Should sexual intercourse be avoided during the embryo transfer cycle? Life-threatening ruptured heterotopic pregnancy after single thawed embryo transfer: case report and review of the literature.

BACKGROUND: To report the life-threatening complication of a raptured heterotopic pregnancy occurring from thawed single embryo transfer. CASE REPORT: A 33-year-old woman underwent in vitro fertilization (IVF) under a step-up regimen. After oocyte collection, blastocysts were frozen, and a single frozen-thawed blastocyst was then transferred according to the natural cycle. On day 17 after embryo transfer, an intrauterine pregnancy was confirmed. On day 28, she complained of sudden abdominal pain and ultrasonography revealed marked fluid retention in the peritoneal cavity. Emergency laparoscopy was performed, revealing hemoperitoneum and a ruptured interstitial heterotopic pregnancy (HP), which was then resected laparoscopically. Because sexual intercourse had occurred shortly before the transfer, a HP comprising a spontaneous pregnancy and a pregnancy achieved by assisted reproductive technology was assumed. The fetus in the uterus survived and was delivered. CONCLUSION: In this case, however, despite the single embryo transfer during the natural-cycle frozen-thawed embryo transfer process, the risk of life-threatening complication as a HP as a consequence of spontaneous pregnancy after sexual intercourse remained.

Periapical bone defects of root filled teeth with persistent lesions evaluated by cone-beam computed tomography.

AIM: To evaluate and categorize the bone defects of root filled teeth with persistent periapical lesions by cone-beam computed tomography (CBCT). METHODOLOGY: Slice images of 532 teeth with persistent periapical lesions were obtained by CBCT in 427 patients and were examined by two endodontists. The periapical lesions were categorized into five types according to the characteristics of the bone defect based on CBCT images. The prevalence of each type was determined and analysed statistically at a 5% significance level using logistic regression. RESULTS: Of the 532 teeth analysed, 67% had buccal or labial bone plate defects (type II), 4% palatal or lingual bone plate defects (type III), 7%'through and through' defects (type IV) and 10% apical root protrusions from the bone plate (type V). Mandibular teeth had a significantly greater prevalence of type I lesions (P=0.0005) and a significantly lower prevalence for types IV (P=0.041), V (P=0.001), V-1 (P=0.015) and V-2 (P<0.001) as compared to maxillary teeth. CONCLUSION: CBCT accurately identified the type of periapical bone defect in persistent lesions. Because 10% of the teeth had apical root protrusions, which could not be identified by periapical radiography, the diagnostic information obtained by CBCT was an essential component of the treatment planning process.

Análise da carga microbiana de implantes mamários de silicone / Microbial load analysis in silicone gel breast implants

Silicone breast implants consist of biomaterials widely used in breast reconstitution surgeries or in mammary augmentation for esthetic reasons. A preliminary stage of the implant production process is vulcanization, which consists of heating the implant to 165±5ºC for approximately 9 hours. The aim of this work was to evaluate the bioburden of silicone breast implants prior to the vulcanization process and the decline in bioburden due to this process, and to confirm the sterility of the gel contained in the membrane. Breast implant production stages were evaluated by microbial counting in different steps, according to the USP 32 methodology. To evaluation of decrease in microbial load, spores strips were introduced inside the implant, and after vulcanization cycles the strips were removed from the implant. The strips were transferred to tubes containing TSB, followed by incubation for 7 days at 30-35ºC. The results obtained showed that the level of microbial contamination of gel implants is relatively low, and that vulcanization allowed for the inactivation of up to 108 spores. This study led us to the conclusion that vulcanization leaded to sterility of the gel inside the product. Thus, the final sterilizing process contributed to an increase in the Sterility Assurance Level.1.

