Routine application of partial zona dissection for male factor infertility.

Partial zona dissection (PZD) increases the chances of fertilization by improving the access of spermatozoa to the perivitelline space (PVS) helping those spermatozoa unable to penetrate the zona pellucida (ZP) and possibly those poorly able to penetrate the oolemma. Problems arise in assessing semen to decide which parameters might indicate defects of this nature. PZD, by circumventing the ZP, may also increase the rate of polyspermy, especially in infertility where ZP and oolemmal penetration are not defective. Given these drawbacks, we performed PZD as routine treatment for male infertility in 70 in-vitro fertilization cycles. In three different groups, PZD proved to be either effective, ineffective or unnecessary. In the first group of 35 cycles, fertilization was 23% with initial PZD and 33% with PZD reinsemination (36% and 41% polyspermy respectively). No fertilization occurred following conventional insemination (CONV). Four pregnancies occurred in this group. In a second group of 19 cycles, fertilization did not occur with either PZD or CONV. In the final group of 16 cycles, fertilization was similar following both PZD and CONV, but polyspermy was 48% in the PZD category. Transfer of mixed PZD and CONV embryos in this group yielded 10 pregnancies. Assessment of all patient and seminal profiles, and those in an oligozoospermic subcategory, revealed no parameters of relevance to success or failure with PZD. However, one subgroup in the group of total failure to fertilize did have a significantly lower percentage of normal morphology (P less than 0.005), suggesting that degree of teratozoospermia may be a prognosticator of success using PZD.

Lysozyme in chronic liver disease: a biochemical and histological study.

Serum lysozyme activities and semiquantitative analysis of tissue lysozyme distribution were studied in patients with primary biliary cirrhosis (PBC), chronic hepatitis (CH), miscellaneous liver diseases, and normal subjects. Serum lysozyme was significantly raised in PBC and CH. Portal venous blood has similar lysozyme activities to peripheral venous blood in a group of various liver diseases. Lysozyme-containing intralobular cells were decreased in all liver diseases studied but portal tract lysozyme was increased only in PBC and CH. Thus the increase in serum lysozyme in PBC and CH appears to originate from the portal inflammatory infiltrate, seen in these diseases.

Urinary amine metabolites in depression: a combined biochemical and general practice study: II. Biochemical aspects.

Peripheral measures of amine metabolites may be related to response to treatment with antidepressants. Urinary studies of MHPG levels have indicated a different response to treatment between patients with low levels who responded well to imipramine and those who responded well to amitriptyline. Such findings lead to the consideration of the newer antidepressants such as clomipramine and maprotiline, with their more selective actions on the individual amine systems, as the medication of choice for specific groups of patients. It was hypothesized that patients having a low excretion of MHPG might have deranged noradrenaline metabolism, and therefore respond best to maprotiline and conversely a low excretion of 5 HIAA might indicate a derangement of serotonin metabolism and therefore a good response to clomipramine. A clinical study, however, showed that changes in amine levels, interesting though they were with respect to the response to medication, were not consistent with the known preferences of maprotiline and clomipramine for single amine systems. There was no evidence of the existence of clearly defined groups within the population studied having a derangement of a single amine system.

Amine metabolism, thyroid function and response to clomipramine and maprotiline medication in depression.

The various clinical types of depression may correspond to biochemically distinct forms of the condition. If these could be characterized, antidepressant treatment might be tailored to correction of the underlying biochemical change(s) in individual patients. In particular, the selective actions of clomipramine and maprotiline on the serotonergic and noradrenergic systems respectively might be exploited therapeutically. Studies of the clinical response to these two antidepressants included tests of urinary 5-hydroxy-indoleacetic acid (5-HIAA) excretion and of serum thyroxine levels. While thyroid stimulation tests may prove of value for investigating depressed patients, urinary 5-HIAA levels are inconvenient, subject to extraneous influences and hard to interpret in terms of brain chemistry. (An alternative is proposed in the next paper.)