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PubMed2004

Accelerated progression of carotid stenosis in patients with previous external neck irradiation.

OBJECTIVE: Radiotherapy to the head and neck often results in carotid stenosis, but the course of disease is unknown. We investigated the natural history and progression of asymptomatic carotid stenosis induced by external irradiation. Patients and methods The study included 130 carotid arteries in 95 patients who had received external radiation therapy to the head and neck area and who had asymptomatic, mild internal carotid artery or common carotid artery stenosis. Stenosis of 15% to 49% on duplex ultrasound (US) scans defined mild (<50%) disease. Another 95 arteries in 74 patients with matched degree of carotid artery stenosis but who had not received radiation therapy were used as control. Both groups were followed up prospectively with serial duplex US scanning, and degree of carotid artery stenosis was categorized as 15% to 49%, 50% to 69%, 70% to 99%, and occlusion. Progression of carotid artery stenosis was defined as increase in stenosis from less than 50% to 50% or greater at ultrasonography. Secondary end points included progression to higher disease category, new cerebrovascular symptoms, and death. Data from irradiated arteries was compared with control data with the life table method. A Cox regression model was used to analyze disease progression, adjusted for covariates of sex, age, smoking, diabetes, and hypertension. RESULTS: Mean follow-up was 36 months. Adjusted freedom from progression rates at 3 years were 65% for irradiated arteries and 87% for control arteries at life-table analysis (P =.035; odds ratio, 3.1). The annualized progression rate from less than 50% to 50% or greater in irradiated arteries was 15.4%, compared with 4.8% in nonirradiated arteries. A long history of cervical irradiation (>6 years) was the only significant risk factor for disease progression. There was no difference between the two groups regarding development of new symptoms or mortality. CONCLUSIONS: Carotid stenosis associated with external irradiation progresses more rapidly compared with nonirradiated atherosclerotic arteries. Aggressive surveillance is recommended.

Aged↗

PubMed2001

Lipoprotein (a) level and mortality in patients with critical lower limb ischaemia.

OBJECTIVE: to investigate if serum lipoprotein (a) level is a predictor of survival in patients with lower limb atherosclerotic occlusive disease. DESIGN: prospective follow up study. METHODS: demographic, biochemical and disease variables were collected prospectively in 441 patients with lower limb arterial occlusive disease. Survival data were obtained at a mean follow up of 44 months, and significant risk factors identified by the life table method and multivariate Cox regression analysis. RESULTS: the cumulative survival for all patients at three and five years was 79% and 63%. Lipoprotein (a) level was the only significant independent biochemical predictor for all deaths and cardiorespiratory deaths on multivariate analysis, along with age, diabetes mellitus, renal impairment, cardiac diseases and major amputation. An elevated Lipoprotein(a) level of >24 mg/dl incurred a 107% and 45% increase in mortality at three and five years respectively. The higher mortality associated with elevated Lipoprotein (a) was particularly evident in patients with critical ischemia, in whom three and five year survival was reduced from 85% to 63% and 67% to 53% (p=0.0064). In claudicants a survival discrepancy was manifested only after five years (73% vs 62%), and the overall association did not reach statistic significance (p=0.52). CONCLUSIONS: lipoprotein (a) level is a reliable biochemical marker for survival in patients with critical ischemia where traditional atherosclerosis risk factors were prevalent.

Adult↗

PubMed1996

The non mortality of hypertrophic cardiomyopathy in an unselected, community diagnosed and treated population.

Hypertrophic Cardiomyopathy (HC) is portrayed in past literature as having an ominous prognosis. However, most studies emanated from medical centers and suffered from potential referral bias. A population based, community diagnosed and treated survival study is analyzed by the life table method. Despite potential causes for both underestimation of the observed mortality as well as for overestimation of expected mortality, the study appears to reveal a more favorable prognosis for HC in this population.

Adult↗

PubMed1997

[Transthoracic-transabdominal resection of esophageal carcinoma].

54 patients suffering from esophageal cancer have been treated in a period from 1990 to 1994. In 29 cases curative resection was possible, corresponding to a resection rate of 54%. Average age of resected patients was 62 years. According to pTNM-classification the stages T1 and T2 amounted to 45%, T3 and T4 to 55%. Lymphatic node metastases were discovered with an incidence of 55%. In patients treated conservatively more unfavourable stage distributions and increased rates of lymphatic node metastasis were shown. Transthoracal-transabdominal esophageal resection was preferred as curative management. Lethality amounted to 13.8%. In 3 of 4 lethal cases after resection autopsy confirmed absence of tumor. Lethal complications were two respiratory insufficiencies, one suture line dehiscence and one alcoholic delirium. Survival rates were calculated by life-table-method. We consider the transthoracal-transabdominal esophageal resection as an acceptable therapeutic option in esophageal cancer offering a real chance of enduring curing.