Os implantes mamários de silicone constituem-se em biomateriais que têm sido amplamente utilizados em cirurgias para reconstituição da mama ou para o aumento do tamanho da mama por motivos estéticos. Uma etapa preliminar do processo produtivo do implante é a vulcanização, que consiste no aquecimento do implante a 165±5ºC por aproximadamente 9 horas. O objetivo deste estudo foi avaliar a carga microbiana dos implantes mamários de silicone antes do processo de vulcanização, o decaimento da carga microbiana neste processo e confirmar a esterilidade do gel contidointernamente à membrana. Os estágios do processo produtivo dos implantes mamários foram avaliados pela contagem microbiana em diferentes etapas, de acordo com a metodologia da USP 32. Para avaliação do decaimento da carga microbiana, tiras de esporos foram introduzidas no interior do implante e após os ciclos de vulcanização foram retiradas do implante. As tiras foram transferidas para tubos contendo TSB, seguidos pela incubação por 7 dias a 30-35ºC. Os resultados obtidos mostraram que o nível de contaminação microbiana dos implantes gelatinosos é relativamente baixo e que a vulcanização possibilitou a inativação de até 108 esporos. Este estudo nos leva à conclusão que a vulcanização levou à esterilidade do gel interno ao produto. Desta forma, o processo esterilizante final contribuiu para um aumento no Nível de Garantia de Esterilidade.1.

Gamma irradiation, rheological and microbiological analysis of cosmetic products.

In this study, we aimed to use gamma irradiation for decontamination of cosmetic product (gel) achieve the acceptable microbiological limits. Cosmetic product vials were irradiated (10-100 kGy) and physicochemical, microbiological and biological properties of these samples were evaluated in normal conditions. Decontamination dose for all samples was found to be about 10 kGy or below. A pseudoplastic feature was induced in the gel after irradiation suggesting a large applicability of gamma radiation to this purpose.

Sterilization by pure oxygen plasma and by oxygen-hydrogen peroxide plasma: an efficacy study.

Plasma is an innovative sterilization method characterized by a low toxicity to operators and patients, and also by its operation at temperatures close to room temperatures. The use of different parameters for this method of sterilization and the corresponding results were analyzed in this study. A low-pressure inductive discharge was used to study the plasma sterilization processes. Oxygen and a mixture of oxygen and hydrogen peroxide were used as plasma source gases. The efficacy of the processes using different combinations of parameters such as plasma-generation method, type of gas, pressure, gas flow rate, temperature, power, and exposure time was evaluated. Two phases were developed for the processes, one using pure oxygen and the other a mixture of gases. Bacillus subtilis var. niger ATCC 9372 (Bacillus atrophaeus) spores inoculated on glass coverslips were used as biological indicators to evaluate the efficacy of the processes. All cycles were carried out in triplicate for different sublethal exposure times to calculate the D value by the enumeration method. The pour-plate technique was used to quantify the spores. D values of between 8 and 3 min were obtained. Best results were achieved at high power levels (350 and 400 W) using pure oxygen, showing that plasma sterilization is a promising alternative to other sterilization methods.

An ex vivo evaluation of a new root canal irrigation technique with intracanal aspiration.

AIM: To evaluate the effectiveness of a new root canal irrigation technique with intracanal aspiration in removing the smear layer and to assess irrigant extrusion ex vivo. METHODOLOGY: Thirty-five instrumented canals of extracted human canine teeth that had been resected apically by removing 3 mm of the root tip were divided into one control and four experimental groups of seven teeth each. The roots were fixed in a plastic case and surrounded with normal saline agar coloured with 1% acid red. No irrigation was performed in the control teeth. Each root canal in the experimental groups was irrigated with 9 mL of 14% ethylenediaminetetraacetic acid for 3 min, and then with 6 mL of 6% sodium hypochlorite (NaOCl) for 2 min. In the intracanal aspiration technique, the irrigant was delivered from the tip of an injection needle placed 12 mm from the apical root-end and an aspiration needle that was connected to a Root ZX apex locator placed 2 and 3 mm short of the apical root-end in groups 1 and 2, respectively. In the conventional method, the tip of an injection needle used for delivery of the irrigant and as an active electrode was placed 2 and 3 mm short of the apical root-end in groups 3 and 4, respectively, the tip of the aspiration needle was placed 12 mm from the apical root-end in these groups. The readings of the Root ZX during irrigation were recorded. The cleanliness of the canal was evaluated by scoring smear layer from scanning electron microscopy (SEM) images of the canal. Extrusion of NaOCl was detected by measuring the discoloured area of the agar around the apical root-end. The data obtained were statistically analysed by one-way anova, the Kruskal-Wallis test and Friedman's test. RESULTS: In the SEM study, the canals in groups 1-3 were significantly cleaner than those in the control and group 4 (P < 0.05). The mean Root ZX readings in groups 1-3 were approximately "0.5". The discoloured area in group 3 was significantly larger than the other groups (P < 0.05). CONCLUSIONS: Irrigation using the intracanal aspiration technique allowed more effective removal of the smear layer than that performed by the conventional method in an apically resected canine tooth. The intracanal aspiration technique produced limited extrusion of the irrigant beyond the apical foramen.

