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Biomedical subjects

G Westlander

Publications and source records attributed to G Westlander.

At least 19 recordsLinked to original sources
PubMed2003

Different fertilization rates between immotile testicular spermatozoa and immotile ejaculated spermatozoa for ICSI in men with Kartagener's syndrome: case reports.

We report two cases of infertility treatment in couples where males suffered from Kartagener's syndrome (KS) and a total absence of motile sperm in the ejaculate. A total of three ICSI cycles was carried out. In all cycles, viable ejaculated or testicular spermatozoa were selected using the hypo-osmotic swelling (HOS) test. Case 1: In the first ICSI cycle total fertilization failure occurred after using ejaculated spermatozoa. In the following cycle testicular spermatozoa were used for ICSI, resulting in 75% fertilized oocytes and a pregnancy. Case 2: In the same ICSI cycle 50% of the oocytes were injected with ejaculated and 50% with testicular spermatozoa. The fertilization rates were 44 and 56% respectively and high quality embryos were achieved in both groups. One single embryo derived from testicular sperm was transferred with a resulting singleton pregnancy. In conclusion, testicular sperm for ICSI seem to have reliable fertilization capacity in men with KS, while ejaculated sperm, even if tested viable, seem more unpredictable. HOS test for selection of viable sperm for ICSI is recommended when ejaculated as well as testicular sperm are used for ICSI.

Adult↗
PubMed2001

Testicular ultrasonography and extended chromosome analysis in men with nonmosaic Klinefelter syndrome: a prospective study of possible predictive factors for successful sperm recovery.

OBJECTIVE: To investigate whether extended chromosome analysis or testicular sonography, including flow Doppler imaging, before diagnostic testicular sperm extraction have predictive value for successful sperm retrieval in men with nonmosaic Klinefelter syndrome. DESIGN: Prospective clinical study. SETTING: IVF clinic and genetics laboratory at a university hospital. PATIENT(S): Nineteen patients with nonmosaic Klinefelter syndrome and azoospermia. INTERVENTION(S): Collection of blood samples; histopathologic examination of testicular tissue; fluorescence in situ hybridization; sonography, including Doppler imaging; and testicular sperm extraction. MAIN OUTCOME MEASURE(S): Testicular volume, serum FSH and serum testosterone levels, percentage of normal XY cells, ultrasound echogenicity, intratesticular blood flow resistance, and sperm recovery. RESULT(S): Testicular volume and levels of serum FSH and serum testosterone levels did not differ significantly. No differences in testicular echogenicity or intratesticular blood flow resistance were found between 47,XXY men in whom sperm recovery was successful and those in whom sperm recovery failed. Significant differences were seen between all patients with the Klinefelter syndrome and controls with normal sperm values. Fluorescence in situ hybridization of peripheral lymphocytes and buccal tissue showed no correlation between frequency of normal 46,XY cells and testicular spermatogenesis. CONCLUSION(S): In azoospermic men with the Klinefelter syndrome, histopathologic findings seem to be predictive for successful sperm recovery. Infertility work-up, including diagnostic testicular sperm recovery, is recommended, and, if possible, viable sperm should be cryopreserved.

Adult↗
PubMed2001

Sperm retrieval, fertilization, and pregnancy outcome in repeated testicular sperm aspiration.

PURPOSE: To report the outcome of sperm retrieval and results after ICSI in up to six repeated testicular sperm aspiration procedures. METHODS: Twenty-two men with obstructive and thirty-four men with nonobstructive azoospermia underwent 50 and 91 needle aspirations, respectively. Sufficiency of spermatozoa for ICSI and cryopreservation, fertilization rate, and pregnancy outcome was analyzed retrospectively. RESULTS: No major differences were found in sperm recovery or pregnancy outcome in the repeated cycles. Testicular aspirate containing motile spermatozoa with maintained fertilizing capacity was obtained in up to six repeated procedures in the nonobstructive group. No postoperative complications were reported for any of the participants. CONCLUSIONS: Testicular sperm aspiration is a simple and effective method of sperm retrieval, which can be performed from the same testis up to several times with good recovery of motile spermatozoa for ICSI and maintaining high fertilization and pregnancy rates, in men with both obstructive and nonobstructive azoospermia.