Adenocarcinoma↗

PubMed1995

Comparison of clinical and angiographic outcomes after saphenous vein graft angioplasty using coronary versus 'biliary' tubular slotted stents.

BACKGROUND: Saphenous vein graft (SVG) angioplasty using 15-mm articulated, tubular slotted stents results in low (0% to 20%) residual diameter stenoses and infrequent (< 5%) major complications. A "biliary" stent design with greater radial compressive strength, enhanced visibility, and more variable sizing (diameter and length) has been approved for noncoronary indications. A comparison of outcomes after coronary versus biliary stent placement in SVG stenoses has not been performed. The purpose of this study was to compare the angiographic and clinical results after SVG angioplasty using these two balloon-expandable, tubular slotted stent designs. METHODS AND RESULTS: During a 3-year period, 231 patients with 305 SVG lesions were treated using Palmaz-Schatz coronary (n = 108) or biliary (n = 123) stents. Cineangiograms were reviewed using qualitative morphological and quantitative angiographic methods. Time-dependent clinical outcome (freedom from death, Q-wave myocardial infarction, or the need for repeat coronary bypass surgery or SVG angioplasty) was assessed using Kaplan-Meier life-table methods. Unstable angina (P < .001) and recent myocardial infarction (P = .001) were present more often in patients undergoing biliary stent versus coronary stent placement. Biliary stent-treated SVG lesions were more frequently de novo (P = .001), ostial in location (P = .002), > or = 10 mm in length (P = .009), thrombus containing (P = .001), and ulcerated (P < .001) than coronary stent-treated SVG lesions. Angiographically, biliary stent-treated lesions had larger reference vessel diameter (3.43 +/- 0.59 mm versus 3.10 +/- 0.64 mm, P < .001), higher balloon-to-artery ratio (1.15 +/- 0.16 mm versus 1.07 +/- 0.19, P = .0001), and lower residual diameter stenosis (6 +/- 17% versus 14 +/- 11% in coronary stent-treated patients; P < .001). Procedural success rates were high (95%), in-hospital major complications were uncommon (< 3%), and follow-up clinical outcomes were favorable (6-month event-free survival approximately 80%) in both groups. CONCLUSIONS: Despite frequent short-term ischemic syndromes and unfavorable lesion characteristics, both biliary and coronary cohorts have similarly favorable short-term procedural results and long-term clinical outcomes. The increased strut thickness of the biliary stent confers greater fluoroscopic visibility and radial compressive strength in exchange for decreased stent flexibility and added technical demand in stent deployment. Extreme caution is recommended with biliary stent placement in the treatment of SVG lesions as clinical results are highly operator dependent.

Aged↗

PubMed2006

Long-term follow-up of initial trabeculectomy with mitomycin C for primary open-angle glaucoma in Japanese patients.

PURPOSE: To determine the long-term intraocular pressure (IOP) control and postoperative complications after initial trabeculectomy with use of mitomycin C (MMC) in patients with primary open-angle glaucoma (POAG). PATIENTS AND METHODS: A retrospective review was conducted of a consecutive series of 123 eyes (87 patients) with POAG who underwent initial trabeculectomy with MMC and had at least 4 years of follow-up. All patients underwent standard trabeculectomy with 0.04% MMC applied intraoperatively for 3 minutes. The long-term outcomes (IOP control and bleb leak, long-standing hypotony, bleb-related infections) were analyzed with the Kaplan-Meier life-table method on the basis of three definitions of successful IOP control (defined as IOP <18 mmHg (definition 1), IOP <16 mmHg (definition 2), and IOP decrease of by > or =30% and <21 mmHg (definition 3)). RESULTS: The mean follow-up time was 6.8+/-1.4 (mean+/-SD) years. The cumulative survival rates were 67.0+/-4.6%, 44.5+/-5.4%, and 74.1+/-4.2%, respectively, based on definitions 1, 2, and 3, 8 years postoperatively by life-table analysis. At 8 years, bleb leak occurred in 7.9+/-2.6% of eyes, long-standing hypotony in 8.3+/-2.5%, and bleb-related infections in 5.9+/-2.4%. CONCLUSION: Long-term outcome after initial trabeculectomy with MMC in Japanese POAG patients is comparable with that reported in other populations and with that after trabeculectomy with 5-fluorouracil.

