A new era in reproductive technologies: the emotional stages of in vitro fertilization.
Explore the source record for details and available documents.
Embryo Transfer↗
Biomedical subjects
S Levin
Publications and source records attributed to S Levin.
The office approach to the sexually transmitted diseases: Part I.
Sexually transmitted diseases (STDs) are diagnosed in 10 million patients per year in the United States. The infected individuals come from all walks of life and all age groups. They may present with either genital or nongenital signs and symptoms. Most individuals are treated as outpatients, but more than a quarter of a million hospital admissions for STDs are necessary each year. These numbers will rise precipitously as the number of AIDS cases increases. More than 10,000 deaths per year are caused by STDs, primarily because of AIDS, cervical carcinoma, and hepatitis B induced cirrhosis and hepatoma. Physicians must become highly skilled in the diagnosis and treatment of the common STDs caused by herpes simplex virus, Neisseria gonorrhoeae, and Chlamydia trachomatis. Simple office microscopic skills are needed for the diagnosis of vaginitis, cervicitis, and urethritis, and all physicians should be encouraged to develop these skills. Physicians will need to keep abreast of the rapidly evolving changes in the diagnosis and treatment of STDs.
Epididymitis↗
The office approach to the sexually transmitted diseases: Part II.
All physicians share a responsibility for educating the public in the expanding risks of sexually transmitted diseases, and in the vital importance of safe sexual practices. Both the public health implications of undiagnosed STDs and the adverse social consequences of an incorrect diagnosis emphasize the need to comprehensively and precisely diagnose these diseases, despite the problems encountered in obtaining material for culture. Current interest in AIDS should not obscure the facts that genital herpes continues to increase in prevalence, and that syphilis no longer is declining. The many extragenital syndromes associated with STDs, such as perihepatitis, polyarthritis, and acute septic states make it necessary to evaluate all sexual contacts.
Acquired Immunodeficiency Syndrome↗
Advanced papillary adenocarcinoma of unknown origin as tumor previa during late pregnancy.
A 41-year-old woman with advanced abdominal adenocarcinoma presented at term pregnancy. The tumor was presented as previa and obstructed the delivery. A cesarean section was performed and a healthy child was born. At surgery diffuse metastatic disease was detected throughout the pelvis and abdomen and was partially resected. Combined chemotherapy consisting of cis-platinum, adriamycin and cytoxan was administered for 5 months. At second-look laparotomy no residual disease was found. We present an unusual presentation of metastatic abdominal undifferentiated carcinoma treated as ovarian cancer.
Abdominal Neoplasms↗
Immunoreconstitution of T-cell impairments in asymptomatic male homosexuals by thymic humoral factor (THF).
The feasibility of using Thymic Humoral Factor (THF) for immunomodulation in asymptomatic male homosexuals was evaluated in a study on fifteen subjects with T-cell impairments, selected on the basis of a 2SD reduction in T helper/inducer (T4+) cells and one additional lymphocytic defect. Following two biweekly courses of treatment, mean relative increments of T4+ (P less than 0.002), T3+ (P less than 0.02) and total lymphocyte (P less than 0.05) populations of the group receiving THF (n = 7) were significantly increased when compared to the placebo group (n = 8). In addition, a transient increase in T4+ lymphocytes was observed after the first course in the two individuals of the THF-treated group who were seropositive for HTLV-III/LAV but not in those who were seronegative. No difference was found between the groups in fluctuations of serum interferon (IFN) or proliferation of peripheral mononuclear cells to mitogens. The results of this limited trial demonstrate that THF is capable of correcting T-cell impairments that may predispose asymptomatic homosexuals to infection by HTLV-III, without affecting IFN production. These findings suggest that future strategies for AIDS prevention in high-risk groups should include institution of large controlled trials in immunodeficient, asymptomatic, HTLV-III/LAV-seronegative male homosexuals to study the potential of selective immunoreconstitution as a preventive measure against HTLV-III/LAV infection.
Acquired Immunodeficiency Syndrome↗
Successful long-term exocrine and endocrine function of the autotransplanted pancreas in humans.
Segmental pancreatic autotransplantation has been performed to prevent the severe metabolic complications of total pancreatectomy. To date 15 segmental pancreatic autotransplants have been reported, 11 of which have been performed for relief of the abdominal pain of chronic pancreatitis. The major problem with segmental pancreatic graft relates to the handling of the pancreatic duct and its secretion. In all the reported cases, the autotransplanted duct was either ligated, stapled, or occluded with synthetic polymers. In this article we present a patient who has undergone a total pancreatectomy with segmental pancreatic autotransplantation and subsequent Roux-en-Y anastomosis to the transplanted duct. Physiologic studies indicate normal endocrine function 7 years following transplant. The patient is insulin-independent and tolerates a normal meal, requiring no oral pancreatic enzyme supplementation. To our knowledge this is the first long-term report of a patient with an autotransplanted pancreas who is presently both insulin sufficient and with intact exocrine function.
