The recovery obtained for andrographolide treatment in the presence of CCl4 was two-fold compared to A. paniculata extract for all other related biochemical parameters investigated. The results of the study indicate that andrographolide is a potent inhibitor of CCl4-mediated lipid peroxidation.

Povidone iodine causes opacification of silicone intraocular lens implants.

PURPOSE: Four cases of silicone intraocular lens (IOL) opacifications presented at a routine cataract service at a UK district general hospital. A systematic investigation was performed to identify and eliminate the causative factor. METHODS: An experiment was set up to determine the role of a chemically induced IOL injury. Silicone IOLs were exposed to the various chemical agents used during cataract surgery. One IOL was not exposed to any chemicals and was used as a control. The samples were then photographed with the same camera settings against the same background in a medical photography studio. RESULTS: All samples photographed using this technique were clear as the unexposed control IOL, except the IOLs that had come into contact with povidone iodine (PI). Exposure to higher concentrations of PI appears to give a greater opacification and staining--a graded effect. CONCLUSION: While the toxic effects of PI on corneal endothelial health is well recognized, as far as the authors are aware no reports exists on the possible harmful effects of PI on IOLs. The results from the current study suggest that exposure of silicone IOLs to even small volumes of 5% PI can lead to IOL opacifying effects. Further studies are needed to determine the toxic effects of PI on all IOL materials. However, based on the results of our study, we strongly recommend extreme caution in the use of PI as prophylaxis against infection at the conclusion of cataract surgery and recommend great care to ensure complete wound closure.

Crossover analysis using immunofluorescent detection of MLH1 foci in frozen-thawed testicular tissue.

To date, the effects of freezing on spermatogenesis have not yet been fully investigated at a molecular level. Antibody localization studies have identified the MutL homolog 1 (MLH1) protein, a mis-match repair protein, at the prophase I stage of meiosis, which allows the detection of recombination foci during pachytene. This study investigated the effect of long-term testicular tissue cryopreservation on meiotic prophase I, identified by recombination foci frequency and synaptonemal complex (SC) integrity. Frozen-thawed testicular tissues from 12 males who had each fathered a child were used. Because vasectomy or reverse vasectomy procedures are rare in the locale of the investigation, it was not possible to obtain fresh testicular tissue and use the males as their own controls. Immunocytogenetic analysis of 612 spermatocytes at the pachytene stage was performed. The results indicated a mean number of MLH1 foci of 49.2 (SD +/- 5.9), and no correlation was found between the freezing period, the MLH1 frequency and the SC integrity. The results suggest that freezing of testicular tissue taken post-puberty does not appear to be detrimental to the crossover process as identified by occurrence of MLH1 loci.

Simultaneous preconcentration of uranium(VI) and thorium(IV) from aqueous solutions using a chelating calix[4]arene anchored chloromethylated polystyrene solid phase.

A new chelating polymeric sorbent is developed using Merrifield chloromethylated resin anchored with calix[4]arene-o-vanillinsemicarbazone for simultaneous separation and solid phase extractive preconcentration of U(VI) and Th(IV). The "upper-rim" functionalized calix[4]arene-o-vanillinsemicarbazone was covalently linked to Merrifield resin and characterized by FT-IR and elemental analysis. The synthesized chelating polymeric sorbent shows superior binding affinity towards U(VI) and Th(IV) under selective pH conditions. Various physico-chemical parameters that influence the quantitative extraction of metal ions were optimized. The optimum pH range and flow rates for U(VI) and Th(IV) were 6.0-7.0 and 1.0-4.0mlmin(-1) and 3.5-4.5 and 1.5-4.0mlmin(-1), respectively. The total sorption capacity found for U(VI) and Th(IV) was 48734 and 41175mugg(-1), respectively. Interference studies carried out in the presence of diverse ions and electrolyte species showed quantitative analyte recovery (98-98.5%) with lower limits of detection, 6.14 and 4.29mugl(-1) and high preconcentration factors, 143 and 153 for U(VI) and Th(IV), respectively. The uptake and stripping of these metal ions on the resin were fast, indicating a better accessibility of the metal ions towards the chelating sites. The analytical applicability of the synthesized polymeric sorbent was tested with some synthetic mixtures for the separation of U(VI) and Th(IV) from each other and also from La(III), Cu(II) and Pb(II) by varying the pH and sequential acidic elution. The validity of the proposed method was checked by analyzing these metal ions in natural water samples, monazite sand and standard geological materials.

