Successful management of intrauterine twin and concomitant cervical pregnancy: a case report.

Use of in vitro fertilization techniques increases the frequency of pathological implantation. However, simultaneous pregnancies are a rarity. Ectopic implantation of the embryo may occur in the cervical canal. This is the first case report, which describes successful management of an intrauterine twin pregnancy which occurred simultaneously with a cervical pregnancy. Diagnostic and therapeutic options are discussed along with the outcome of pregnancies. The cervical pregnancy was removed by aspiration, without dilation of cervical canal, which saved the lives of intrauterine fetuses and preserved fertility for following pregnancies. Finally we review the advanced methods in the literature.

Intracytoplasmic sperm injection with motile and immotile frozen-thawed testicular spermatozoa (the Hungarian experience).

The authors summarize their experience in 75 in vitro fertilization cycles, where frozen-thawed testicular spermatozoa were used for intracytoplasmic sperm injection. In 32 cases, motile spermatozoa could be observed in the frozen-thawed sample. In 34 cases, motility could be induced by pentoxifylline and in nine cases immotile spermatozoa, selected with hypoosmotic swelling test, were used for fertilization. The fertilization rates obtained with motile and immotile spermatozoa (66.1% versus 52.3%) were not significantly different. Our data demonstrate that freezing of testicular spermatozoa opened new possibilities for the treatment of azoospermic men. The clinical pregnancy rate per embryo transfer (ET) (21.87%) was comparable with previous results use of fresh testicular spermatozoa (27.7%). The quality and number of transferred embryos had the most significant impact on the pregnancy rate. The fertilization rate and frequency distribution of good-quality embryos were lower in the case of immotile spermatozoa, and pregnancies were only achieved when motile spermatozoa had been used.

Five years experiences with microinjection of testicular spermatozoa into oocytes in Hungary.

The aim of the study was to summarize our five years experience (1996-2000) of testicular spermatozoa for intracytoplasmic sperm injection in Hungary. The influence of sperm count, maternal age, number of transferred embryos, and application of assisted hatching on outcome was investigated. Testicular spermatozoa were retrieved by microsurgical testicular sperm extraction. Samples were classified depending on the number of spermatozoa. Indication for testicular sperm extraction in conjunction with intracytoplasmic sperm injection was severe azoospermia or azoospermia combined with tubal origin infertility. Ovarian stimulation was carried out using an ultrashort protocol with GnRH agonist and gonadotrophin. Intracytoplasmic sperm injection was performed without PVP. Embryos were cultured for 48 or 72 h before embryo transfer. Indications for assisted hatching included elevated maternal age, increased zona thickness or at least two previous unsuccessful IVF cycles. Testicular spermatozoa were successfully retrieved in 218 out of 273 cases. Extreme low sperm count was found more frequently in cases of nonobstructive azoospermia. No significant differences were observed in fertilization rate (61.1% vs. 51.7%) or clinical pregnancy rate (29.0% vs. 26.7%) between patients with obstructive or nonobstructive azoospermia. Maternal age, number of transferred embryos and application of assisted hatching had a significant effect on outcome. A total of 55 clinical pregnancies were achieved, including 14 sets of twins, three sets of triplets and two sets of quadruplets. It is concluded that testicular sperm extraction is an efficient way of obtaining testicular spermatozoa, allowing not only successful fertilization by ICSI, but also freezing of testicular spermatozoa for use in subsequent cycles.

[Delivery following cryopreserved embryo transfer]. / Szülés mélyfagyasztva tárolt praeembriók beültetését követöen.

In this case report the authors describe the first delivery following cryopreserved preembryo transfer in Hungary. They concluded that this method may help to improve the cumulative pregnancy rate during in vitro fertilization cycles and alleviate the ethical problems associated with the destruction of viable preembryos.

The effect of platelet homogenate fractions on megakaryocytopoiesis in the mouse.

Platelet homogenate suppresses megakaryocytopoiesis more effectively than intact platelets do. In mouse experiments mitochondrial, lysosomal, and microsome fractions separated by ultracentrifugation from platelet homogenate did not influence megakaryocytopoiesis, while the cytosol fraction inhibited it similarly as platelet homogenate. Besides thrombopoietin, the substance released from the platelets also takes part in the regulation of thrombocytopoiesis and this substance passes into the cytosol fraction on separation by ultracentrifugation.

Prognostic factors in dysmyelopoietic syndromes.

Dysmyelopoietic syndromes are characterized by cytopenia in peripheral blood and marrow maturation abnormalities. The condition has been studied in 33 patients with regard to the initial haematologic picture. A certain number of variables of prognostic value was observed: excess of marrow blasts, pancytopenia, and decreased growth of bone marrow cells in agar culture. The length of survival and the percentage of leukaemic transformation were different in patients with refractory anaemia and refractory anaemia with an excess of blasts.

[The role of splenectomy in the treatment of lymphomas of low malignancy]. / Die Rolle der Splenektomie in der Behandlung von Lymphomen niedriger Malignität.

The effect of splenectomy was studied in 30 patients with non-Hodgkin lymphoma of low malignancy. Severe bacterial infections occurred in 9 patients. Follow-up of the total group of 72 patients-years revealed one infection requiring hospitalization per eight patient-years. With chronic lymphatic leukaemia there was no difference in the incidence of severe infection between splenectomized and non-splenectomized patients. In 12 patients the splenectomy produced favourable results in that in some (8) cytostatic treatment was no longer required, while in others (4) the dose of cytostatic drugs could be reduced after several months without any medication. Survival rate was not influenced by splenectomy.

[In vitro study of bone marrow from leukemia patients and patients without hematologic disease]. / In-vitro-Untersuchung des Knochenmarkes von Leukämiekranken und Patienten ohne hämatologische Abweichungen.

