Complete hydatidiform mole with a coexisting fetus resulting from in vitro fertilization.
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Adult↗
Biomedical subjects
J L Hwang
Publications and source records attributed to J L Hwang.
Small cell carcinoma of the endometrium with concomitant pelvic inflammatory disease.
BACKGROUND: Small cell carcinoma of the endometrium is a rare disease entity characterized by bulkiness and predisposition to necrosis. Clinical presentations include postmenopausal bleeding, lower abdominal mass, chronic abdominal pain and menorrhagia. We present a case of small cell carcinoma of the endometrium with concomitant pelvic inflammatory disease. The literature is also reviewed. CASE: A 64 year old female presented was admitted with the principal complaints of fever, lower abdominal pain and malodorous vaginal discharge. Bimanual examination revealed cervical motion tenderness with a WBC of 9400 cells/microL and increased levels of neutrophils, band cells and C-reactive protein. Sonography revealed an adnexal echocomplex compatible with tubo-ovarian abscess. Culture of the vaginal discharge revealed the presence of E. coli. Symptoms persisted despite three days of antibiotics administration so a laparotomy was performed with a friable hemorrhagic uterus revealed and an area of necrosis evident in the left adnexa. Malignancy was confirmed from frozen section. Total abdominal hysterectomy, with bilateral salpingooophorectomy and optimal debulking, was performed. The final pathology report confirmed small cell carcinoma of the endometrium. CONCLUSION: Malignancy and pelvic inflammatory disease have overlapping clinical characteristics. Once pelvic inflammatory disease is suspected in a postmenopausal patient, malignancy should also be suspected, and a thorough examination and a tumor-marker analysis performed.
Carcinoma, Small Cell↗
Amniotic membrane used for vulvar adhesion treatment.
We report here a case of vulvar adhesion that was difficult to cure by estrogen only. We used amniotic membrane to be a barrier and after the operation, the symptoms of vulvar adhesion were resolved.
Aged↗
Ultrasound diagnosis of a pregnancy in a Cesarean section scar.
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Adult↗
Pregnancy after intentional cryopreservation of percutaneous sperm aspiration specimens and intracytoplasmic sperm injection. A report of two cases.
BACKGROUND: Microsurgical epididymal sperm aspiration (MESA) and percutaneous epididymal sperm aspiration (PESA) are two methods of obtaining spermatozoa from patients with irreparable obstructive azoospermia. Intentionally using frozen-thawed spermatozoa obtained from MESA had been reported to be successful. With minimal invasiveness, intentionally cryopreserved PESA specimens and intracytoplasmic sperm injection (ICSI) were carried out in two cases. CASES: Two cases of irreparable obstructive azoospermia received PESA, and the spermatozoa were cryopreserved intentionally. Successful ICSI was performed later, utilizing frozen-thawed spermatozoa. CONCLUSION: PESA and ICSI are promising methods for these patients. The major advantages are minimal invasiveness and flexibility for further treatment.
Adult↗
Fetal compression syndrome caused by myoma in pregnancy: a case report.
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Adult↗
Increase in the expression of killer cell inhibitory receptors on peritoneal natural killer cells in women with endometriosis.
OBJECTIVE: Malfunction of peritoneal natural killer cells (NK) may result in endometriosis. The present study was designed to determine whether the decrease in NK cytotoxicity occurs at early and advanced stages of endometriosis and is due to the increase in the NK inhibition receptors. DESIGN: A case control study. SETTING: A tertiary-care infertility center . PATIENT(S): A total of 44 women (controls, n = 11; women with early-stage endometriosis, n = 11; and women with advanced-stage endometriosis, n = 22) were included in this study. INTERVENTION(S): Laparoscopic examination. MAIN OUTCOME MEASURE(S): NK cytotoxicity was determined by assay of (51)Cr release against K562 cells, and the expression of killer cell inhibitory receptors (KIR, including NKB1, GL183, and EB6) in NK cells was examined by flow cytometry. RESULT(S): Women with endometriosis showed a decrease in peritoneal NK cytotoxicities against K562 at early and advanced stages of endometriosis. The expression of KIR (NKB1 and EB6) was significantly elevated in the peritoneal NK cells of women with advanced-stage endometriosis compared with controls. KIR (NKB1) was also significantly increased in peritoneal NK cells of women with advanced-stage endometriosis, compared with those of women with early-stage endometriosis. CONCLUSION(S): The results of this study suggest that the decrease in peritoneal NK cytotoxicities against K562 is observed and that this disease may be partially due to the increased expression of KIR on these NK cells.
