No abstract available.
Meningitis, Cryptococcal*

OBJECTIVE: To compare the clinical outcomes of intrauterine insemination (IUI) according to the catheter used. MATERIALS AND METHOD: From March 1998 to September 1998, total 95 infertile patients were included in this study. Patients were randomly allocated to TomCat group (n = 39) and Mackler group (n = 56) according to the catheter for insemination. The controlled ovarian hyperstimulation (COH) using luteal long protocol of gonadotropin releasing hormone agonist (GnRH-a) was used in all patients. Statistical analysis was performed using Student's t-test, Fisher's exact test, and x2 test as appropriate. Statistical significance was defined as p < 0.05. RESULTS: The total dose and duration of exogeneous gonadotropin required were similar between the two groups. There were also no significant differences in serum estradiol (E2) level, endometrial thickness and texture on the day of hCG administration between the two groups. However, the percentage of uterine souding due to failure of initial approach was significantly higher in TomCat group compared to Mackler group (23.1% vs. 0%, p < 0.01). The percentage of bleeding after IUI in TomCat group seemed to be higher than that in Mackler group (15.4% vs. 3.6%, p = 0.06), although there was no statistically significant difference between the two groups. There was also no significant difference in the clinical pregnancy rate per patient between the two groups. CONCLUSION: These results suggested that using Mackler catheter might be effective for IUI, especially for the patients with cervical factor infertility.
Catheters* ; Estradiol ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Hemorrhage ; Humans ; Infertility ; Insemination* ; Pregnancy Rate

OBJECTIVE: To analyze the efficacy of intracytoplasmic sperm injection (ICSI) for totally unfertilized oocytes by the conventional insemination during in vitro fertilization and embryo transfer (IVF-ET) METHODS: From March 1996 to April 1998, 15 couples who experienced total fertilization failure after conventional IVF without severe male factor infertility in semen analysis were evaluated. Fertilization were assessed by the presence of 2 pronucleus (PN) after 14-16 hours of conventional insemination. All unfertilized oocytes were reinseminated by ICSI and checked for signs of fertilization between 6-10 hours after ICSI. The embryos with fertilization and development were transferred to the uterine cavity and the outcome was analyzed. RESULTS: Total numbers of unfertilized oocytes were 120, and total numbers of oocytes injected on day 1 using ICSI were 102. Total numbers of oocytes with normal fertilization after ICSI were 74 and mean fertilization rate of 71.1 +/- 24.0% was obtained. The numbers of embryos transferred was 3.6 +/- 1.7. The biochemical pregnancy rate was 13.3% (2/15) and the clinical pregnancy rate was 6.7% (1/15) per cycle. CONCLUSION: ICSI to totally unfertilized oocytes by conventional insemination technique during IVF-ET on the next day of oocyte retrieval seems to be a relatively successful mean and afford a chance of pregnancy to the infertile couples whom the ET could not perfomed to because of total fertilization failure."
Embryo Transfer ; Embryonic Structures ; Family Characteristics ; Fertilization ; Fertilization in Vitro ; Humans ; Infertility ; Insemination ; Male ; Oocyte Retrieval ; Oocytes* ; Pregnancy ; Pregnancy Rate ; Semen Analysis ; Sperm Injections, Intracytoplasmic*