Adult↗
PubMed2001

Serial ultrasonography, hormonal profile and antisperm antibody response after testicular sperm aspiration.

BACKGROUND: In many fertility centres, intracytoplasmic sperm injection (ICSI) with epididymal or testicular spermatozoa is a routine treatment for men with azoospermia. In this prospective study, the physiological consequences after testicular sperm aspiration (TESA), using suction and a 19 gauge needle, were evaluated. METHODS AND RESULTS: Thirty-five consecutive men with azoospermia underwent TESA. Testicular ultrasonography with Doppler flow imaging was performed and testicular volumes were evaluated pre-operatively and 3 months after aspiration. If focal testicular lesions were found, further examinations were performed 6 and 9 months after TESA. Serum FSH, testosterone and antisperm antibodies (ASA) were analysed. Focal testicular lesions were seen in four out of 61 testes (6.6%) at the 3 month investigation point. Three lesions were resolved after 6 months and all after 9 months. Testicular echogenicity remained unchanged in 50 cases (82%) 3 months after TESA. Four men (11.4%) reported severe subjective discomfort post-operatively, but only one had a medical consultation where an intratesticular haematoma was diagnosed. There were no significant changes in FSH and testosterone after surgery and testicular volumes were similar after 3 months. There were three borderline cases of ASA in serum, but none was classified as ASA-positive. CONCLUSIONS: The puncture method of testicular sperm aspiration seems to be a safe method for sperm retrieval, with minimal physiological consequences.

Adult↗
PubMed2000

Obstetric outcome of pregnancies following ICSI, classified according to sperm origin and quality.

The aim of this study was to report the outcome of all clinical pregnancies obtained after intracytoplasmic sperm injection (ICSI) performed during a 5 year period at two fertility clinics, with special reference to delivery outcome associated with different sperm origin and quality and the transfer of fresh or frozen-thawed pre-embryos. A total of 1293 clinical pregnancies was analysed. Deliveries occurred in 75.9% (n = 982) and early spontaneous abortion, late spontaneous abortion and ectopic pregnancy in 21.4, 1.0 and 1.2% respectively. Multiple birth occurred in 21.3% (208 sets of twins and one set of triplets) of the deliveries, with the highest incidence in the epididymal sperm group (30.2%) and lowest in the cryopreserved group (13.7%). A total of 1192 infants was born. Preterm birth occurred in 15.7% of all deliveries. Preterm birth was not related to sperm origin or quality but was related to multiple birth. The prematurity rate was 8.4%, 42.3% and 100% for singletons, twins and triplets respectively. Singleton infants born after cryopreservation as embryos had a significantly higher birthweight than the ejaculated sperm group with fresh embryo transfer. The perinatal mortality rate was 11.7 per 1000 born infants. Eighty-seven of the 1192 infants (7.3%) had a malformation, 40 of which were minor. The perinatal mortality rate and the malformation rate were similar in the different subgroups. Prenatal karyotyping was performed on 149 fetuses (12.5%) and abnormal results were found in four cases (2.7%). In conclusion, obstetric outcome of ICSI pregnancies was similar to that of conventional IVF and was not influenced by sperm origin or quality. The high incidence of multiple births is still the major concern.

Abnormalities, Multiple↗
PubMed1999

Diagnostic epididymal and testicular sperm recovery and genetic aspects in azoospermic men.