Detection of the second mesiobuccal canal in mesiobuccal roots of maxillary molar teeth ex vivo.

AIM: To assess the effectiveness of magnification and dentine removal (troughing) when locating the second mesiobuccal canal in mesiobuccal roots of maxillary molars. METHODOLOGY: A total of 208 extracted human maxillary molars were examined. After crown and pulp removal, the MB1 and 2 canals in the mesiobuccal root were located in three stages that were performed by two undergraduate dental students. Stage 1: canals were located with an endodontic explorer; stage 2: additional canals in the same teeth were located under magnification with a digital microscope (VH-8000, Keyence, Japan); stage 3: additional canals in the same teeth were located by removing dentine (troughing) from the pulp chamber floor within 3 mm from MB1 canal towards the palatal canal with an Enac ultrasonic tip (ST 21, Osada, Japan). In each group, the canals were prepared with Gates Glidden burs and K-files. The distal and palatal roots were then removed, and Indian ink was injected into the canal system within the mesio-buccal root. The root surfaces were washed with 6% NaOCl, and then rendered transparent to observe canal morphology. The root canal configurations were classified into five categories following the modified Weine's classification. RESULTS: More than one canal in the mesio-buccal root was observed in 48% of specimens. Detection rates of multiple canals were 7, 18 and 42% following stages 1, 2 and 3, respectively. There was a significant difference between the stages for detecting the MB2 canal (P < 0.05, Friedman test). CONCLUSIONS: Both magnification (stage 2) and dentine removal under magnification (stage 3) were effective in detecting the presence of the MB2 canal. However, MB2 canals could not be detected in 13% of the teeth because of canal calcification or branching located more apically.

Pharmacokinetic investigation of oral itraconazole in stratum corneum level of tinea pedis.

In the present study, the authors administered 100 mg itraconazole (ITCZ) twice daily for a period of 1 week to six patients with hyperkeratotic type tinea pedis, and examined its efficacy, safety profile, and usefulness. ITCZ concentration in stratum corneum was also measured to examine the mobility of the drug into the affected site of planta pedis. ITCZ concentration in the stratum corneum of the affected part was first detected at 1 week after the completion of administration, gradually increased over time, and peaked at 3 weeks, with the sum of ITCZ and hydroxyitraconazole (OH-ITCZ) amounting to 163.7 ng g(-1) on a average. It then gradually decreased to a total sum of 10.3 ng g(-1) on average at 8 weeks following the completion of administration. When compared with the geometric mean minimum inhibitory concentration (MIC) of ITCZ against fresh clinical isolates of dermatophytes (Trichophyton rubrum) (0.06 microg ml(-1)), the stratum corneum ITCZ concentration in this study was 2.1-fold of the geometric mean MIC at 2 weeks following the completion of administration, and 2.4-fold at 4 weeks. Although ITCZ does not produce therapeutic effectiveness (fungistasis) during the period of administration, it starts appearing at 2 weeks after the completion of administration, and after it peaks out at 3-4 weeks, clinical symptoms started improving. These results suggest that satisfying effects can be achieved in a short-term oral ITCZ at a dose of 100 mg twice daily for a period of 1 week in cases of hyperkeratotic type tinea pedis.

The effect of colonisation by Helicobacter pylori in Praomys (Mastomys) natalensis on the incidence of carcinoids.

