OBJECTIVE: The purpose of this study was to determine the effect of the presence of myomas and prior myomectomy on the pregnancy rate and pregnancy outcome in an in vitro fertilization (IVF) program. DESIGN: Data collected from office and hospital records were analyzed retrospectively. SETTING: Patients (all with private insurance carriers) were enrolled in an academic IVF program at The Jones Institute for Reproductive Medicine. PATIENTS: All IVF patients enrolled in series 26-41, from 1987 to 1990, were reviewed. Only patients with well-documented myomas [by laparoscopy, laparotomy, hysteroscopy, or hysterosalpingography (HSG)] or prior myomectomy (confirmed by operative and pathology report) were included. MAIN OUTCOME MEASURES: Pregnancy rates and pregnancy outcome were the main outcome measures. Pregnancy rates were calculated per preovulatory embryo transfer. Chi-square, Student t-test, and the Whitney-Mann test were used in the statistical analysis and P less than 0.05 was considered significant. RESULTS: Among 1415 IVF patients, 11 had confirmed myomas present and 47 others had prior myomectomies. The mean age of patients with myomas and myomectomy was 37.1 +/- 4.1 and 36.1 +/- 1.9 years, respectively. Ten of the patients with myoma had normal endometrial cavities on HSG. Subserosal tumors were present in 10 of 11 patients with myomas. Ten of the 47 myomectomy patients had an abnormal cavity prior to surgery and all were corrected. About half of the patients with prior myomectomy had subserous myomas, while 10% were submucous in location. Two of the patients had hysteroscopic removal; all the rest were performed abdominally. The ongoing pregnancy rate from fresh embryo transfer for patients with myomas and myomectomy was 20.8 and 16.9%, respectively. This was comparable to the 19.0% ongoing pregnancy rate for all patients in these series. Despite the small number, and the fact that most had subserosal myomas, patients with myomas had a 50% abortion rate, while those postmyomectomy had a 34.2% abortion rate (statistically not significant). Moreover, if subdivided by their primary IVF indications, patients with prior myomectomy had similar ongoing pregnancy rates from fresh embryo transfer compared to the whole IVF population. CONCLUSION: The incidence of myomas or prior myomectomy among infertility patients presenting for IVF was rather low. Myomectomy did not interfere with IVF performance in relation to overall and ongoing pregnancy rate.

Female↗

PubMed1992

Properties of cyclopean motion perception.

This study investigated the ability of human observers to discriminate the direction of laterally-moving cyclopean stimuli, in order to assess some of the properties of stereoscopic mechanisms that mediate the perception of cyclopean motion (motion existing at levels of binocular integration). The stimuli were moving grating patterns created from dynamic random-dot stereograms. Experiment 1 showed that duration thresholds for discrimination decrease with velocity; they are not governed by temporal frequency nor a constant spatial displacement. Experiment 2 revealed that discrimination thresholds increase with disparity magnitude, for both the crossed and uncrossed disparity directions equally. Experiment 3 showed that the rate of temporal variation at and above which direction discrimination fails (cyclopean upper limit of temporal resolution) is 8 Hz. Our results indicate that a mechanism for motion perception exists at binocular-integration levels of the visual system, which supports a model of motion perception that posits the existence of first-order and second-order processes.

Depth Perception↗

PubMed1992

Localization of inhaled trimellitic anhydride to lung with a respiratory lymph node antibody secreting cell response.

Male Sprague-Dawley rats were exposed to trimellitic anhydride (TMA) by inhalation (500 micrograms/m3), 4 hours a day, for 1 to 10 days. TMA was localized to lung cells by immunoelectron microscopy. Enzyme-linked immunosorbent assay (ELISA) and Western blot analysis were used in an attempt to localize TMA to lung lavage proteins. The lung-associated lymph node (LALN) B-lymphocyte response was measured by quantitation of immunoglobulin (Ig)G, IgA, and IgM antibody secreting cells specific for TMA rat serum albumin (TM-RSA) by use of the enzyme-linked immunospot assay (ELISPOT) method. The IgG, IgM, and IgA antibody response to TM-RSA in serum and lavage fluid was quantitated by ELISA. Lung injury was assessed by the number of external lung hemorrhagic foci and lung weight. Immunoelectron microscopy localized TMA to alveolar and bronchial cells on all exposure days. ELISA detected trace amounts of TMA haptenized lavage proteins that could not be detected by Western blot analysis. A marked increase occurred in lung injury from day 7 to 10. The LALN IgG, IgA, and IgM antibody secreting cell response to TM-RSA paralleled measures of lung injury. IgG, IgM, and IgA serum and lavage antibody to TM-RSA were correlated with lung injury measures. Lavage and serum IgG antibody levels had the highest correlation with lung injury.