OBJECTIVE: To determine whether the somatostatin analogue, octreotide, given concunently with human menopausal gonadotropin (HMG) affects ovarian response, ovulation induction outcome, and serum levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) in infertile patients with polycystic ovarian syndrome (PCOS) resistant to clomiphene citrate (CC). METHODS: From August 1996 to June 1998, 42 infertile patients with PCOS urresponsive to CC were enrolled in the present study. Women who had other infertility factors were excluded from this study. Patients were randomly allocated either to combined HMG and octreotide treatment (treatment group) (n=21) or HMG alone (control group) (n=21). In the treatment group, 100 micrograms of octreotide were administered daily concomitantly with HMG from the 3rd day of menstrual cycle to the preceding day of human chorionic gonadotropin (HCG) injection. RESULTS: Patient's characteristics were comparable in both groups. One cycle in the control group was abandoned because of excessive follicular development. However, none of the cycles in the treatment group was abandoned. There were no differences in the number of HMG ampules required and the duration of HMG administration between the two groups. The number of follicles > 14mm diameter on the day of HCG injection was significantly less in the treatment group than that in the control group (p<0.01). The serum estradiol level on the day of HCG injection was also significantly lower in the treatment group, with 1391.0 +/- 695.5 pg/ml compared with 2217.5 +/- 811.6pg/ml in the control group (p<0.001). The incidence of severe ovarian hyperstimulation syndrome seemed to be lower in the treatment group, but the difference did not achieve significance (4.9% vs 23.8%). There were no differences in the clinical pregnancy rate, miscarriage rate and multiple pregnancy rate between the two groups. Although serum GH levels were comparable between the two groups, serum IGF-1 level on the day of HCG injection was significantly higher in the treatment gmup than that in the control group (p<0.001). CONCLUSION: This study suggests that the combined octreotide and HMG treatment could improve hormonal milieu and folliculogenesis compared to HMG alone, and therefore may be effective in ovulation induction for patients with PCOS resistant to CC.
Abortion, Spontaneous ; Chorionic Gonadotropin ; Clomiphene ; Estradiol ; Female ; Gonadotropins ; Growth Hormone ; Humans ; Incidence ; Infertility ; Insulin-Like Growth Factor I ; Menstrual Cycle ; Octreotide ; Ovarian Hyperstimulation Syndrome ; Ovulation Induction* ; Ovulation* ; Polycystic Ovary Syndrome* ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple ; Somatostatin*

OBJECTIVE: To evaluate whether the basal serum luteinizing hormone (LH) levels in the presence of normal serum follicle stimulating hormone (FSH) are useful as a prognostic indicator of ovarian response to controlled ovarian hyperstimulation (COH). METHODS: From January 1997 to January 1999, 91 infertile women with tubal factor who had undergone in vitro fertilization and embryo transfer (IVF-ET) were enrolled in the present study. COH was performed using long protocol of gonadotropin-releasing hormone (GnRH) agonist. All patients included in this study had blood samples drawn on cycle day 2 or 3 prior to COH for measurement of basal FSH and LH. Women who had other infertility factors or high basal FSH levels (> or = 8.5 mIU/ml) were excluded from this study. The results of COH and IVF-ET were compared between two groups according to the level of basal LH (low LH group [< 3mIU/ml] vs. control group [> or = 3mIU/ml]). RESULTS: Patient's characteristics were comparable in both groups except basal LH level. The number of ampules and duration of exogenous gonadotropins required were significantly higher in the low LH group than those in the control group (p<0.001; p<0.005, respectively). The number of follicles > or = 14mm diameter on the day of human chorionic gonadotropin (hCG) injection was significantly less in the low LH group than that in the control group (p<0.001). The serum estradiol level on the day of hCG injection was also significantly lower in the low LH group, with 1115.5 +/- 380.9 pg/ml compared with 1340.6 +/- 403.0 pg/ml in the control group (p<0.005). There were significantly lower numbers in oocytes retrieved, oocytes fertilized and embryos frozen in the low LH group than those in the control group (< 0.001; < 0.001; <0.005, respectively). However, there was no difference in the fertilization rate between the two groups. The clinical pregnancy rate per cycle seemed to be lower in the low LH group, but the difference did not achieve significance (26.2% vs 39.7%). There were no differences in the miscarriage rate and multiple pregnancy rate between the two groups. CONCLUSION: This study demonstrates that the low basal LH levels ( < 3 mIU/ml) could be predictive of low ovarian response to COH and poor IVF results.
Abortion, Spontaneous ; Chorionic Gonadotropin ; Embryo Transfer ; Embryonic Structures ; Estradiol ; Female ; Fertilization ; Fertilization in Vitro ; Follicle Stimulating Hormone ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Infertility ; Lutein* ; Luteinizing Hormone* ; Oocytes ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple

OBJECTIVES: To examine the in vitro interactions of blastocyst attachment using type I collagen. MATERIALS AND METHODS: ICR mice were used and follicular growth was stimulated by pregnant mare serum gonadotropin and human chorionic gonadotropin. On day 4 of pregnancy, the uteri were removed and blastocysts were flushed. Mixtures of 1mL sterile water, 0.5mL DMEM, 2mL type collagen solution and 0.5mL 0.1M NaOH were prepared and transferred to an incubator where the collagen solution polymerized. Blastocysts were transferred to dishes previously coated with type I collagen. CMRL 1066 was used as the basic culture medium. It was supplemented with 1mM glutamine and 1mM sodium pyruvate plus 50 IU/ml penicillin and 50 mg/ml streptomycin. During the first 4 days the culture medium was supplemented with 20% fetal calf serum and thereafter with 20% heat inactivated human cord serum. All blastocysts were initially cultured for 2 days without media change. After 2 days, fresh medium was renewed daily. The stages of embryo growth were examined and recorded everyday under a dissecting microscope and classified according to the standard in vivo criteria set forth by Witschi. RESULTS: By 48h, nearly all blastocysts had attached to the surface of collagen pad. Following adhesion to the collagen pad, the blastocysts maintained their 3-dimensional integrity in contrast to control. The embryos in collagen pad were not flattening and kept polarity and spherical shape during culture. The polar trophoblast invaded the type I collagen downward unlike the horizontal growth in control. In the developmental stage of mouse blastocyst, there were significant differences between control and type I collagen group during day 4 and 5 culture. CONCLUSION: Blastocyst development was better in type I collagen group than control. Therefore, in vitro culture study using type I collagen could provide improved model for the establishment of blastocyst implantation study.
Animals ; Blastocyst ; Chorionic Gonadotropin ; Collagen ; Collagen Type I* ; Embryo Implantation ; Embryonic Structures* ; Female ; Glutamine ; Gonadotropins ; Hot Temperature ; Humans ; Incubators ; Mice* ; Mice, Inbred ICR ; Penicillins ; Polymers ; Pregnancy ; Pyruvic Acid ; Sodium ; Streptomycin ; Trophoblasts ; Uterus ; Water

OBJECTIVES: To investigate the effect of granulocyte colony stimulating factor (G-CSF) and granulocyte macrophage colony stimulating factor (GM-CSF) on expression of matrix metalloproteinase-2, 9 (MMP-2, 9) mRNA in mouse embryos. Materials and METHOD: From October 1997 to December 1998, morula stage mouse embryos were cultured for 48 hours with G-CSF and GM-CSF at concentrations of 0.1 pg/ml, 1 pg/ml, 10 pg/ml, 100 pg/ml, 1 ng/ml and 10 ng/ml, respectively. Embryos not treated with G-CSF or GM-CSF were served as control. Reverse transcription-polymerase chain reaction (RT-PCR) has been used to examine the expression of MMP-2, 9 mRNA in developed blastocysts. Following reverse transcription, strategically designed nested primers, optimized for specificity, were used for amplification from the cDNA equivalent of a single embryo. The products were then verified by restriction enzyme digestion and sequence analysis. Results were analyzed with Kolmogorov-Smirnov test and analysis of variance (ANOVA). The statistical significance was defined as p< 0.05. RESULTS: The relative quantities (relative volume x intensity) of MMP-2 mRNA expressed in embryos of all G-CSF treatment groups were significantly increased than in the control, especially in 10, 100 pg/ml and 1 ng/ml treatment groups. The relative quantities of MMP-2 mRNA in all GM-CSF treatment groups were also significantly increased than in the control, especially in 100 pg/ml treatment group. The relative quantities of MMP-9 mRNA of all GM-CSF treatment groups except 10 ng/ml group were significantly increased than in the control, especially 10, 100 pg/ml and 1 ng/ml treatment group. However, the relative quantity of MMP-9 mRNA was significantly increased in only 10 ng/ml G-CSF treatment group than in the control and other treatment groups. CONCLUSION: This study suggests that G-CSF and GM-CSF may increase the m-RNA expression of MMP-2 or 9 in mouse blastocysts with the concentration-specific manner.
Animals ; Blastocyst ; Colony-Stimulating Factors* ; Digestion ; DNA, Complementary ; Embryonic Structures* ; Granulocyte Colony-Stimulating Factor ; Granulocyte-Macrophage Colony-Stimulating Factor* ; Granulocytes* ; Matrix Metalloproteinase 2* ; Mice* ; Morula ; Reverse Transcription ; RNA, Messenger ; Sensitivity and Specificity ; Sequence Analysis