An animal model of experimental gastric Helicobacter pylori infection has been developed in the Z strain of Praomys (Mastomys) natalensis; this animal has been reported to develop gastric carcinoids and adenocarcinoma spontaneously. In the present study, male and female Mastomys were killed at 1, 2, 4, 8 and 16 weeks after H. pylori inoculation. Colonisation of H. pylori was maintained in the stomachs of all animals for up to 16 weeks. H. pylori were mainly found in the antrum. Lymphoid infiltration appeared in the antral lamina propria and submucosa in all male and female animals from 4 to 16 weeks after inoculation. On microscopic examination after immunostaining for H. pylori, the organisms were detected in the antral mucus layer of the gastric epithelium. Serum immunoglobulin G specific for H. pylori could be detected 2 weeks after inoculation in female and 4 weeks after inoculation in male Mastomys, and persisted throughout the 16-week study period. At 18 months after inoculation, H. pylori positive rates for male and female Mastomys were 15 of 21 and 7 of 27, respectively. Carcinoids developed in 27 of 100 inoculated and in 49 of 100 uninoculated male, and in 5 of 100 inoculated and in 21 of 100 uninoculated female animals at 18 months after inoculation. Adenocarcinoma developed in 1 of 100 male Mastomys in both the inoculated and uninoculated groups, but in none of the female animals in either the inoculated or uninoculated groups. These results indicate that antrum-predominant colonisation by H. pylori caused the decrease in incidence of carcinoid formation in Mastomys.

Experimental Helicobacter pylori gastric infection in miniature pigs.

An experimental Helicobacter pylori infection in miniature pigs was developed and investigated. Eighteen miniature pigs were inoculated with an H. pylori strain that has high virulence in mice at c. 5 x 10(10) cfu. H. pylori infection in miniature pigs was achieved by the administration of agar 1% in brucella broth with fetal bovine serum 10% just before inoculation. The bacterial colonisation and distribution were analysed by mapping of viable cell counts in the stomach in pigs of three different ages. The mapping assay was achieved on post-infection day 3 for the 5-day-old and 2-week-old pigs, and between days 41 and 43 for 3-month-old pigs. The highest cell counts were observed in 5-day-old pigs, which averaged 4.9 x 10(6) cfu/g of mucosa (n = 4). The bacteria were colonised mainly in the cardiac and fundus gland region in the 5-day-old and 2-week-old pigs, whereas the colonisation sites did not depend on the region in the 3-month-old pigs. Biopsy assay of the antral mucosa of a 3-month-old pig after H. pylori infection showed that this infection persisted for >22 months. Serum antibody against H. pylori was detected in the infected pigs but not in the uninfected animal. Immunostaining demonstrated the presence of bacteria on the epithelial surface of the infected pigs. A microscopic finding common to all the infected pigs, focal gastritis with infiltration of lymphocytes detected on the lesser curvature of the stomach, resembled the microscopic appearance in H. pylori-infected human patients. These results suggest that miniature pigs might be a suitable model for studying H. pylori infection.

A prospective randomized study comparing endocrinological and clinical effects of two types of GnRH agonists in cases of uterine leiomyomas or endometriosis.

OBJECTIVE: In order to assess the endocrinological changes associated with 2 types of low-dose GnRH agonists depot as well as their clinical efficacy, we performed a randomized prospective comparison study of patients having uterine leiomyomas or endometriosis. METHODS: A prospective randomized study involving 67 patients with uterine leiomyomas or endometriosis was carried out. These patients were randomly administered either buserelin MP 1.8 mg (Group B, n = 34) or leuprolide 1.88 mg (Group L, n = 33). In each group we evaluated the symptoms of genital bleeding and hot flashes during GnRHa treatment, as well as the levels of serum LH, FSH, and estradiol 8 weeks after the start of treatment. In addition, the endometrial thickness was measured by transvaginal ultrasonography, and changes in the volume of the uterine leiomyoma or endometrial cyst at the end of treatment. The GnRHa depot was administered from 3 to 8 times, 28 days apart, in both groups. RESULTS: The incidence of menstruation-like genital bleeding 8 weeks after treatment was significantly (p < 0.01) higher in Group B. However this difference disappeared by 12 weeks after treatment. The climacteric symptom of hot flashes was found to be significantly (p < 0.01) more severe in Group L, and this tendency continued until 20 weeks after treatment. The 2 groups did not differ significantly with regard to the levels of the serum LH, FSH, and estradiol at 8 weeks after treatment or in the endometrial thickness at the end of the GnRHa treatment. In both groups, the volumes of the uterine leiomyomas were significantly (p < 0.01) lower after the treatment. In contrast, the volumes of the endometrial cysts did not decrease after administration of GnRHa in both groups. CONCLUSION: Leuprolide 1.88 induced pituitary down regulation more rapidly than buserelin MP. However the hypoestrogenic symptoms such as hot flashes were more severe in cases treated with leuprolide 1.88 than in those treated with buserelin MP. Our data confirm that the therapeutic efficacy of buserelin MP and leuprolide 1.88 are similar, with both being sufficient to treat uterine leiomyomas and endometriosis.