Gamete intrafallopian transfer (GIFT) in women with bicornuate uteri.

Fourteen women with bicornuate uteri underwent a total of 30 gamete intrafallopian transfer procedures. All patients responded adequately to ovarian stimulation. Eight women conceived, two of them twice. Five women delivered at term and three had a premature delivery. There was one spontaneous abortion and an ectopic pregnancy. No neonatal deaths occurred in this series. No increase in the incidence of spontaneous abortion was noted but there appeared to be an increase in the incidence of premature labor. These findings suggest that the prospects of conception for infertile women with bicornuate uteri treated with gamete intrafallopian transfer are similar to those of the rest of the infertile population treated at our center.

Day care management of severe ovarian hyperstimulation syndrome avoids hospitalization and morbidity.

Severe ovarian hyperstimulation syndrome (OHSS) is a dreaded complication of ovulation induction for assisted reproduction treatment. In the past, conservative management has been recommended and this leads to prolonged hospitalization. A total of 18 patients who developed severe OHSS were managed according to two protocols. The first group (n = 8) was managed conservatively with hospitalization, i.v. hydration and supportive therapy. The average duration of hospitalization was 11 days and the patients were uncomfortable throughout. A second group (n = 10) was managed on an out-patient basis with early, ultrasound-guided trans-abdominal paracentesis. While the patient was hydrated intravenously, 1-3 1 of fluid were removed over 2-3 h. The duration of hospitalization was between 6 and 7 h and no in-patient stay was required. Prompt relief of symptoms was reported and none of the patients required re-tapping. Pregnancy was achieved in 68% of all patients. Day care management with easy abdominal paracentesis was found to be simple, safe and effective; patients found it more acceptable as it avoided in-patient hospitalization.

Comparison of pregnancy outcome of pronuclear- and multicellular-stage frozen-thawed embryo transfers.

PURPOSE: Our purpose was to determine if supernumerary embryos generated by in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) should be frozen (using 1,2-propanediol) at the pronuclear or multicellular stage. METHODS: The study was a retrospective analysis conducted at the Dubai Gynaecology & Fertility Centre of the Department of Health & Medical Services, Dubai, U.A.E. One hundred forty-one women undergoing frozen-thawed embryo replacement cycles with IVF generated embryos and 84 women undergoing the same with ICSI generated embryos. RESULTS: Supernumerary, IVF-generated embryos frozen at the multicellular stage had a significantly higher rate of survival on thawing (73.9%) than embryos frozen at the pronuclear stage (64.4%). The morphological grades of the embryos in the two groups were similar, but a significantly higher pregnancy rate was obtained with embryos frozen at the multicellular stage (22.8%) than with pronuclear-stage embryos (14.8%). Similarly, with ICSI-generated embryos, significantly higher survival was seen with multicellular-stage frozen embryos (74.8%) than pronuclear-stage embryos (64.4%). The morphological grades of the embryos and pregnancy outcomes of the two groups were similar. CONCLUSIONS: Supernumerary embryos generated by IVF and ICSI should be frozen at the multicellular stage so as to allow selection of the best embryos for transfer and embryo freezing of only robust embryos.

Percutaneous epididymal sperm aspiration for obstructive azoospermia.

We report the use of percutaneous epididymal sperm aspiration as a simpler and more acceptable alternative to microscopic epididymal sperm aspiration for patients with obstructive azoospermia in whom bypass surgery is not feasible or has not been successful. Some contamination of the aspirate with blood is inevitable, but with careful sperm preparation techniques this can be reduced substantially in the final aliquot used for assisted conception. Spermatozoa with active forward progression may be used for gamete intra-Fallopian transfer treatment, but when this capacity is absent intracytoplasmic sperm injection is recommended. Three pregnancies were obtained in seven couples and a set of twins has been delivered.

