Coronary revascularization: an opportunity for lipid screening and treatment.
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Coronary Disease↗
Biomedical subjects
M P McGowan
Publications and source records attributed to M P McGowan.
Social support of inner-city fathers and mothers.
OBJECTIVE: To examine mutual support of inner-city parents and how it relates to the father's expected role as a parent. DESIGN: Cross-sectional study. SETTING: An urban teaching hospital in inner-city Baltimore, Md. PATIENTS OR OTHER PARTICIPANTS: Inner-city-dwelling parents whose neonates were born at an urban teaching hospital between March and May 1992. INTERVENTION: Data were collected through structured independent interviews with each parent during the neonate's hospitalization. MAIN OUTCOME MEASURES: General social support was assessed by Sarason's Social Support Questionnaire. Paternal involvement was defined as the father's expected accessibility, engagement in child-rearing tasks, and decision-making responsibility during infancy. RESULTS: Most mothers and fathers cited the other parent as a source of general support. Most believed that the other parent would help and would not hinder them in their role as parent. For mothers, the father's expected accessibility, engagement, and decision-making responsibility was positively correlated with his general support. For the fathers, expected accessibility was positively related to general support from the mother. As parents' mutual support increased, so did concordance in their expectations of the father's role. CONCLUSIONS: Many inner-city parents do rely on each other. Pediatricians can promote shared parenting by recognizing and building on this mutual support.
Cross-Sectional Studies↗
Intervention in hypercholesterolemic college students: a pilot study.
PURPOSE: Since atherosclerosis begins in childhood and cholesterol levels can track from adolescence to adulthood, early intervention to lower elevated levels may be important. Our objective was to test the effectiveness of a health education intervention in hypercholesterolemic college students. METHODS: Thirty-nine university students with plasma low-density lipoprotein cholesterol (LDL-C) levels > or = 75th percentile (2.84 mmol/L, 110 mg/dL) were randomized into two study groups. The control group (n = 19) attended a lecture and viewed a brief video on diet and cholesterol. The intervention group (n = 20) participated in 7 weekly sessions on nutrition and behavior modification. At baseline and 8 weeks later, all subjects completed standardized tests assessing knowledge and attitudes regarding cholesterol, saturated fat, fiber, and heart-healthy lifestyles. Lipid profiles were analyzed at baseline, 8 weeks, and 8 months after study initiation. RESULTS: The groups did not differ at baseline in terms of knowledge, attitudes or lipid profiles. At the 8-week post-test, the intervention group's knowledge was superior to that of the control group (p = < 0.001). Both groups showed improvement in their attitude toward a heart-healthy diet. At the 8-week follow-up, the intervention group lowered their mean plasma LDL-C by 0.21 mmol/L (8 mg/dL) whereas the control group's level fell by an average of 0.05 mmol/L (3 mg/dL) (p = 0.40). At the 8-month follow-up, LDL-C levels increased from baseline in both groups, but the control group levels rose significantly more than the intervention group (0.34 mmol/L vs. 0.05 mmol/L, p = 0.045). Students whose baseline LDL-C was > or = 95% (3.36 mmol/L, 130 mg/dL) benefitted more from the intervention than those with levels > or = 75% but < 95%. CONCLUSIONS: We conclude that a 7-week intervention results in significant improvement in nutritional knowledge and protects hyperlipidemic college students with levels > or = 95% from significant increases in LDL-C.
Adolescent↗
Primary testicular choriocarcinoma with pulmonary metastases presenting as ARDS.
We report a case in which ARDS was the presenting manifestation of testicular choriocarcinoma with numerous metastases to the lungs. We also review the literature on other cases in which ARDS developed as a result of neoplastic infiltration of the lungs and stress the fact that it may be indistinguishable from ARDS from other causes. Because potentially effective chemotherapy for the neoplastic processes most commonly involved (ie, germ cell tumors, acute leukemia and lymphoma) is available, we emphasize the importance of considering a neoplastic disorder in the differential diagnosis of cases of otherwise unexplained ARDS. Early accurate diagnosis could conceivably result in an improved outcome in these cases.