Various procedures for sperm recovery in azoospermic men have been described, from open testicular biopsy to simple needle aspiration from the epididymis and the testis. Fifty-one obstructive and 86 non-obstructive azoospermic men were treated to compare the recovery of spermatozoa obtained by percutaneous aspiration from the epididymis (PESA) and aspiration/extraction from the testis (TESA, TESE) with histopathology. If TESA failed, the work up proceeded with TESE. All patients were karyotyped. Spermatozoa were recovered by PESA or TESA in all obstructive men (51/51 patients). In 22 out of 86 patients with non-obstructive azoospermia, testicular spermatozoa could be successfully recovered by TESA. In five additional patients TESE was successful in recovering spermatozoa where TESA had failed. In 43 patients, neither TESA nor TESE was successful. Sixteen patients chose not to proceed with TESE. Seven out of 86 patients had an abnormal karyotype in the non-obstructive group (8%), none in the obstructive group. In the non-obstructive patient group testicular histopathology showed hypospermatogenesis, incomplete maturation arrest and germ cell aplasia with focal spermatogenesis in cases where spermatozoa were recovered and complete germ cell aplasia, complete maturation arrest and fibrosis in cases where no spermatozoa were found. Spermatozoa were recovered by PESA or TESA from all patients with obstructive azoospermia and from approximately 40% of patients with non-obstructive azoospermia by TESA or TESE. Retrieval of viable spermatozoa in the infertility work-up was highly predictable for sperm recovery in subsequent ICSI cycles. TESA performed under local anaesthesia seems almost as effective as more invasive procedures in recovering testicular spermatozoa, both in obstructive and non-obstructive azoospermic men.

Epididymis↗
PubMed1998

Sperm retrieval and fertilization in repeated percutaneous epididymal sperm aspiration.

Percutaneous epididymal sperm aspiration (PESA) for retrieval of spermatozoa for intracytoplasmic sperm injection (ICSI) is a new simplified technique in the treatment of men with obstructive azoospermia. There has been a fear that the PESA procedure, being blind, could cause damage to the epididymal duct system and make it impossible to retrieve spermatozoa if a repeated procedure is required. We report here on repeated PESA procedures from the same unilateral epididymis. Twenty-seven men with obstructive azoospermia were investigated retrospectively regarding sufficiency of the number of motile spermatozoa for ICSI, fertilization rate (FR) and possibility of collecting spermatozoa for cryopreservation in repeated PESA procedures. Sufficient motile spermatozoa for ICSI were found in a similar proportion of men at the first two attempts: 91 and 89% respectively. Fertilization rate and the possibility of collecting spermatozoa for cryopreservation were also similar at the first two PESA procedures: 62 versus 67% and 33 versus 33% respectively. At the third procedure, motile spermatozoa for ICSI were retrieved in 86% (6/7), FR was 47% and spermatozoa were cryopreserved in one case. Two men underwent a fourth PESA. In both cases, a sufficient number of motile spermatozoa for ICSI was found and FR was 62%. This study shows that in men with obstructive azoospermia, PESA can be repeated on the same unilateral epididymis up to three times, with good opportunity of retrieving sufficient motile spermatozoa for ICSI.

Adult↗
PubMed1998

Attitudes of different groups of women in Sweden to oocyte donation and oocyte research.

OBJECTIVES: To evaluate attitudes of Swedish women towards oocyte donation and oocyte research. METHODS: Five different groups of women, with approximately 50 patients in each, were asked anonymously about their attitudes to legislation, tentative roles as donors or recipients, anonymity, suitable donors or recipients, research on fetuses and cadavers as a source of oocytes, age limits and economic aspects. The groups were: 1. Women undergoing IVF treatment (IVF). 2. Infertile women during work-up (INF). 3. Recently delivered women attending a maternity unit (MAT). 4. Women attending a family planning center applying for therapeutic abortion (FPC). 5. Women with Turner's syndrome (TUR). RESULTS: More than 90% of women in all groups investigated advocated amendment of the law in order to permit oocyte donation. The women of infertile groups were more in favor of donating oocytes compared to women of fertile groups (p<0.05). A great majority would prefer anonymity both if they were donors and if they were recipients. If no anonymity was guaranteed, the acceptance of both the donor and recipient groups decreased but more than half of the women in all groups would still donate/accept oocytes. There was a significant difference in attitude towards non-anonymous oocyte donation, with the highest acceptance among Turner patients and the lowest among IVF patients (p<0.01). A majority in all groups were more motivated to donate/accept oocytes from a close relative, with the exception of Turner patients (p<0.01). All groups had a negative attitude to the use of donated fetuses and cadavers as sources of oocytes. IVF patients, close relatives and volunteers were all regarded as suitable donors by a majority of women in all groups. Women of fertile age, with ovarian failure or a genetic disorder, were accepted as recipients by all groups. Postmenopausal women were not accepted as recipients by a great majority in all groups. All groups preferred an age limit for recipients. More than 70% set the limit to the interval 40 to 45 years of age. A majority in all groups believed that donors should be paid to cover medication and loss of income. The recipients were expected, by a majority of women, to pay for some of the costs of the oocyte donation program. CONCLUSIONS: A great majority wanted a change in the Swedish legislation to permit oocyte donation. All groups had a generous attitude to donation of oocytes although anonymity would be preferred. Ovarian dysfunction and genetic disorders among women of fertile age were regarded as major indications for oocyte donation. IVF patients, close relatives and volunteers were all regarded as acceptable donors.