What factors predetermine the risk of having a high-order multiple pregnancy with gamete intra-fallopian transfer?

Limiting the number of oocytes transferred at gamete intra-Fallopian transfer (GIFT) has limited the incidence of high-order pregnancy but at the same time compromised the fertility potential of some patients. A review of 300 patients who have undergone GIFT using a flexible approach as to the number of oocytes transferred identifies the patients at risk of high-order pregnancy as those aged under 30 years in whom more than six oocytes are returned and whose partner's spermatozoa have high progressive motility.

Secretion of atrial natriuretic peptide and digoxin-like immunoreactive substance during pregnancy.

We investigated the secretion of atrial natriuretic peptide (ANP) and digoxin-like immunoreactive substance (DLIS) during pregnancy, labor, and the puerperium, as measured in maternal and umbilical cord plasma. There were no significant changes in maternal concentrations of ANP during all three periods, and the concentrations were similar to those found in nonpregnant controls and in umbilical cord plasma. Maternal concentrations of DLIS increased significantly in the second half of pregnancy, peaked during labor, then decreased abruptly within 24 h of expulsion of the infant and placenta to values approaching the nonpregnant range. DLIS concentrations in umbilical cord plasma, however, were significantly higher than in maternal plasma during labor. The abrupt fall in DLIS in maternal plasma and the absence of a significant difference in DLIS concentrations between arterial and venous cord plasma suggest that, during pregnancy, the fetus, not the placenta, is the source of DLIS in maternal plasma.

Follicular fluid histamine concentrations in infertile women with pelvic adhesions.

Dense pelvic adhesions can arise as a result of pelvic infection, endometriosis, peritonitis, or pelvic surgery. The burnt-out disease is associated with evidence of a chronic inflammatory response. One of the chemical mediators of inflammation is histamine; and human and animal studies have indicated a role for histamine in the ovulatory process. In women with dense pelvic adhesions we have found significantly elevated concentrations of histamine in the follicular fluid when compared with the follicular fluid obtained from women without adhesions. This may lead to premature ovulation during a normal cycle, resulting in the release of an immature oocyte. It is possible that this may contribute to the lower fertility in women who have pelvic endometriosis but patent fallopian tubes, and in those patients where tubal patency has been restored following tubal surgery.

Suppression of puerperal lactation using jasmine flowers (Jasminum sambac).

The efficacy of jasmine flowers (Jasminum Sambac) applied to the breasts to suppress puerperal lactation was compared that of Bromocriptine. Effectiveness of both regimens was monitored by serum prolactin levels, clinical evaluation of the degree of breast engorgement and milk production and the analgesic intake. While both bromocriptine and jasmine flowers brought about a significant reduction in serum prolactin, the decrease was significantly greater with bromocriptine. However, clinical parameters such as breast engorgement, milk production and analgesic intake showed the 2 modes of therapy to be equally effective. The failure rates of the 2 regimens to suppress lactation were similar; however, rebound lactation occurred in a small proportion of women treated with bromocriptine. Jasmine flowers seem to be an effective and inexpensive method of suppressing puerperal lactation and can be used as an alternative in situations where cost and nonavailability restrict the use of bromocriptine.

Analysis of 1071 gift procedures--the case for a flexible approach to treatment.

An analysis of the outcome of first gamete intrafallopian transfers for 1071 women indicates that for those aged 40 years or more all the oocytes had to be transferred to obtain a 19.2% pregnancy rate. In this age-group pregnancy rate and multiple pregnancy rate were significantly lower than those for younger women. Success rate, but not multiple pregnancy rate, was significantly higher in the group of women from whom 11 or more oocytes were recovered and transferred after ovulation induction than when only 1-4 oocytes were recovered and transferred. The findings suggest that the number of oocytes transferred should depend on clinical circumstances.