Adult↗
Is conventional bacteriology useful in the management of male infertility?
An aetiological role for non-specific genital tract infection (GTI) in male infertility has long been postulated and has led to routine bacteriologic culture of semen in some laboratories. To assess the value of examination of various semen characteristics and conventional culture of semen as diagnostic criteria for GTI, frequencies of bacterial isolation and relationships with leukocytospermia and other abnormalities of semen were determined in 806 samples from 459 men seen over a 2 year period. Combinations of features suggestive of GTI were present in 19.6%. High leucocyte counts were found in 13.5% of specimens and evidence of possible accessory sex organ dysfunction in 57.7%. Significant numbers of bacteria were isolated from 19.5% of samples. Of the few pathogens cultured (46 specimens), 53% were Staphylococcus aureus, a possible contaminant. Furthermore, only one specimen had more than 10(6) pathogenic bacteria per ml, also Staph. aureus. There was a lack of correlation between the presence of bacteriospermia, leukocytospermia and semen changes possibly attributable to accessory sex organ dysfunction, shedding doubt on their relevance to identification of GTI. This was the case even in repeatedly culture-positive specimens. Conventional bacteriological examination of semen specimens is not merited as a routine procedure.
Bacteriology↗
Increased frequency of autoantibodies in men with sperm antibodies.
Autoantibodies to thyroid microsomes were more frequent in 102 infertile men with complement-dependent sperm-immobilizing activity (sperm immobilization test [SIT] ) in serum (11.8%) than in a control group of 277 men of comparable ages and semen quality without sperm antibodies (4.3%, P less than 0.05). Frequencies of organ-specific antibodies (antigastric parietal cell, antithyroglobulin, and antithyroid microsome) in 57 men with genital tract obstructions and positive SIT were similar to those for control subjects, and there were no significant differences in the frequencies of non-organ-specific autoantibodies (antinuclear antibody, rheumatoid factor, antimitochondrial, and anti-smooth muscle) in the three groups. Because in men without genital tract obstruction antithyroid microsomal autoantibodies were more common with sperm antibodies than without, the possibility of a genetic factor in the causation of sperm autoimmunity should be considered.
Adult↗
Immunoglobulins on human sperm: validation of a screening test for sperm autoimmunity.
The immunobead test (IBT) is a new method of detecting antisperm antibodies with the advantages of enabling determination of the presence of antisperm antibodies during routine semen analysis, immunoglobulin isotypes and antibody specificity for binding to sperm structures such as head or tail. The IBT is compared with the conventional methods of detecting antisperm antibodies in serum; the tray agglutination test (TAT) and the sperm immobilization test (SIT). Positive IBT (50% or more of washed motile sperm binding to anti-IgG and/or anti-IgA immunobeads) were found in 6.8% of 689 men being investigated for infertility. Both IgG and IgA were found to be present in all cases. The IBT correlated closely with the serum antisperm antibody tests; of the 202 men tested by all three methods, 200 (99%) were either positive for circulating antibodies and IBT or negative for both. No men with serum antisperm antibodies lacked local antisperm antibodies as detected by IBT, and only two men (1%) were IBT positive in the absence of either one or both types of circulating antibodies. Individually, the TAT and the SIT correlated equally well with the IBT; 97% and 98% of men tested by TAT and IBT, and SIT and IBT respectively, were either positive by both or negative by both. It is concluded that the IBT is an excellent procedure for the detection of sperm antibodies.
Autoimmune Diseases↗
A controlled trial of the use of erythromycin for men with asthenospermia.
A double-blind crossover controlled trial of Erythromycin was conducted in 78 men with asthenospermia (mean pretreatment sperm concentration greater than or equal to 20 X 10(6)/ml and motility less than 60%). Sperm motility increased above the pretreatment mean after the first one month course of treatment for both Erythromycin (7.9 +/- 2.6% P less than 0.01; mean +/- SEM) and the placebo group (7.5 +/- 2.2% P less than 0.01) and also after the second one month course of treatment, given one month after the first, for both Erythromycin (11.8 +/- 2.7% P less than 0.001) and placebo (11.4 +/- 2.8% P less than 0.001). There was no significant difference between the changes in sperm motility with Erythromycin and placebo. Twelve pregnancies occurred during the four month trial time--eight with Erythromycin and four with placebo (chi 2 = 2.51 P = NS). It is concluded that in infertile men, sperm motility tends to increase spontaneously with time. Erythromycin treatment has no significant effect on semen quality and a larger trial will be required to determine if Erythromycin increases fertility.
