The effect of altered function on gingival tissue.
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Denture, Partial, Fixed↗
Biomedical subjects
A Lewin
Publications and source records attributed to A Lewin.
Probable coeliac disease in 13-week-old baby.
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Celiac Disease↗
Prognostic factors in patients with subdiaphragmatic Hodgkin's disease.
Between April 1969 and December 1980, 329 patients with pathologically staged IA-IIB Hodgkin's disease were treated at the Joint Center for Radiation Therapy. Twenty-five (7.6 per cent) of these patients presented with inguinal-femoral or superficial iliac adenopathy and had disease limited to below the diaphragm. In addition 11 patients presented with intra-abdominal masses and Hodgkin's disease was diagnosed on laparotomy. The median age, histologic subtypes, and actuarial relapse free and overall survival of patients with peripheral adenopathy limited to below the diaphragm were similar to patients with supradiaphragmatic Hodgkin's disease. Patients with disease limited to the pelvic or inguinal-femoral nodes were treated with pelvic and para-aortic irradiation alone. Staging laparotomy identified those patients with para-aortic or splenic involvement and these patients were treated with total nodal irradiation or combined modality treatment. The small group of patients who presented with intra-abdominal disease without peripheral adenopathy was older, had a predominance of lymphocyte depleted histology, and had a worse prognosis than the other patients described.
Actuarial Analysis↗
Prenatal diagnosis of oculocutaneous albinism type I: review and personal experience.
Oculocutaneous albinism type I (OCA I) comprises autosomal recessive syndromes of hypopigmentation and low vision, caused by the lack of tyrosinase activity. Affected families seek genetic counseling and prenatal diagnosis as preventive measures. Until recently, prenatal diagnosis of OCA I was achieved by histologic and electron microscopic examination of fetal skin biopsies. Lately, a molecular genetic approach has become possible by the identification of the two mutated copies of the TYR gene, coding the tyrosinase, in which over 60 mutations have been identified. We report here our experience in prenatal diagnosis of OCA I using the two strategies. Thirty-four prenatal tests were performed in fetuses at risk for OCA I. In 31 cases the diagnosis was made in fetal scalp biopsies using the histological approach. The microscopic observations revealed normal melanogenesis in 26 biopsies. Five albino fetuses were diagnosed by the demonstration of arrest of melanogenesis in early stages I and II. In three pregnancies, molecular genetic tests were performed on DNA extracted from amniocytes, using direct mutation analysis (in one), and complemented by linkage analysis (in two). One albino and two normally pigmented fetuses were diagnosed. The prenatal molecular genetic test can be applied to families when at least one mutation is diagnosed in the albino patient. The histological approach is applicable in all families at risk for OCA I.
Albinism, Oculocutaneous↗
The role of ultrasonography in the evaluation of endometrial receptivity following assisted reproductive treatments: a critical review.
We set out to estimate the value of ultrasonographic parameters as prognostic indicators of implantation following in-vitro fertilization (IVF) and embryo transfer. Our survey included 414 natural cycles, 3558 cycles following ovarian stimulation for IVF and embryo transfer, and 411 cycles with hormone replacement therapy for oocyte donation, reviewing 27 reports identified in a computerized literature research. The ultrasonographic prognostic indicators for implantation evaluated included peri-ovulatory endometrial thickness and pattern and Doppler measurements of uterine artery blood flow. Topics include: definitions of the ultrasonographic parameters proposed to evaluate uterine receptivity; the clinical context in which they were used; the proposed optimal timing for sonographic evaluation; and, finally, their actual correlation with pregnancy rate following assisted reproductive technologies. For various sonographic parameters, negative predictive value, positive predictive value, sensitivity and specificity were calculated, based on published data. Sonographic parameters had a high negative predictive value and sensitivity, but a limited positive predictive value and low specificity. Several confounding factors may influence the interpretation of reports, and the statistical evaluation sometimes lacks calculation of the positive and negative predictive values of the parameters examined. Although ultrasonographic parameters of endometrial receptivity have a strong negative value in setting some minimum criteria, their value as prognostic indicators for implantation following embryo transfer has yet to be proved.
Embryo Implantation↗
nodSU, two new nod genes of the broad host range Rhizobium strain NGR234 encode host-specific nodulation of the tropical tree Leucaena leucocephala.