Ascitic Fluid↗
In vitro maturation and fertilization of immature oocytes: a comparative study of fertilization techniques.
PURPOSE: Our purpose was to investigate the factors influencing maturation and fertilization of immature oocytes. METHODS: Immature oocytes were obtained from women undergoing cesarean section. They were cultured in the maturation medium either with or without cumulus cells. After maturation to metaphase II, they were randomly fertilized by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). RESULTS: After incubation for 48 hr, 441 oocytes (42.8%) reached metaphase II. Among them, 56.6% of cumulus-enclosed oocytes, but only 29.2% of denuded oocytes, reached metaphase II. Of the 289 cumulus-enclosed oocytes, the fertilization rates by IVF and ICSI were 56.3 and 84.1%, respectively (P < 0.01). Of the 152 denuded oocytes, the fertilization rates by IVF and ICSI were 39.5 and 84.5%, respectively (P < 0.01). The cleavage rates, however, were similar. CONCLUSIONS: Cumulus cells are beneficial in the maturation of human oocytes in vitro and that ICSI increases the fertilization rate for the in vitro matured oocytes. The developmental potential of the fertilized oocytes, however, is similar irrespective of the fertilization method or the presence or absence of cumulus cells.
Adult↗
Methotrexate for cesarean scar pregnancy after in vitro fertilization and embryo transfer. A case report.
BACKGROUND: Cesarean scar pregnancy is an exceedingly rare occurrence. We present the first case of cesarean scar pregnancy following in vitro fertilization-embryo transfer (IVF-ET). CASE: A 40-year-old woman with a history of a previous cesarean section presented with five years of unexplained infertility. The patient complained of abdominal pain 16 days after embryo transfer. Ultrasonography revealed a gestational sac with cardiac activity located outside the lower segment of the uterus. Dilatation and curettage was performed due to misdiagnosis of inevitable abortion. Two weeks later, repeated sonography demonstrated a sacculus, 4.07 x 4.07 cm, within the uterine isthmus with only 7.1 mm of thickness separating the sac from the urinary bladder. Normal cervical length without ballooning was noted. Cesarean scar pregnancy was diagnosed. Local injection of methotrexate (MTX) under ultrasound guidance was performed. Plasma beta-hCG levels declined from 23,328 to 8 mlU/mL within two months. CONCLUSION: For women with cesarean scar pregnancy who desire fertility, conservative treatment using MTX is an excellent choice.
Abortifacient Agents, Nonsteroidal↗
Prenatal diagnosis of meconium peritonitis in a twin pregnancy after intracytoplasmic sperm injection. A case report.
BACKGROUND: Meconium peritonitis occurring in pregnancies following artificial reproductive techniques (ART) is rare. We report the first case of meconium peritonitis following intracytoplasmic sperm injection (ICSI). CASE: A 37-year-old woman attended our in vitro fertilization (IVF) program because her husband suffered from hypospermatogenetic azoospermia due to cancer surgery and radiotherapy. The patient achieved a twin pregnancy through ICSI from testicular sperm extraction at our IVF center. Meconium peritonitis, fetal ascites, polyhydramnios, bowel dilatation, hydrocele and intraabdominal calcification were noted in one of the twins on ultrasound at 30 weeks' gestation. Cesarean section due to breech presentation in labor was performed at 36 weeks' gestation. A normal female and male infant with a distended abdomen were delivered. Emergency laparotomy was performed on the male twin because of dyspnea. A 0.2-cm perforation was found in the terminal ileum. Ileotomy was performed and closed after 27 days. CONCLUSION: Prenatal diagnosis of meconium peritonitis is possible through careful ultrasonographic examination, and early surgical intervention and intensive postoperative support are required to improve the prognosis.