Administration, Inhalation↗

PubMed1992

IgE-mediated rhesus monkey asthma: natural history and individual animal variation.

This report reviews the 20 years of experience with naturally occurring allergy in dogs and allergic rhesus monkeys. The primate model of allergy is characterized by IgE-mediated cutaneous and respiratory responses to Ascaris antigen. Individual assessments of these monkeys have been carried out over several years and separate populations which are analogous to human IgE-mediated allergic populations defined. These populations are as follows: (1) monkeys which have persistent and consistent IgE-mediated cutaneous and asthmatic responses to Ascaris antigen; (2) monkeys which have cutaneous and airway reactivity to Ascaris antigen but in which the airway reactivity subsides and disappears analogous to a spontaneous remission human asthma, and (3) finally, there is a group of animals with cutaneous reactivity but no asthma analogous to humans with a similar absence of asthma. Within these groups the animals, like humans, have individual variations of severity.

Animals↗

PubMed1992

Factors that affect depth perception in stereoscopic displays.

This study investigated several factors that affect depth perception in stereoscopic displays: half-image separation magnitude, separation direction (crossed vs. uncrossed), viewing distance, stimulus size, and exposure duration. The depth perceived under various combinations of levels of these factors was compared with depth predicted by the geometry of stereopsis. Perceived depth in the crossed-separation direction was frequently close to predictions, such that increases in separation and viewing distance produced appropriate increases in perceived depth. Depth in the uncrossed direction was frequently less than that predicted, especially for small stimuli presented at a long viewing distance, with a large half-image separation, and/or with a brief duration. Thus depth in both crossed and uncrossed directions equaled predictions only for large stimuli exposed for a long duration.

Adult↗

PubMed1992

Human stereopsis.

This paper reviews much of the basic literature on stereopsis for the purpose of providing information about the ability of humans to utilize stereoscopic information under operational conditions. This review is organized around five functional topics that may be important for the design of many stereoscopic display systems: geometry of stereoscopic depth perception, visual persistence, perceptual interaction among stereoscopic stimuli, neurophysiology of stereopsis, and theoretical considerations. The paper concludes with the presentation of several basic ideas related to the design of stereoscopic displays.

Animals↗

PubMed1992

Goals in the management of asthma.

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Absenteeism↗

PubMed1992

Problem cases in asthma and problems in asthma management.

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Asthma↗

PubMed1992

The diagnosis of potentially fatal asthma in hospitalized adults. Patient characteristics and increased severity of asthma.

We evaluated various patient characteristics in patients hospitalized for asthma during 1987 to 1990. Potentially fatal asthma was identified in 26 of 87 adult patients (29.9 percent) hospitalized. Patients with PFA had increased frequency of prednisone use prior to hospitalization (p less than 0.001), shorter duration of symptoms before hospitalization (p less than 0.001), longer hospitalization (p less than 0.001), were more likely to have had three or more prior hospitalizations (p less than 0.001), and had reduced presenting peak expiratory flow rates (p less than 0.05). Major psychiatric diagnoses and noncompliance were significantly related to PFA cases. The diagnosis of PFA identifies a higher risk patient with asthma. The data suggest that at the time of hospitalization the PFA patient has had a shorter recognized prodrome of increased respiratory symptoms, reduced peak expiratory flow rates and greater likelihood of major psychiatric disease or noncompliance. Effective ambulatory control of PFA and non-PFA is advisable with earlier use and higher dosages of oral corticosteroids.

Adult↗

PubMed1992

Insoluble immune complex-stimulated neutrophil leukotriene B4 production is dependent on Fc gamma RII and Fc gamma RIII and independent of pertussis toxin-sensitive signal transduction pathways.

Leukotriene B4 (LTB4) release initiated by interaction of immune complexes (ICs) with Fc gamma RII and Fc gamma RIII receptors on human neutrophils was studied using well-defined complexes. Immune complexes consisting of polyclonal rabbit antibody to human albumin were prepared at equivalence (insoluble complex) and at five times antigen excess (soluble complex). Incubation of human neutrophils with soluble and insoluble ICs led to the synthesis of LTB4 from endogenous arachidonic acid (AA). LTB4 release induced by ICs was markedly inhibited by monoclonal antibodies against either Fc gamma RII or Fc gamma RIII receptor. Treatment of neutrophils with pertussis toxin significantly inhibited the release of LTB4 induced by soluble ICs. However pertussis toxin treatment minimally inhibited the LTB4 release induced by insoluble ICs. Crosslinking of either Fc gamma RII and Fc gamma RIII receptors on neutrophil surfaces induced LTB4 release. This is the first experimental observation showing that both Fc gamma RII and Fc gamma RIII directly induce neutrophil LTB4 metabolism in the absence of exogenous AA. These studies also suggest the involvement of novel pertussis toxin insensitive signal transduction pathways in insoluble ICs stimulation of neutrophils.