The bone-marrow of 26 patients not affected with hematological diseases and 10 patients with untreated leukemia was investigated according to Dexter in long-term cultures. Survival time and cell content of those long-term cultures started with normal bone marrow were not influenced significantly, if reinoculation was made with autologeneic or allogeneic bone marrow. Even without repeated inoculation, leukemic cells grew for a longer time in long-term cultures than normal bone marrow cells. As far as the outcome of the disease is concerned, no conclusion can be drawn from the duration of cultivating leukemic cells growth.

Relationship between the age of platelets and their megakaryocytopoiesis-inhibiting effect.

Homogenate made from young platelets suppressed thrombocytopoiesis in mice more effectively than homogenate made from old platelets. To achieve the same suppressive effect as that of young platelets, homogenate made from twice as many old platelets were needed.

Regulation of haemopoiesis in long-term bone marrow cultures. IV. Glycosaminoglycan synthesis and the stimulation of haemopoiesis by beta-D-xylosides.

Sulfated glycosaminoglycans (GAGs) are distributed in consistent and distinctive patterns between the cell surface and the growth medium of haemopoietically active long-term bone marrow cultures. Heparan sulfate is the main cell surface component and chondroitin sulfate is the major sulfated species in the medium. When the cultures are supplemented with beta-D-xylosides a significant increase in chondroitin sulfate synthesis is observed but no stimulation of heparan sulfate synthesis occurs. The chondroitin sulfate accumulates in the culture medium in beta-D-xyloside-treated cultures but the composition of sulfated GAGs in cell-surface derived material is unaffected. beta-D-xylosides also stimulate the production of haemopoietic cells without any apparent alteration in the adherent stromal cells of the marrow cultures. Equivalent increases are obtained in cells at all stages of development so that a fivefold increase in pluripotent stem cells (CFU-S) is matched by fivefold increase in the granulocyte-macrophage progenitors (GM-CFC) and in mature granulocytes. The stimulation persists for many weeks in beta-D-xyloside-treated cultures. These results indicate that the sulfated GAGs may play an important role in the regulation of haemopoiesis.

A comparative study of the inhibitory effect of trypan blue on mouse erythrocyte and C3 binding receptors of peripheral blood mononuclear cells from healthy donors and patients suffering from chronic lymphocytic leukaemia.

Trypan blue has previously been shown to interact with the C3 receptor, but not with the Fc receptor. In the present work the effects of Trypan blue on mouse erythrocyte (ME) and C3 binding receptors of the peripheral blood mononuclear cells have been studied in healthy individuals and in patients with chronic lymphocytic leukemia (CLL). The resulting dose-response curves have been compared with each another. The results of statistical analysis indicate that there is no significant difference between the effects of trypan blue on the two receptors in healthy individuals. In contrast ME and C3 binding receptors differ significantly in trypan blue sensitivity in CLL patients. These data suggest that the two receptors are similar, or are situated on the cell membrane in such a way that the trypan blue bound to one of them inhibits the functioning of the other one too, but they are not the same. In the course of leukemic transformation, the trypan blue sensitivity of the ME binding receptor does not vary, whereas that of the C3 receptor is enhanced significantly.

Effect of sera obtained from thrombocytopenic mice on syngeneic long-term bone marrow cultures.

BDF1 mice were rendered severely thrombocytopenic by antiplatelet serum and the effect of serum from these thrombocytopenic mice on early precursors of syngeneic bone marrow was studied in Dexter's long-term cultures. The CFUMega content had increased on the first day, reaching its maximum on the second and third days, and returned to its initial value by the seventh day. Repeated treatment prolonged the effect, and larger doses produced larger increases in CFUMega. Besides the increase in CFUMega content, the number of CFUS and of total cells also increased. The CFUC number did not change.

[Effect of thrombopenia on bone marrow CFU-S level and its capability to modify the circulating thrombocyte number]. / Die Auswirkung der Thrombopenie auf den CFU-S-Gehalt des Knochenmarks und seine Fähigkeit zur Beeinflussung der zirkulierenden Thrombozytenzahl.

Thrombocytopenia (rise of the thrombopoietin level) was induced by an antithrombocyte serum in mice. After 6 hours of existence of thrombocytopenia, the CFU-S and megakaryocyte-commmitted stem cell content of the bone marrow and spleen was determined by transplantation into mice pretreated with 800 cGy-rtg irradiation. Thrombocytopenia did not influence the CFU-S content. Thrombocytopoiesis of the recipient mice was better restored by bone marrow and spleen cells of thrombocytopenic animals than by cells transplanted from animals with a normal thrombocyte count.

Effect of platelet homogenate on platelet production of bone-marrow-transplanted mice.

Haemopoiesis of mice was reconstituted with 1 X 10(6) bone marrow cells after 800 r total body irradiation. Then their megakaryocytopoiesis was inhibited by platelet homogenates given at different points of time on three subsequent days. The effect was measured by the peripheral platelet counts on the 14th day after transplantation when the platelet count of irradiated and marrow-transplanted CFLP animals was 410 X 10(9)/l, and that of CBA mice was 185 X 10(9)/1. Platelet homogenates prepared from 1-2.5 X 10(8) platelets daily given on days 1, 2 and 3 did not significantly reduce the peripheral platelet count estimated on the 14th day, while homogenates given on days 8, 9 and 10 reduced it markedly. Homogenates prepared from 0.7-1.0 X 10(6) white blood cells did not influence the 14th day platelet count. Thus, platelet homogenates exert their inhibitory effect at a late stage of platelet production, i.e. not by an inhibition of thrombopoietin or a thrombopoietin effect.