Adult↗
A comparison between loop electrosurgical excision procedure and cold knife conization for treatment of cervical dysplasia: residual disease in a subsequent hysterectomy specimen.
OBJECTIVE: The purpose of this study was to determine whether the loop electrosurgical excision procedure (LEEP) is as effective as cold knife conization (CKC) in the removal of cervical dysplasia. METHODS: One-hundred sixteen patients with cervical intraepithelial neoplasia were included: 73 cases treated with LEEP and 43 cases treated with CKC. All of these patients underwent subsequent hysterectomy within 6 months of treatment. A thorough histological evaluation of the cone specimens and post-cone hysterectomy specimens was performed. RESULTS: No residual disease in the post-cone hysterectomy specimens was identified in 63% of the LEEP group and 72.1% of the CKC group. There was no significant difference in the proportion of negative residual disease (P > 0.05). The mean diameters of the base as well as the depth of the cone specimens were smaller in the LEEP group than in the CKC group (P < 0.05). The operating time in the LEEP group was significantly shorter than that of the CKC group (P < 0.05). Although thermal artifacts of margin were found in 8.2% of LEEP specimens, there was no difficulty in histological interpretation. Furthermore, the postoperative complications were similar in both groups. CONCLUSION: The findings of this study demonstrate that the LEEP is a convenient, safe, and effective treatment for the management of cervical dysplasia. Cone specimens obtained during LEEP are adequate for thorough histological evaluation of cervical dysplasia.
Adult↗
An analysis of catering options within NHS acute hospitals.
Reforms of the NHS's healthcare structure have placed additional pressure on all aspects of hospital management. Evaluation of the effects of these reforms is difficult without more information on current conditions. Hospital catering in acute care trusts has little contemporary background research available. With this in mind, a survey of all the acute care NHS trusts within the eight regions in England was undertaken to investigate the hospital meal service process. A mailed questionnaire asked for the meal production system, food service method and food delivery personnel used by each trust, and a copy of a weekly menu. Results, from an 80.7 per cent response rate, indicate that most trusts use batch cooking to prepare their meals, and plated meal service to deliver the food to the wards. Almost 75 per cent of the trusts use nurses, at least in part, to serve food. English foodstuffs dominate the menus. Most of the trusts have moved towards meeting the goals set by the Patients' Charter and other NHS recommendations.
Cooking↗
Percutaneous epididymal sperm aspiration in psychogenic anejaculation during IVF. A report of two cases.
BACKGROUND: Psychogenic anejaculation on the day of oocyte retrieval is uncommon in in vitro fertilization (IVF) programs. Before the use of intracytoplasmic sperm injection (ICSI), either the cycle had to be canceled or a sperm donor recruited. CASES: Two couples were enrolled for IVF. On the day of oocyte retrieval, the male partners developed psychogenic anejaculation. CONCLUSION: In cases of psychogenic anejaculation during IVF, percutaneous epididymal sperm aspiration can be utilized to obtain sperm for ICSI.
Adult↗
Two amino acid residues of transposase contributing to differential transposability of IS1 elements in Escherichia coli.