Rhizobium species strain NGR234 nodulates at least 35 diverse genera of legumes as well as the nonlegume Parasponia andersonii. Most nodulation genes are located on the 500-kilobase pair symbiotic plasmid, pNGR234a. Previously, three plasmid-borne host range determinants (HsnI, HsnII, and HsnIII) were identified by their ability to extend the nodulation capacity of heterologous rhizobia to include Vigna unguiculata. In this study, we show that HsnII contains two new nod-box linked hsn genes, nodS and nodU.nodS controls nodulation of the tropical tree Leucaena leucocephala, while the nodSU genes regulate nodulation of the pasture legume Desmodium intortum and the grain legume V. unguiculata. Regulation of the nod-box upstream of nodSU by the flavonoid naringenin was shown using a fusion with a promoterless lacZ gene. Determination of the nucleotide sequence of the nodS gene did not reveal homology with any gene in the EMBL library, although Bradyrhizobium japonicum USDA110 contains both nodS and nodU (M. Göttfert, S. Hitz, and H. Hennecke, Molecular Plant-Microbe Interactions 3:308-316, 1990). We suggest that broad host range in NGR234 is controlled in part by a nodD gene which interacts with a wide range of flavonoids, and in part by host-specific nod genes such as nodS.
Amino Acid Sequence↗
Multifetal pregnancy reduction: is it always justified?
In the present study we summarized the world literature on first trimester multifetal pregnancy reduction between 1985 and 1992 and added our own experience. Our aim was to reach a comprehensive view on the survival rate of reduced high multifetal pregnancies, as the data in various studies are somewhat confusing, possibly as a result of the small number of cases. The data so gathered were classified by the number of fetuses. Of 94 triplet pregnancies reduced to twins 91.6% survived. Of 108 quadruplet pregnancies reduced to twins 92.6% survived. Of 40 quintuplet pregnancies 72.5% survived, and of 93 septuplets or more 87.1% survived. The outcome of pregnancies reduced to triplets did not differ from the outcome of pregnancies reduced to twins, with a survival rate of 85.7 and 72.5%, respectively. In our opinion, in view of the infertility history of many of these patients, the risk of pregnancy loss, the high survival rate of triplets and fetal reduction in triplet pregnancies in this group of patients may be unjustified. Accordingly, our policy in cases where the patients demand or when reduction is done early in pregnancy to reduce the triplets.
Abortion, Therapeutic↗
Hypertension detection and follow-up program. Baseline electrocardiographic characteristics of the hypertensive participants.
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Adult↗
Effect of smoking on concentration, motility and zona-free hamster test on human sperm.
The effect of smoking on sperm concentration, motility, and zona-free hamster egg sperm penetration assay (SPA) was evaluated in 293 smokers of more than 10 cigarettes/day and 382 nonsmokers. Prerequisites for inclusion in the study were sperm concentration of greater than 10 x 10(6)/ml, sperm motility of greater than 30%, and normal morphology of greater than 60%. Although a lower sperm concentration was found in smokers, no significant difference was observed in sperm motility and SPA.
Adult↗
Comparative effects of candesartan cilexetil and losartan in patients with systemic hypertension. Candesartan Versus Losartan Efficacy Comparison (CANDLE) Study Group.
The antihypertensive efficacy and tolerability of the novel angiotensin-II (A-II) receptor blocker candesartan cilexetil and the prototype A-II receptor blocker, losartan, were compared in an 8-week, multicenter, double-blind, randomized, parallel-group, titration-to-effect study of 332 adults (42% women, 12% black) with systemic hypertension (sitting diastolic blood pressure [DBP] 95-114 mmHg, inclusive). In patients with a mean trough (24 +/- 3 hours after dose) sitting DBP of 90 mmHg or higher after 4 weeks of once daily administration of candesartan 16 mg or losartan 50 mg, dose was titrated up to candesartan 32 mg or losartan 100 mg once daily. The candesartan regimen was significantly more effective than the losartan regimen in reducing trough sitting DBP at week 8 (11.0 mmHg versus 8.9 mmHg). Candesartan also produced numerically greater reductions in secondary blood pressure parameters, including sitting systolic blood pressure (SBP), trough standing DBP and SBP, and peak (6 +/- 2.5 hours after dose) sitting and standing DBP and SBP. Responder rates (sitting DBP < 90 mmHg or reduction in blood pressure of > or = 10 mmHg) and control rates (sitting DBP <90 mmHg) were higher with candesartan (64% versus 54% and 54% versus 43%, respectively). A total of 1.9% of the patients taking candesartan and 6.5% of those taking losartan discontinued prematurely because of adverse events or lack of efficacy.
Analysis of Variance↗
Accuracy of laparoscopic diagnosis of endometriosis.