Clinical Trials as Topic↗
Prevalence of cytomegalovirus and herpes simplex virus in human semen.
Cytomegalovirus was isolated from semen in 4 of 170 males seeking evaluation at the Reproductive Medicine Clinic at Prince Henry's Hospital, and from 1 of 40 healthy university students. All initial isolates were from specimens with abnormal semen analysis (P less than 0.01). Herpes simplex virus was not isolated from any sample.
Cytomegalovirus↗
Treatment of sperm autoimmunity in men.
Positive sperm immobilization tests were found in the sera of 6.3% of 491 infertile men. There was a higher frequency of family histories of autoimmune diseases than for other subfertile men. Prognosis for fertility was related to results of sperm-mucus penetration tests: progressively motile sperm indicated a fair outlook--8 of 15 couples conceived within 7 months either spontaneously or with artificial insemination with husband's semen. Absence of progressively motile sperm indicated severe infertility - only 6 of 72 couples produced pregnancies. Treatment of the latter group by temporary suppression of spermatogenesis with testosterone or with Artificial Insemination by Husband (AIH) appeared to be ineffective. However, sperm immobilization titres fell and sperm concentrations, motility and mucus penetration increased during treatment of 14 of the men with prednisolone (0.5-0.75 mg/kg per day) for 4-7 months and there were three pregnancies. It is concluded that sperm autoimmunity in men causing failure of sperm to penetrate cervical mucus produces severe but not absolute infertility. Immunosuppression with continuous high dose glucocorticoid reduces antibody levels and improves semen quality. A controlled trial is needed to determine if this treatment is a practical method for improving fertility in men with sperm autoimmunity.
Adult↗
Selection of high fertility donors for artificial insemination programmes.
One hundred and seventy-seven semen donors were used in an artificial insemination service using frozen semen over a 4 year period. Although the donors were selected for good semen quality, pregnancy rates varied markedly from less than five to greater than 20 pregnancies per 100 treatment cycles. When the characteristics of the 25 most fertile and 25 least fertile donors were compared, only sperm morphology was significantly different. Sperm concentration and motility before and after thawing of semen were similar in the two groups as were the proportions of adverse prognostic factors in the recipients. It is concluded that using more stringent criteria for selection of donors on the basis of sperm morphology and discarding donors who do not produce pregnancies within 12 cycles should improve overall pregnancy rates.
Adolescent↗
Chromosomal variants and male fertility.
One hundred and forty-seven healthy men were investigated to determine whether there was an association between chromosomal variants and decreased fertility. Modern chromosome banding techniques detected normal variant karyotypes in 22 (15%) of these men. The fertility parameters of the 125 men with 46,XY karyotype were compared with those of the 22 men in the variant group. Analysis of the results showed that the two groups were not biologically different with respect to semen analysis and reproductive hormone levels.
Chromosome Banding↗
The incidence of non-specific infection in the semen in fertile and sub-fertile males.
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Bacterial Infections↗
Patterns of human seminal plasma proteins on polyacrylamide gel electrophoresis.
Seminal plasma proteins were separated by sodium dodecylsulphate polyacrylamide gel electrophoresis and the patterns for different conditions compared by densitometry. The changes in pattern with time after ejaculation because of proteolysis could be largely prevented by addition of bacitracin. Patterns were similar within the one man and little influenced by duration of abstinence from ejaculation. There were marked variations in pattern between individuals and no specific differences could be detected between samples from men with normal semen analyses, vasectomy, or azoospermia from seminiferous tubule failure. However, there were distinct patterns with congenital absence of the vasa and seminal vesicles and with androgen deficiency. Methods for identification of testicular and epididymal proteins in semen would expand the clinical usefulness of examination of seminal plasma proteins.
Bacitracin↗