Escherichia coli W3110 contains four types of IS1 elements in the chromosome. Using an insertion element entrapping system, we collected 116 IS1 plasmid insertion mutants, which resulted from a minimum of 26 independent IS1 insertion events. All of them had insertions of IS1 of the IS1A (IS1E and IS1G) type. Inspection of the transposase sequences of the four IS1 types and the IS1 of the resistance plasmid R100 showed that two amino acid residues, His-193 and Leu-217 of transposase, might contribute to differential transposability of IS1 elements in W3110. The two amino acid residues of the transposase in IS1A (IS1E and IS1G) were altered separately by site-directed mutagenesis, and each mutant was found to mediate transposition at a frequency about 30-fold lower than that of IS1A (IS1E and IS1G). Thus, the assumption that His-193 and Leu-217 of transposase contribute to differential transposability of IS1 elements in W3110 was confirmed.
Amino Acid Sequence↗
Pregnancy after immature oocyte donation and intracytoplasmic sperm injection.
OBJECTIVE: To report a case of pregnancy from in vitro-matured primary oocytes fertilized by ICSI. The pregnancy occurred in a woman who was in an oocyte donation program; the woman's husband had normal sperm parameters. DESIGN: Case report. SETTING: Private general hospital affiliated with a university hospital. PATIENT(S): A recipient with premature ovarian failure, a recipient's husband with normal sperm, and a pregnant woman who donated her oocytes. INTERVENTION(S): Aspiration of immature oocytes during cesarean section, in vitro culture for maturation, ICSI of matured oocytes, coculture of fertilized oocytes. MAIN OUTCOME MEASURE(S): Fertilization of oocytes by ICSI, and cleavage of embryos by Vero cell coculture. RESULT(S): Two of seven immature oocytes became metaphase II oocytes, and both were fertilized by ICSI. The two zygotes were cocultured on Vero cells to become grade 1 two-cell embryos. Pregnancy was obtained after transfer. CONCLUSION(S): More studies are necessary to clarify whether ICSI can increase the fertilization rate of in vitro-matured primary oocytes, and to clarify the role of coculture in fertilization.
Adult↗
Survey on the distribution of Vibrionaceae at the seaport areas in Taiwan, 1991-1994.
A monthly survey on the distribution of human-pathogenic Vibrionaceae of the seawater from five principal harbors in Taiwan was conducted by National Quarantine Service from July, 1991 to February, 1994. Of the total 1,167 Vibrionaceae isolates, strains of Vibrio alginolyticus (449 strains) were the most frequently isolated, followed by Vibrio parahaemolyticus (262) , Aeromonas hydrophila (153), Vibrio cholerae non-O1 (86), and Vibrio vulnificus (67). None of Vibrio cholerae O1 was isolated. The pH, salinity, and water temperature in this study ranged from 5.8 to 8.6, 0.1 to 4.2% , and 15 to 34 degrees C, respectively. It is concluded that the family Vibrionaceae exists autochthonously around the coastal waters in Taiwan.
Hydrogen-Ion Concentration↗
Analysis of human in vitro fertilization failure.
Fertilization failure is a serious problem in human in vitro fertilization (IVF) programs and deserves further investigation and management. Two hundred and ninety-four IVF cycles performed at the National Taiwan University Hospital from July 1989 to June 1991 were retrospectively analyzed. Thirty-seven (13%) of the 294 cycles were observed to have fertilization failure. The incidence of fertilization failure in male factor patients was significantly higher (p < 0.05) than in others. Patients with oligoasthenospermia tended to have a higher rate of fertilization failure than patients with oligospermia or asthenospermia alone. In non-male factor patients, a smaller number of oocytes and mature oocytes was found in patients with fertilization failure than in patients achieving fertilization. Sperm penetration assay (SPA) using zona-free hamster eggs was performed for 15 patients with fertilization failure; no correlation was found between SPA and the fertilizing ability of the sperm in vitro. Four patients with severe oligoasthenospermia had repeated fertilization failure in subsequent IVF cycles. The other five patients, including four non-male factor patients and one male factor patient, achieved fertilization in their second IVF trial. Our results suggest that severe oligoasthenospermic patients with repeated fertilization failure should be candidates for micromanipulation of gametes in subsequent IVF trials.
Female↗