Histological evidence of an inflammatory reaction to suture material in the dog vas deferens.

OBJECTIVE: To evaluate changes in histology and semen variables after using an elastomeric-hydrogel matrix plug as a reversible vasectomy device in dogs, and to determine the potential applications for improving fertility after vasectomy reversal. MATERIALS AND METHODS: Semen samples from six adult male dogs were obtained after left vasal ligation, placement of the plug in the right vas deferens, and subsequent removal of the plug. The vasa, epididymides and testes were evaluated histologically in four of the dogs after removal of the implant. RESULTS: No sperm were present in the ejaculate after the plug was removed. Histological sections showed intraluminal spermatids in areas where the plug had been placed. The lumen was occluded, secondary to foreign-body giant-cell reaction, at the vasotomy suture site, but other areas of the was previously containing the implant remained patent after it was removed. CONCLUSIONS: There were no sperm in the ejaculate after the plug was removed because the vasal lumen was occluded as a result of an inflammatory reaction to the suture material. In contrast, areas that had contained the implant but without a vasotomy suture were not inflamed. We suggest that further trials comparing various suture materials are carried out to determine if patency rates can be improved during vasotomy closure or vasovasotomy.

Dexamethasone during ovulation induction for in-vitro fertilization: a pilot study.

The purpose of the present study was to determine whether adrenal androgen suppression with dexamethasone (DEX) during ovulation induction improves the outcome of in-vitro fertilization (IVF) cycles. A total of 25 patients with serum dehydroepiandrosterone sulphate (DHEAS) concentrations > 2.5 micrograms/ml were randomized to receive either 0.5 mg DEX daily or placebo during ovulation induction with leuprolide acetate down-regulation plus human menopausal gonadotrophins (HMG). Nine patients undergoing a subsequent IVF cycle were crossed over to the other treatment group. Ovarian responsiveness and IVF outcome variables analysed included number of follicles > 12 mm in diameter, serum oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration, number of ampoules of HMG administered, number of oocytes retrieved, percentage of oocytes fertilized, number of embryos transferred, implantation rate and numbers of clinical pregnancies and live birth pregnancies. The 31 randomized IVF cycles revealed a trend towards a higher implantation rate for the placebo-treated group compared to the DEX-treated group (24 versus 10%; P = 0.07). The remainder of the IVF cycle variables revealed no statistically significant differences. In conclusion, the suppression of adrenal androgens with DEX in women with DHEAS concentrations > 2.5 micrograms/ml appears to have no beneficial effects on ovarian responsiveness or clinical or live birth pregnancy rates.

Growth factor receptor messenger RNA expression in human fetal brain regions.

OBJECTIVE: To analyze growth factor receptor expression in the human fetal brain. METHODS: Messenger RNA was prepared from six regions of the fetal brain from three 21-22-week abortuses and used as templates for reverse transcription. Polymerase chain reaction (PCR) was used to amplify the complementary DNA for each of the six brain regions. Amplified PCR DNA fragments were analyzed by agarose gel electrophoresis. Restriction endonuclease digestion was used to confirm the identity of the amplified PCR fragments. RESULTS: Polymerase chain reaction amplified DNA fragments consistent with expression of the insulin, insulin-like growth factors I and II, fibroblast growth factor (FGF), transforming growth factor-beta, and epidermal growth factor receptors were detected in each area of the human fetal brain studied. Of the two known insulin receptor subtype sequences, only the smaller (exon 11-) form was detected. We detected both the intact and the 267 base-deleted alternatively spliced forms of the FGF receptor. CONCLUSION: All six of the receptor messenger RNAs studied were detected in the second-trimester human fetal brain. In addition, alternative splicing of the messenger RNA was noted for the FGF and insulin receptors. This report demonstrates growth factor receptor expression and alternate splicing in specific regions of the human fetal brain. These data suggest that growth factor influence on fetal brain development may be mediated through specific growth factor receptors.

Transverse Witzel-T-tube feeding jejunostomy.

BACKGROUND: In patients prone to recurrent aspiration, a feeding jejunostomy is only performed to ensure adequate nutrition. A popular method for placement of the jejunostomy tube is the Witzel procedure, employing a sersosal tunnel on the antimesenteric border. The Witzel procedure, however, frequently suffers from the complication of tube dislodgement and obstruction due to narrowing of the intestinal lumen. METHODS: To minimize the complications associated with the standard Witzel method, we modified the procedure wherein a T-tube is substituted for a standard French rubber catheter, and transversely sutured to the mesenteric border. We believe that the placement of the Witzel line in the transverse plane minimizes the risk of obstruction, and substitution of a T-tube for a standard French catheter should reduce the incidence of tube dislodgement. RESULTS: The Transverse Witzel T-tube feeding jejunostomy has been performed successfully in 30 patients without any complications of tube dislodgement or leaks, and no tube to date has been difficult to remove. Length of tube use has ranged from 1 to 6 months, and no postoperative complications have been observed in this group. CONCLUSIONS: The Transverse Witzel T-tube jejunostomy is an effective and rapid technique for placement of a feeding tube. No serious complications have been observed, and the complication of tube dislodgement appears to be decreased compared to the standard Witzel procedure.

Ruptured pelvic abscess after intrauterine insemination: a case report.

This case reports a serious but previously unreported complication of IUI. Further reports of serious infection would warrant consideration of antibiotic prophylaxis in some cases.