Adult↗

PubMed1999

The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985-1995.

BACKGROUND: Small bowel adenocarcinoma (SBA) accounts for 2% of gastrointestinal (GI) tumors and 1% of GI cancer deaths. The objective of this study was to review the National Cancer Data Base (NCDB) to identify case-mix characteristics, patterns of treatment, and factors influencing survival of patients with SBA. METHODS: NCDB data from patients diagnosed with primary SBA between 1985-1995 were analyzed. Chi-square statistics were used to compare differences between groups. Disease specific survival (DSS) was calculated using the life table method for patients diagnosed between 1985-1990; univariate differences in survival were compared using the Wilcoxon statistic, and multivariate analyses were performed using a Cox regression model. RESULTS: There were 4995 SBA cases reported to the NCDB between 1985-1995, 55% of which occurred in the duodenum, 18% in the jejunum, 13% in the ileum, and 14% in nonspecified sites. The overall 5-year DSS was 30.5%, with a median survival of 19.7 months. By multivariate analysis, factors significantly correlated with DSS included patient age, tumor site, disease stage, and whether cancer-directed surgery was performed. CONCLUSIONS: SBA is found most commonly in the duodenum, and patient DSS is reduced at this site compared with those patients with jejunal or ileal tumors. This reduction in survival was associated with a lower percentage of cancer-directed surgery. Patients age > 75 years had a reduced DSS and more duodenal tumors, and were less frequently treated by cancer-directed surgery than their younger counterparts. This study reflects the experience with SBA from a large cross-section of U.S. hospitals, allowing for the identification of prognostic factors and providing a reference with which results from single institutions may be compared.

Adenocarcinoma↗

PubMedDate not supplied

A 10-year review of penetrating keratoplasty.

PURPOSE: To survey the changes in indications for penetrating keratoplasty (PKP) and re-evaluate the risk factors for allograft rejection and graft failure. METHODS: We evaluated the records of 396 eyes of 335 patients who had undergone PKP at the Tokyo University Hospital between 1987 and 1997. Clinical results were analyzed by the Kaplan-Meier life table method and the log-rank test. RESULTS: The overall rates of graft survival and rejection-free graft survival at 10 years were 72.2% and 76.8%, respectively. The rates of graft survival and rejection-free graft survival were 98.8% and 86.6% in keratoconus, 87.0% and 56.5% in herpetic keratitis, 76.9% and 73.1% in corneal dystrophy and degeneration, 69.4% and 80.6% in nonherpetic keratitis, 62.5% and 75.0% in chemical burns, 61.8% and 72.1% in regrafting, and 51.1% and 79.8% in bullous keratopathy, respectively. The graft survival rates were statistically higher in the PKP alone group than in the combined operation group. The graft survival and rejection-free graft survival rates were statistically higher in the first operation group than in the regrafted group, and in the avascular cornea group than in the vascular cornea group. CONCLUSIONS: We recognized changes in indications for PKP. Combined operation, reoperation, and vascularization of recipient cornea were risk factors for graft failure.

Adolescent↗

PubMed2000

Prognostic impact of trisomies of chromosomes 10, 17, and 5 among children with acute lymphoblastic leukemia and high hyperdiploidy (> 50 chromosomes).

PURPOSE: Children with acute lymphoblastic leukemia (ALL) and high hyperdiploidy (> 50 chromosomes) have improved outcome compared with other ALL patients. We sought to identify cytogenetic features that would predict differences in outcome within this low-risk subset of ALL patients. MATERIALS AND METHODS: High-hyperdiploid ALL patients (N = 480) were enrolled between 1988 and 1995 on Children's Cancer Group (CCG) trials. Karyotypes were determined by conventional banding. Treatment outcome was analyzed by life-table methods. RESULTS: Patients with 54 to 58 chromosomes had better outcome than patients with 51 to 53 or 59 to 68 chromosomes (P = .0002). Patients with a trisomy of chromosome 10 (P<.0001), chromosome 17 (P = .0002), or chromosome 18 (P = .004) had significantly improved outcome compared with their counterparts who lacked the given trisomy. Patients with a trisomy of chromosome 5 had worse outcome than patients lacking this trisomy (P = .02). Patients with trisomies of both chromosomes 10 and 17 had better outcome than those with a trisomy of chromosome 10 (P = .09), a trisomy of chromosome 17 (P =.01), or neither trisomy (P<.0001). Multivariate analysis indicated that trisomy of chromosome 10 (P = .001) was the most significant prognostic factor for high-hyperdiploid patients, yet trisomy of chromosome 17 (P =.02) or chromosome 5 (P = .01) and modal chromosome number (P = .02) also had significant multivariate effects. CONCLUSION: Trisomy of chromosomes 10 and 17 as well as modal chromosome number 54 to 58 identify subgroups of patients with high-hyperdiploid ALL who have a better outcome than high-hyperdiploid patients who lack these cytogenetic features. Trisomy of chromosome 5 confers poorer outcome among high-hyperdiploid patients.