Antigen-Antibody Complex↗

PubMed1992

IgG subclass antibody against trimellitic anhydride in workers with and without immunologic lung diseases.

In a retrospective comparison of two worker cohorts with elevated total antibody against trimellitic anhydride (TMA) conjugated to human serum albumin (TM-HSA), IgG subclass antibodies against TMA were studied in 19 workers with and 12 workers without TMA-induced immunologic lung disease. The main outcome measures were ELISA index of IgG1, IgG2, IgG3, and IgG4 against TM-HSA. There were no statistically significant differences in levels of any IgG subclass between these two groups. Neither were there any statistically significant differences when workers without lung disease were compared with subgroups of workers with lung disease, such as late respiratory systemic syndrome (n = 8), asthma/rhinitis (n = 6), or both (n = 5). In TMA workers with elevated total antibody against TM-HSA, IgG subclasses against TM-HSA in workers with TMA-induced immunologic lung disease were not different from workers without disease.

Adult↗

PubMed1992

Cough variant asthma: usefulness of a diagnostic-therapeutic trial with prednisone.

Cough variant asthma is characterized as a persistent, nonproductive cough with minimal or no wheezing and dyspnea. The diagnosis can be overlooked or misdisagnosed. We describe the severity of cough, the misery of some patients who have this syndrome and the usefulness of a diagnostic-therapeutic trial in ten patients with cough variant asthma. We evaluated ten patients whose chief complaint was persistent nonproductive cough. During the course of evaluation, all patients received a diagnostic-therapeutic trial of prednisone for cough variant asthma after other major causes of cough had been excluded. The duration of cough ranged from 2 months to 20 years. Some patients had significant side effects from coughing including interference with social life, work and sleep, urinary incontinence, stool incontinence, hoarseness, and vomiting. After a diagnostic-therapeutic trial with prednisone, nine patients reported significant improvement of cough in three days. One patient required 2 weeks of therapy for optimal improvement. All were subsequently controlled primarily with inhaled conticosteroids. The diagnosis of cough variant asthma may not be made for a prolonged time. A short course of prednisone as a diagnostic-therapeutic trial can establish a diagnosis and be followed by an effective method of control of cough by inhaled corticosteroids.

Adolescent↗

PubMed1992

Plasma histamine but not anaphylatoxin levels correlate with generalized urticaria from infusions of anti-lymphocyte monoclonal antibodies.

Anti-lymphocyte monoclonal antibodies have shown promise in trials for therapy of lymphocyte malignancies but are associated with a high frequency of immediate-type anaphylactoid reactions. We have previously demonstrated that these immediate-type anaphylactoid reactions are not mediated by immunoglobulin E to anti-lymphocyte monoclonal antibodies. To gain insight into the mechanisms of these immediate-type anaphylactoid reactions, we measured plasma levels of histamine and anaphylatoxins (C3a, C4a, C5a) during 11 infusions in eight patients who received anti-lymphocyte monoclonal antibodies (T101 and Lym-1). Three patients experienced generalized urticaria (two with severe angioedema); a fourth patient had three isolated hives but without generalized manifestations of an immediate-type anaphylactoid reaction. Plasma histamine levels after infusions that were associated with generalized urticaria were significantly higher than those during infusions that were not associated with generalized urticaria (mean, 3.47 vs 0.18 ng/ml, p less than 0.001). Increases in C3a and C4a levels were observed after some infusions, but these did not correlate with generalized urticaria. Measurable rises in plasma C5a levels after infusions were not detected. Although these data should be viewed as preliminary considering the limited number of patients studied, the observed histamine release demonstrates that mast cell or basophil activation that is not mediated by immunoglobulin E to anti-lymphocyte monoclonal antibodies occurs in the pathogenesis of immediate-type anaphylactoid reactions from anti-lymphocyte monoclonal antibodies. Although activation of the classical complement pathway may occur in some anti-lymphocyte monoclonal antibody infusions, this does not appear to explain immediate-type anaphylactoid reactions.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaphylatoxins↗

PubMed1992

Summer camp for future nurses.

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Adolescent↗