Blood Glucose↗
Early-onset hay fever in Israeli children.
In order to investigate the influence of climate and vegetation on the age of onset and clinical picture of hay fever (HF), we examined 116 children with typical HF living in a single climatic area: fifty-four were from rural farming settlements and sixty-two from towns and cities. Overall age of onset was low; 72% of rural children developed HF between the ages of 2 years and 4 years compared to only 24% of urban children (P less than 0.005). At the same time, 57% of rural children had positive skin tests to more than three pollen extracts out of nineteen allergens tested, compared to 19% of urban children (P less than 0.005). There were no significant differences between the rural and urban groups with regard to the incidence of asthma as part of their HF, nor were there differences in total IgE levels. The results of this study suggest that Israeli children develop hay fever earlier than generally reported in the literature, and that this is most marked in the rural areas. This can be explained by their specific environment, which consists of a basically dry, desert-like climate where lawns, crops and trees are extensively irrigated, leading to the dissemination into the environment of large amounts of pollen grains, which are not washed away because of the lack of rain.
Adolescent↗
Atopic babies with wheezy bronchitis. Follow-up study relating prognosis to sequential IgE values, type of early infant feeding, exposure to parental smoking and incidence of lower respiratory tract infections.
Clinical course and sequential IgE values were recorded in a 4-year prospective study of 80 atopic wheezing babies at ages from 6 months to 4-5 years. At final assessment, 68% of the children had been symptom-free for at least 1 year whilst 32% still suffered from wheezing attacks. Total IgE levels from the first visit until final assessment were greater than 2 SD above normal for age in 63% of all children, but no significant correlation could be found between sequential IgE levels and the clinical picture or course of the disease. In all cases IgE levels rose steadily with increasing age, independently of whether wheezing disappeared or persisted. The most significant rise in IgE values occurred between 1 and 2 years of age, and IgE levels at 4 years could be predicted by the value at the age of 2 years (r = 0.97). In the group of children that lost their wheezing tendency there was: a significantly greater number of infants that were breast-fed during at least the first 3 months of life (P less than 0.01), a lower incidence of exposure to parental smoking (P less than 0.01), and a lesser incidence of lower respiratory tract infections (P less than 0.01). Though there was no correlation between increase of IgE levels and type of feeding or exposure to cigarette smoke, statistical data confirms that bottle feeding and parental smoking lead to persistence of wheezing in atopic children.
Asthma↗
The prescription sign; the crossed R.
Explore the source record for details and available documents.
History of Pharmacy↗
The immune system and susceptibility to infections in Down's syndrome.
Explore the source record for details and available documents.
Communicable Diseases↗
CD16+ NK lymphoproliferative disorders: cellular and molecular characterization.
We studied the mononuclear cells obtained from 2 patients with CD16+ lymphoproliferative disorders. In both subjects, over 80% of the circulating peripheral blood mononuclear cells were CD16+, CD2+, CD7+, CD3-, CD4-, and CD8-. In 1 patient, greater than 60% of the cells expressed HLA-DR and HLA-DQ gene products. Functional analysis of the natural killer (NK) cell activity of cells from this patient demonstrated 76% killing of K562 targets at ratios as low as 1:1 effector:targets. Karyotype analysis demonstrated a deletion on the long arm of chromosome 6, supporting the contention that the lymphocytosis in this patient was due to a clonally expanded population of cells. In additional studies, Southern blot analysis of DNA extracted from cells of this patient revealed that the beta-chain of the T cell receptor was of germ line configuration. This information supports the hypothesis that the clonally expanded NK population in this patient is of a lineage distinct from T cells and represents a true NK leukemia.
Aged↗
Future trends in aminoglycoside therapy.
The aminoglycosidic aminocyclitols have been utilized extensively for three decades. Nonetheless, the future use of this class of agents has been questioned of late. Recognized inadequacies of the aminoglycosides and the development of new antibiotics with significant activity against gram-negative bacilli are commonly cited reasons for the theorized decline of these compounds. However, resistance to newly developed antibiotics already has become evident. This insures a continuing role for the aminoglycosides in the treatment of nosocomial infections. Aminoglycosides will have continued use as empiric, potentially synergistic therapies for hospital-acquired infections in neutropenic patients with bacteremia, in enterococcal endovascular infections, and in patients with serious infections associated with Pseudomonas aeruginosa. Those factors that will influence the future role of aminoglycosides in these settings will include economic, administrative, and space pressures to restrict the number of antibiotics available in hospitals, the discovery of novel antibiotics, the utility of combination therapies employing an aminoglycoside and newly available drugs, the comparative toxicities of new antimicrobial regimens, and considerations of cost containment.
Aminoglycosides↗
[Maple syrup urine disease in Israel].
Explore the source record for details and available documents.
Adolescent↗
Endogenous opioid modulation of pancreatic hormone secretion: studies in dogs.