Child↗

PubMed1999

ABO antigen blood-group compatibility and allograft rejection in corneal transplantation.

PURPOSE: To evaluate effects of ABO antigen blood-group matching on the rates of corneal allograft rejection after penetrating keratoplasty. METHODS: We retrospectively studied clinical results of penetrating keratoplasties in terms of graft survival rates and rejection-free graft survival rates. Penetrating keratoplasties were done on 95 eyes between 1993 and 1997. Clinical results were analyzed using the Kaplan-Meier life table method and log-rank test. The corneal transplantations were classified into 2 groups, high-risk (35 eyes) and low-risk (60 eyes) transplantations. High-risk transplantation was defined as significant vascularization in the recipient corneas or a history of graft failure. The remaining transplantations were defined as low-risk. RESULTS: The respective graft survival (p = 0.031) and rejection-free graft survival (p = 0.0097) rates were higher in the low-risk than in the high-risk group. In the high-risk group, the rejection-free graft survival was 68.9% for the ABO-compatible subgroup and 36.4% for the ABO-incompatible subgroup (p = 0.007). CONCLUSION: ABO matching is effective in reducing the risk of allograft rejection in high-risk corneal transplantations.

ABO Blood-Group System↗

PubMed1989

[Methods of standardizing relative survival rates using rectal cancer in East Germany as an example].

Statistical analyses concerning survival of cancer patients are mostly based on the concept of relative survival rates, which besides the crude survival rates, calculated by the life-table-method, take into account the influence of other (competing) causes of death. But the use of relative survival rates by no means a full reduction of the influence of age. Methods for standardization of such rates will be presented and demonstrated on the data of the National Cancer Registry in GDR for rectum cancer in 1980.

Aged↗

PubMed2000

Inequalities in health. Analytic approaches based on life expectancy and suitable for small area comparisons.

STUDY OBJECTIVE: Simple measures of inequalities in health are proposed to facilitate the work of health policy makers and to build on the understanding of health differences between populations. In addition, it is aimed to make these measures applicable for comparisons of small populations and subgroups. METHODS: Inequalities in health or health deficiencies were quantified as the difference between the life expectancy of the subgroup of interest and that of the national population. Health deficiencies were divided into disease specific components by partial application of cause eliminated life table methods. To manage small numbers and to depict time trends, locally weighted regression smoothing was applied. Confidence intervals were constructed through Monte Carlo simulations. APPLICATIONS AND COMPARISONS: The proposed approaches were applied to the health situation in Cape Breton County, Nova Scotia, Canada, and disclosed the significance of different diseases and distinct patterns between communities. The proposed measures were also compared with the traditionally used standardised mortality rates and ratios. Here, the proposed measures appeared beneficial in that they are easier to comprehend and that they provide time trends and more robust estimates. CONCLUSIONS: The above advantages make the proposed approaches beneficial to health policy makers and epidemiologists. The approaches may also be incorporated in economic evaluations as well as in more sophisticated public health models.

Confidence Intervals↗

PubMed2006

Amyotrophic lateral sclerosis: early predictors of prolonged survival.