Abortion, Therapeutic↗
PubMed1996

Postoperative pain relief by topical lidocaine in the surgical wound of hysterectomized patients.

BACKGROUND: To improve postoperative analgesia, local anesthetics have been administered perioperatively as infiltration or as aerosol in the surgical area. A previous study showed good analgesic effects by topical lidocaine in the wound in minor extraabdominal surgery (herniorraphy), while the same treatment in minor lower laparothomies did not improve postoperative analgesia. The present study investigated the effect of topical wound anesthesia using lidocaine aerosol on postoperative pain following major lower abdominal surgery. METHODS: Postoperative pain and analgesic requirements were studied in a double-blind randomized trial including 30 hysterectomized patients. Patients were randomized to receive single wound treatment either with lidocaine aerosol 500 mg (100 mg/ml; Xylocain aerosol, ASTRA, Sweden) (n = 15) or placebo aerosol (n = 15). Postoperative pain was evaluated by visual analogue scale (VAS). Requirements of opiate analgesics (buprenorphine) after surgery were monitored. RESULTS: Lidocaine aerosol induced a significantly (P < 0.001) better analgesia at rest (VAS) and a significant (P < 0.001) reduction in postoperative requirements of buprenorphine during the first 24 hours after surgery compared to placebo aerosol. Differences between the groups in pain scores (VAS) and buprenorphine requirements during the second postoperative day were not significant. Mean pain scores upon mobilization 24 h after surgery were significantly lower in the group receiving lidocaine aerosol (P < 0.05). The plasma lidocaine concentration 4 h after the administration of lidocaine was well below toxic level and plasma lidocaine was detectable 48 h postoperatively. No drug-related side effects were reported. CONCLUSION: A single dose of lidocaine aerosol topically administered in the surgical wound of hysterectomy patients improved analgesia during the first postoperative day with minimal risk of side effects.

Adult↗
PubMed1995

Evaluation of an ergonomics intervention programme in VDT workplaces.

This paper focuses on an intervention programme based on the concept of participatory ergonomics. The study was designed within the framework of a multidisciplinary project concerned with identifying the work conditions and problems necessary to improve the working life of VDT operators with routine data-entry and data-dialogue tasks. The intervention programme was evaluated in two follow-up studies. The evaluation criteria covered the proposals for improvement emerging from (1) the intervention programme's final joint decisions (of experts and employees) on measures needed, and (2) workers' views of the effectiveness of the programme itself. As the implementation period was marked by increasing turbulence caused by recession in many branches of the Swedish economy, attention was paid to the impact of the restructuring and rationalization effected by company management in the workplaces under study. To obtain a better understanding of the outcome of the intervention programme, the follow-up was extended systematically to explore the disturbing organizational factors operating during the implementation period. The results of the evaluation offer increased knowledge of organizational barriers to the implementation of ergonomics measures decided upon within the framework of intervention research.

Journal Article↗
PubMed1995

Means, goals, and outcomes of a comprehensive occupational health program for telephone operators.