BACKGROUND AND OBJECTIVE: Laparoscopy is the standard method to visually identify endometriotic lesions under magnification within and outside the minor pelvis. The aim of this study was to analyze the accuracy of laparoscopic visualization in diagnosing the various endometriotic sites as confirmed histologically. METHOD: Presumed endometriotic sites were observed in 164 patients operated on under the clinical suspicion of endometriosis. Targeted biopsies were performed for histologic corroboration, comparing the laparoscopic findings and diagnosis to the histological results. RESULT: The histological reports of the biopsies confirmed the presence of endometriosis in 138 patients (84.1%), but in 26 patients (15.9%), no evidence of endometriosis was observed. 100% of "red" lesions, 92% of "black" lesions, and 31% of "white" lesions turned out to be endometriosis. Of the 264 various suspected endometriotic sites observed, 142 (53.8%) were confirmed histologically. The most accurate diagnosis was in lesions on the parietal peritoneum of the pelvis, confirmed in 9/9 cases (100%); the ovarian fossa, confirmed in 8/12 cases (66.7%); and the uterosacral ligaments and posterior surface of the broad ligament, confirmed in 83/138 cases (60.1%). As for the other sites, the histologic confirmation rates in the ovarian surface, bowel serosa, and vesicouterine fold of the peritoneum were 48%, 40%, and 13%, respectively. CONCLUSION: Endometriosis has a multiple appearance, and the lesions may be confused with nonendometriotic lesions. It is clear that a nonhistology-based diagnosis may lead to unnecessary prolonged medical treatment and operations and may delay the proper treatment measures from being applied. Therefore, a meticulous histological confirmation should still be the first step in the laparoscopic diagnosis and treatment of suspected endometriosis.
Endometriosis↗
Second-trimester heterotopic pregnancy after in vitro fertilization and embryo transfer--a case report and review of the literature.
Seven cases of heterotopic pregnancies following in vitro fertilization (IVF) and embryo transfer (ET) have been seen. In these cases, concomitant intrauterine and extrauterine pregnancies were described in the first trimester. We present the first case of second-trimester heterotopic pregnancy after IVF with successful surgical treatment of the ectopic pregnancy and subsequent full-term birth of the intrauterine pregnancy. The etiologic factors, possible explanation for the relatively frequent occurrence of heterotopic pregnancies in IVF, and the diagnostic difficulties are presented.
Embryo Transfer↗
The combined use of human menopausal gonadotropin and Parlodel (bromocriptine) for in vitro fertilization.
A successful pregnancy resulting from in vitro fertilization and embryo transfer in which bromocriptine was utilized for ovulation induction is reported. Suppression of transient hyperprolactinemia during induction of ovulation is suggested.
Adult↗
The cytology of vaginal, cervical and endometrial smears obtained at the time of embryo transfer during in vitro fertilization.
Seventy-four women enrolled in an in vitro fertilization (IVF) program had cytologic smears of the vagina, cervix and endometrium obtained at the time of embryo transfer (ET). Of these, 68 vaginal, 46 cervical and 25 endometrial smears were available for cytologic examination. Of the 68 vaginal smears, 4% showed a proliferative pattern, 40% were early secretory and 56% were advanced secretory. The 46 cervical smears demonstrated a delayed hormonal effect, with 70% showing a proliferative pattern, 23% early secretory and 7% advanced secretory cytology. Endometrial cells were obtained only when the Jones catheter, which has a side opening, was used. Twenty-two patients had both vaginal smears and suitable endometrial smears. Of these, 8 of the 9 patients with early secretory vaginal cytology had secretory endometrium while 10 of the 12 patients with mid-secretory vaginal cytology had secretory endometrium. The value of endometrial cytology in predicting conception following IVF-ET is unknown. It seems, however, that a good correlation exists between endometrial and vaginal cytology and that the latter may be of value as an additional, noninvasive tool for the evaluation of endometrial development.
Adult↗
Long-acting diltiazem CD is safe and effective in a hypertensive Mexican-American population.
STUDY OBJECTIVE: To evaluate the safety and effectiveness of diltiazem CD for reducing blood pressure in Mexican-American patients with mild to moderate hypertension. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Twelve clinical sites in the United States. PATIENTS: Patients with baseline diastolic blood pressures between 95 and 115 mm Hg. INTERVENTIONS: Patients were treated with an average daily dose of diltiazem CD 246 mg (60 patients) or placebo (58 patients) to achieve a trough diastolic blood pressure below 90 mm Hg. MEASUREMENTS AND MAIN RESULTS: Diltiazem CD significantly reduced mean diastolic blood pressure compared with placebo, -8.2 versus -4.1 mm Hg, respectively (p=0.0025). Diastolic blood pressure below 90 mm Hg or a reduction of 10 mm Hg or more was achieved by 57% of diltiazem CD versus 28% of placebo recipients. Systolic blood pressure and heart rate were also reduced with diltiazem CD. Adverse events were mild, with similar frequency for diltiazem CD (15%) and placebo (19%). CONCLUSION: Diltiazem CD is safe and effective in hypertensive Mexican-Americans, and diastolic blood pressure reductions compare with those in non-Hispanic white patients.
Adolescent↗