The effect of HLA alleles on response to interferon therapy in patients with chronic hepatitis C.

OBJECTIVE: To compare HLA alleles in the patients with chronic hepatitis C treated with interferon-alpha (IFN-alpha) between patients with response to IFN treatment and nonresponse. METHOD: Sixty-seven Japanese patients with chronic hepatitis C were treated with daily intramuscular administration of IFN-alpha (6 million units) for 2 weeks followed by three times per week for 22 weeks. Viral loads of hepatitis virus C (HCV), HCV genotypes and HLA antigens were determined just before IFN-alpha treatment. Responders to IFN-alpha were defined as normalization of alanine aminotransferase at the end of treatment and during a follow-up period at least longer than 6 months. The patients who could not reach the above response criteria were defined as nonresponders. RESULTS: There were 20 responders and 47 nonresponders to IFN treatment. The low viral load with less than 1 x 10(6) copy/ml (P< 0.05), and type 2a genotype (P< 0.05) were significantly increased in responders. Other clinical and biochemical parameters were not significant. There was no difference in HLA-A and C antigens between responders and nonresponders. In contrast, HLA-B54,DR4 and A24-B54-DR4 haplotype of nonresponders increased compared with responders or controls (Pc < 0.0001, Pc < 0.001, Pc < 0.0001, respectively). At multivariate analysis, viral loads, HLA-B54 and HLA-A24-B54-DR4 haplotype were significant (P=0.0002, P=0.0258, P=0.0378, respectively). CONCLUSION: The low viral load is a good predictor. HLA-B54 and HLA-A24-B54-DR4 haplotype should be predictors for poor response to IFN therapy in patients with chronic hepatitis C.

Xanthogranulomatous pyelonephritis.

A 76-year-old woman presented with spiking fever and right back pain. Ultrasonography (US) revealed that her right kidney was enlarged. Computed tomography (CT) showed the parenchyma was replaced by non-enhancing masses but the overall kidney shape was maintained. These findings were compatible with those of xanthogranulomatous pyelonephritis (XP). The nonenhancing masses on CT coincided with the multiple butter yellow nodules of the resected kidney and microscopically these lesions were proved to be abscesses with xanthoma cells. In this case, the US and CT findings reflected the pathological feature of XP and thus these techniques are thought to be useful for the diagnosis of XP.

[The possibility of evaluation on inflammatory change at respiratory tract in chronic bronchial asthma using 67Ga scintigraphy].

67Ga scintigraphy was performed in 17 patients with chronic bronchial asthma to grasp the inflammatory change of respiratory tract. On 67Ga scintigraphy, abnormal accumulations were detected on lung fields in 6 cases (35.3%) of 17 cases. In 5 cases of these 6 cases, the defect areas which were pointed out on 81mKr ventilation scintigraphy were matched to the abnormal accumulation areas which were pointed out on 67Ga scintigraphy. In dynamics, the abnormal accumulation areas which were pointed out on 67Ga scintigraphy were matched to the defect areas which had been at all times pointed out on 81mKr ventilation scintigraphy. 67Ga scintigraphy was expected to be one of index to grasp the inflammatory change of respiratory tract in patients with chronic bronchial asthma.

[The first case of Sjögren's syndrome with anti-Wa antibody].

A 42-year-old woman presented in 1992 with Raynaud's phenomenon, polyarthralgia and morning stiffness and next year developed xerostomia and xerophthalmia. Investigations revealed 20 mm/hr of ESR, positive test for RAPA (1 : 320), ANF (1 : 1280), anti-SS-A antibody and anti-Wa antibody, and positive Schirmer tear test. A biopsied specimen of minor salivary gland of lip showed lymphocytic infiltration around the ducts and fibrotic changes and a sialogram demonstrated diffuse dilatations of the peripheral ducts. Resulting from the data shown above, the diagnosis of Sjögren's syndrome was made. Anti-Wa antibody, which recognizes a 48 kD tRNA associated protein was identified in serum from a patient with systemic sclerosis by Yamagata in 1985. So far the antibody has been specific for systemic sclerosis, because all of six patients with anti-Wa antibody previously reported were diagnosed as having systemic sclerosis. However, we here described the first case of Sjögren's syndrome with anti-Wa antibody.