The role of endogenous opioid peptides in the modulation of secretion of hormones from the endocrine pancreas was studied in dogs. In response to insulin-induced hypoglycemia, plasma glucagon secretion significantly increased, followed by an increase in plasma somatostatin immunoreactivity. Pretreatment with the opiate antagonist, naloxone, prevented the somatostatin response but had no effect on the augmented glucagon secretion. Neither the degree of hypoglycemia nor recovery from the induced glucose nadir were affected by naloxone. Arginine Hcl administration resulted in prompt increases in immunoreactive glucagon and insulin secretion, as well as a rise in serum glucose. Pretreatment with naloxone failed to affect any of these responses. Our results suggest that endogenous opioid peptides mediate the somatostatin response following hypoglycemia-induced glucagon secretion.
Animals↗
Limited dermal ossification: clinical features and natural history.
For 9 years we have observed a girl who has ossification in the dermis with a strikingly limited distribution. Recently a second girl with similar dermal ossification restricted to a single extremity was identified. The ectopic bone is histologically identical to normal membranous bone. These two patients have no obvious underlying cause for soft tissue bone formation, and no disorder of calcium or phosphate metabolism. Ossification first involved the dermal and subcutaneous connective tissue, and with time advanced locally in the affected areas to bridge joints and limit mobility. The ossification has now extended to involve muscle fascia but has not involved the muscle itself. This disease appears to represent a heretofore unrecognized disorder of mesenchymal differentiation.
Bone and Bones↗
Fulminant community-acquired infectious diseases: diagnostic problems.
The processes presented here do not represent an all-inclusive list of fulminant infectious diseases. Some of the more common acute, overwhelming infections of the central nervous system and lungs are covered elsewhere in this issue. We have selected less common, potentially catastrophic syndromes that might be recognized earlier if certain historical clues, physical findings, or laboratory abnormalities are appreciated. Specific and effective therapy is available for most of the diseases we have chosen. Meningitis due to Naegleria fowleri, a free-living ameba that may invade the central nervous system through the cribriform plate in persons swimming in brackish water, and hemorrhagic mediastinitis due to inhalation of Bacillus anthracis, which is acquired in occupational exposure to goat's hair, wool, or an animal with anthrax, are other examples but are lacking in proven effective therapy. Although most physicians quickly consider exotic and overwhelming infections in the severely compromised patient, fewer recognize this risk in the diabetic, cirrhotic, or healthy person with a unique occupational or travel history. During the present epidemic of AIDS, previous exposure to the HTLV-3 virus must be considered in all severely ill patients. The proper use of new diagnostic tests may permit the physician to intercede effectively if these life-threatening diseases are suspected.
Deglutition Disorders↗
Effects of suramin on in vitro HBsAg production by PLC/PRF/5 cells and hepatitis B virus DNA polymerase activity.
The effects of suramin, an antiparasitic agent, upon in vitro hepatitis B surface antigen production by the human hepatoma cell line PLC/PRF/5 and hepatitis B virus associated DNA polymerase activity in the serum of a chronically infected patient were examined. Treatment with suramin resulted in decreases in hepatitis B surface antigen production and hepatitis B-virus associated DNA polymerase activity. The decrease in hepatitis B surface antigen production was paralleled by a general decrease in hepatoma cell viability and cellular protein synthesis. Although the inhibitory effects of suramin for hepatitis B virus appear to be nonspecific as demonstrated in these two in vitro systems, the recently announced trial of suramin for the treatment of the acquired immunodeficiency syndrome should afford an unusual opportunity to evaluate the effectiveness of suramin in the treatment of chronic hepatitis B virus infection.
Carcinoma, Hepatocellular↗
Comparative longitudinal study of 2 methods of scheduling maintenance visits; 2-year data.
This report compares the clinical and microbiological status of 2 groups of subjects with treated periodontis on different maintenance schedules. 43 control (C) subjects were given prophylaxes every 3 months. 40 test (T) subjects were given this service on a flexible schedule according to the proportions of spirochetes and/or motile rods in fresh smears of subgingival scrapings. Both groups were examined every 6 months clinically and microbiologically. This report presents base line, 1- and 2-year data. Generally, mean values for both groups did not differ significantly from one another. Both groups exhibited comparable increases in GI and PLI scores during the first 2 years of this study. No change in probing depth was noted between base line and the 2-year examination. However, a slight increase in attachment level, as determined by probing, was noted in both groups. Both groups also exhibited similar proportions of bacterial morphotypes at base line and subsequent examinations. Disease recurrence, defined as an increase in probing depth of 3 mm or more from base line on any tooth surface during the 2-year period, tended to be more prevalent in the C than in the T group (15/43 C and 9/40 T subjects). However, the proportional difference between the groups was not statistically significant. Subjects with disease recurrence in the T group had greater proportions of spirochetes at base line than subjects in the same group without disease recurrence (20.2% versus 9.8%, p less than 0.01). This difference in proportions persisted if both groups were examined jointly, but was only of borderline significance (16.0% versus 10.5%, p = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