OBJECTIVE: In order to define the predictors of prolonged survival available at the time of first examination we performed a historical cohort study of amyotrophis sclerosis (ALS) patients referred to our ALS Clinic over the last 20 years. METHODS: In a group of 1034 patients with the diagnosis of definite or probable ALS the effects of individual prognostic factors on tracheostomy-free survival were assessed with the Kaplan-Meier life-table method. The prognostic value of each factor was estimated using univariate and multivariate Cox proportional hazard analyses. RESULTS: The median survival time was 3.45 years, (95%CI 3.27-3.74). Both the univariate and multivariate Cox models indicated that younger age, limb site of onset, longer diagnostic delay, lower Appel ALS score (AALSS) at first examination, lower AALSS-rate of change between first symptom and first exam (preslope), and higher baseline forced vital capacity (FVC) were associated with longer survival. In addition, four factors: age, diagnostic delay, baseline FVC and AALSS preslope have been identified as independent predictors of survival in our patient population. CONCLUSIONS: The identification of younger age, limb site of onset and longer diagnostic delay as predictors of prolonged survival in ALS clinic population supports the findings of several, earlier studies that were based on smaller groups of patients. More significantly, several additional variables assessed at the first examination predict longer survival: lower baseline AALSS, lower AALSS- preslope and higher baseline FVC. All of these parameters are of value in patient management and in clinical trial development.

Adult↗

PubMed2004

Long-term survival of dialysis patients with bacterial endocarditis in the United States.

BACKGROUND: The incidence of bacterial endocarditis is much greater in long-term dialysis patients compared with the general population, and chronic kidney disease has been postulated as an independent host-related risk factor. Limited data are available on the long-term survival of dialysis patients with endocarditis. METHODS: Dialysis patients hospitalized for bacterial endocarditis between 1977 and 2000 were studied retrospectively using data from the US Renal Data System database. Long-term survival was estimated by means of the life-table method. A Cox proportional hazards model was used to identify the impact of demographic characteristics and comorbidity on outcome. RESULTS: A total of 13,130 dialysis patients with bacterial endocarditis were identified. The in-hospital mortality rate for the entire cohort was 23.5%. Survival rates at 1, 2, 3, and 5 years were 45.9%, 33.3%, 24.3%, and 14.7% for patients hospitalized between 1977 and 1991 and 41.0%, 29.1%, 20.6%, and 10.9% for those hospitalized between 1992 and 1996, respectively. Survival rates at 1, 2, and 3 years were 38.4%, 25.3%, and 18.3% for patients hospitalized between 1997 and 2000, respectively. The most powerful independent predictors of all-cause death were age, diabetes as cause of end-stage renal disease, and cerebrovascular accident or transient ischemic attack as a comorbid condition. CONCLUSION: Dialysis patients with bacterial endocarditis have poor long-term survival, even in the current treatment era, with survival rates changing little in the past 2 decades. Additional studies are needed to identify risk-reduction measures and develop additional treatment strategies for dialysis patients with endocarditis.

Aged↗

PubMed2002

Long-term survival of dialysis patients in the United States with prosthetic heart valves: should ACC/AHA practice guidelines on valve selection be modified?

BACKGROUND: Minimal data exist on the long-term survival of dialysis patients after cardiac valve surgery. Current practice guidelines of the American College of Cardiology/American Heart Association Task Force on the management of patients with valvular heart disease proscribe the use of bioprosthetic (tissue) valves in hemodialysis patients. METHODS AND RESULTS: Dialysis patients hospitalized for heart valve replacement surgery from 1978 to 1998 were retrospectively identified from the US Renal Data System database. Long-term survival was estimated by the life-table method. The impact of demographic differences and comorbidity on outcome were examined in a Cox proportional hazards model. The in-hospital mortality of 5858 dialysis patients undergoing valve surgery was 20.7%. Aortic valve replacement was performed in 3415 patients (58%), mitral valve replacement in 1848 patients (32%), and combined aortic and mitral valve replacement in 562 patients (10%). Tissue valves were used in 881 patients. There was no significant difference in survival related to type of prosthetic valve. The 2-year survival rate was 39.7+/-3.5% with tissue valves versus 39.7+/-1.4% for nontissue valves. Compared with nontissue prosthetic valves, the use of tissue valves was not predictive of death (RR 0.98; 95% CI 0.90 to 1.07). CONCLUSIONS: There is no significant difference in survival of dialysis patients after cardiac valve replacement with tissue versus nontissue prosthetic valves. Current practice guidelines proscribing the use of bioprosthetic heart valves in hemodialysis patients should be rescinded.

Adult↗

PubMed2006

[Contraceptive efficacy of bioadhesive benzalkonium chloride gel in comparison with nonoxynol-9 gel].