No abstract available.
Myasthenia Gravis*

PURPOSE: To compare the diagnostic performance of clinical and radiologic examination for the interproximal caries on intraoral periapical radiographs and to evaluate the value of periapical radiographs. METHODS: One hundred seven dental patients were examined clinically, with a mouth mirror and an explorer, by a dentist at the department of oral medicine, and the presence or absence of interproximal caries lesion was recorded. The patients were prescribed one or more dental periapical radiographs. Radiographs were assessed for the presence of interproximal caries by three radiologists independantly. Two thousand sixty interproximal surfaces were included in this study. The diagnostic accuracies of clinical and radiologic examinations for interproximal caries were calculated. To assess the degree of agreement between clinical and radiologic examinations, Cohen's coefficient of agreement was computed. RESULTS: The specificity of clinical and radiologic examination was 0.991, 0.997 and the sensitivity was 0.279, 0.985 respectively. The diagnostic accuracy of radiologic examination was statistically significantly higher than that of clinical examination(P<0.05). Cohen's kappa value of clinical and radiologic examination was 0.335, 0.942 respectively. These results suggested that clinical examination show only fair agreement, whereas radiologic examination show perfect agreement. CONCLUSION: The diagnositic performance of the dental periapical radiographs on interproximal caries were higher than that of clinical examination, thus this study showed the validity of periapical radiographs for detecting interproximal caries lesion without bitewing radiograph.
Dentists ; Diagnosis* ; Humans ; Mouth ; Oral Medicine ; Radiography ; Sensitivity and Specificity

Until recently, the gastrointestinal lymphomas were classified according to the criteria developed for the node-based lymphomas. In recent years, the REAL classification provided a new category of MALT lymphoma and Mantle cell lymphoma in B-cell lymphomas. Low-grade MALT lymphomas have been well characterized clinically, histologically, and immunophenotypically. We retrospectively recategorized 41 cases of the primary gastrointestinal B-cell lymphoma and investigated the expression of cyclin D1, bcl-2, bcl-6, p53 protein, and PCNA by immunohistochemical method. The cases were categorized in 5 groups, low grade MALToma, low/high grade MALToma, high grade MALToma, diffuse large cell lymphoma, and mantle cell lymphoma according to the morphological findings. The expression of cyclin D1 protein was restricted to the cases of mantle cell lymphoma. The bcl-2 protein expression was higher in the low grade MALT lymphoma than in the high grade lymphoma (P=0.006). The bcl-2 protein expression was higher in the low grade area than in the high grade area in the low/high grade MALT lymphoma (P=0.005). The bcl-6 and p53 protein expression was higher in the high grade MALT lymphoma than in the low grade lymphoma (P=0.022, P<0.018). However, the bcl-6 protein expression of the tumor cells was higher in high grade area than in low grade area in the low/high grade MALT lymphoma (P=0.004). The degree of the PCNA expression was positively correlated with the grade of the malignant lymphoma (P=0.003). The above results suggest that the cellular proliferation assessed by PCNA index correlates with the histologic grade. And the bcl-2, bcl-6, p53 protein may be effective in the transition from the low grade MALT lymphoma to the high grade lymphoma. Therefore, we can differentiate the low grade lymphoma from the high grade lymphoma by the immunohistochemical staining for cyclin D1, bcl-2, bcl-6, p53 protein and can predict the prognosis of the patients in accordance with the grade of the tumor.
B-Lymphocytes* ; Cell Proliferation ; Classification* ; Cyclin D1* ; Cyclins* ; Gastrointestinal Tract ; Humans ; Lymphoma ; Lymphoma, B-Cell* ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Large B-Cell, Diffuse ; Lymphoma, Mantle-Cell ; Prognosis ; Proliferating Cell Nuclear Antigen* ; Retrospective Studies