A means-goals analysis requires a plan with some degree of distinctness, which is worked out beforehand and specifies reasonably clear goals and intended means. This article draws its material from a broadly designed strategy for organizational change that meets these criteria. A service division of Swedish Telecom underwent a program of comprehensive organizational change; major efforts were made to improve the occupational health of 300 telephone operators in manual service operations. Over a full three-year period, a number of specific problems were to be resolved. An independent research team evaluated the implementation of the program prospectively. The team followed an evaluation model in which stringent distinction was made between: (1) action areas, (2) intended specific means, (3) intended immediate goals, and (4) the longer-term favorable effects of achieving these immediate goals. In addition, an attempt was made to interpret and understand the findings of the means-goals evaluation by paying systematic attention to the implementation process and factors that might permit an understanding of the final outcomes of the program. Compared with other efforts to improve telephone operators' work conditions as reported in the research literature, this strategy for the promotion of change is broad and ambitious.

Comprehensive Health Care↗
PubMed1991

The psychological background of pregnancy outcome: a critical evaluation of research.

This paper concentrates on the scientific attempts to find psychological interpretations of pregnancy outcome. The author presents a critical discussion of the literature based on an extensive evaluation undertaken during 1988. The aim of the analysis was to clarify the state-of-the-art and choices of methodologies in studies exploring and identifying the non-medical factors behind pregnancy outcome. Three distinctive psychology based approaches are found, which are based on personality theory, psychosocial theory and life-event theory. These bases argue for very different causal contexts of pregnancy outcome and are, therefore, according to the author's view, very important to recognize, particularly when it comes to occupational health research on work environment and pregnancy outcome.

Female↗
PubMed1989

Organizational change and health at work.

The focus of this article is the link between organizational change and individual working conditions. In some organizational development projects health aspects may be left to chance, in others they may be to some extent respected, and in still others they are the main theme of the process and direction of change. Along this line, the author presents and discusses a number of Swedish cases. The analysis aims at emphasizing a necessary characteristic of occupational health experts, namely, to be sensitive to the differences between the goals of various projects in organizational development. Preventive work must be based on a careful identification of the sort of health aspects that are overlooked in every effort at organizational change.

Adaptation, Psychological↗
PubMed1988

Inhibition of peritonitis by amide local anesthetics.

Peritonitis was induced in rats by exposing the peritoneal surface to 0.1 M hydrochloric acid (HCl). Peritonitis was quantified by extraction of Evans blue-bound albumin from the tissue exposed to HCl and analyzed by a spectrophotometric technique. In the first set of experiments, one group of rats had the peritoneal surface exposed to HCl following local pretreatment with isotonic saline; a second group of rats had the peritoneum exposed to HCl after topical pretreatment with an equal volume of lidocaine 1%, whereas in a third group the peritoneal surface was exposed only to saline without HCl. The experimental design in the second set of experiments was similar to that of the first set except that bupivacaine 0.5% was used instead of lidocaine in the second group. Results show a significant inhibition of peritonitis in the groups pretreated with lidocaine (P less than 0.01) and bupivacaine (P less than 0.05) compared with rats in the saline pretreated group. In the lidocaine-pretreated group Evans blue-albumin extravasation did not differ significantly from the rats not receiving HCl, whereas the bupivacaine-pretreated group showed a slightly but significantly (P less than 0.05) more pronounced peritonitis than control rats not exposed to HCl. In the third set of experiments the peritoneum was topically treated with either lidocaine 1%, bupivacaine 0.5%, or isotonic saline after first having exposed the peritoneal surface to HCl. A significant inhibition of albumin extravasation was seen following lidocaine (P less than 0.001) or bupivacaine (P less than 0.001) treatment compared with treatment with isotonic saline.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Swedish women and new technology.

This paper provides information and analysis on the overall situation of women in Sweden with regard to computer based new technology. It is based on a survey of computer use in Sweden, carried out in June 1984 by Statistics Sweden. The aim of the study was to ascertain the knowledge base and experience with computers of the Swedish population. In order to study whether sex differences exist a special analysis of the data was carried out. Women are involved in new technology in Sweden to a very great extent, however, there is male dominance in both the initiation and development of the technology. This may be as much reflective of general male and female roles in the workplace as of the nature of new technology itself.

Career Mobility↗