OBJECTIVE: To compare the contraceptive efficacy of a new spermicide, bioadhesive benzalkonium chloride (BZK) gel, with the traditional nonoxynol (NP-9) gel. METHODS: A total of 240 child-bearing age women volunteers were randomly divided into two groups: 120 using the BZK gel for contraception, and the other 120 using the NP-9 gel. Using life table method and log-rank test, we compared the pregnancy rates and discontinuation rates after follow-up for 6 months in two groups. RESULTS: No abnormal findings of cervical smears were detected before and after this clinical trial in all 240 women. The follow-up rates at 6 months were 100.0% and 99.2% in the BZK group and the NP-9 group, respectively. The 6-month gross cumulative pregnancy rates of typical use were 1.72 and 0.91 per 100 women (P > 0.05), respectively. If we excluded the 2 pregnant women (1 in each group), who did not correctly or consistently use the spermicides for every intercourse, the cumulative pregnancy rates at 6 months in perfect use would be 0.87 and 0 per 100 women (P > 0.05). And the gross cumulative discontinuation rates due to allergy or other adverse reactions at 6 months in typical use were 0 and 2.68 per 100 women (P > 0.05), respectively. CONCLUSION: The contraceptive efficacy of bioadhesive BZK gel is the same as that of the NP-9 gel, and it is more acceptable in clinical use.

Adult↗

PubMed2004

Effects of mercury on the life table demography of the rotifer Brachionus calyciflorus Pallas (Rotifera).

Mercury is highly toxic to a variety of aquatic organisms including zooplankton. The functioning of freshwater ecosystems can be altered if rotifers, being a natural food link between phytoplankton and fish larvae, are contaminated by mercuric compounds. In order to detect age-specific responses of the rotifer Brachionus calyciflorus to mercury toxicity (5 nominal concentrations as chloride viz. 0, 0.000625, 0.00125, 0.0025 and 0.005 mg l(-1)), we used the standard life table method at two different food (Chlorella vulgaris) levels (0.5 x 10(6) and 1.5 x 10(6) cells ml(-1)). Data indicated that increase in mercury concentration had an increasingly intense negative effect on many of the life history variables, while at higher food levels, its impact was less. A nearly rectangular survivorship pattern was obtained in controls, especially at higher food levels. This trend gradually changed to a steep fall as the concentration of the heavy metal in the medium increased from 0 to 0.005 mg l(-1). At any given food density, increase in the mercury concentration resulted in decreased age-specific reproduction. A maximum of 3.5 offspring female(-1) was observed in controls at higher food density. The average lifespan varied from 6 to 8 days at low food level, depending on the heavy metal concentration in the medium. The corresponding values at high food level varied from 8 to 12 days. Regardless of mercury concentration in the medium, gross and net reproductive values varied from 10 to 33 and 4 to 19 offspring female(-1). The longest generation time (about 9 days) of B. calyciflorus was obtained at 1.5 x 10(6) cells ml(-1) food density in control, while the shortest was 5 days at low food level and high (0.005 mg l(-1)) mercury concentration in the medium. Depending on the food level and heavy metal concentration in the medium, the rate of population growth (r) varied from 0.32 to 0.62 d(-1). In general, higher food level resulted in higher r. Except generation time, all other derived variables were significantly influenced by food level and the heavy metal concentration in the medium.

Analysis of Variance↗

PubMed1990

[A continuous-step density percoll gradient for use in AIH and life table analysis of pregnancy rates].

For use in artificial insemination with husband's semen (AIH), a continuous-step Percoll density gradient technique was used to wash and concentrate sperm from ejaculate. To evaluate usefulness, the pregnancy rates were analyzed by the life table method. 1. After washing by the continuous-step Percoll density gradient method, sperm density increased from 28.8 X 10(6)/ml (original semen) to 40.9 X 10(6)/ml and sperm motility improved from 52.4% (original semen) to 77.0% respectively. 2. A group of 119 infertile patients whose diagnosis involved oligoasthenozoospermia, cervical factor and unexplained infertility were selected for AIH. After 640 insemination cycles, 37 women conceived with a pregnancy rate of 31.1%. By using life table analysis, the cumulative conception probability rate reached 0.652 after 13 insemination cycles. 3. Cumulative pregnancy rates by diagnostic category were 0.494 in male factor and 0.745 in cervical factor after 12 cycles, respectively. 4. The poorest results were obtained in unexplained infertility with a cumulative pregnancy rate of only 0.355 after 12 cycles. 5. In the follow up study, 24 viable babies were born and seven (18.9%) resulted in spontaneous abortion in the first trimester. These results indicate that the continuous-step Percoll density gradient technique is useful for improving the pregnancy rate in AIH.

Adult↗