First births with a simplified culture system for clinical IVF and embryo transfer.

This study reports the outcome results from a pilot clinical trial using a simplified laboratory method for human IVF. This system reproducibly generates de novo the atmospheric and culture conditions that support normal fertilization and preimplantation embryogenesis to the hatched blastocyst stage without the need for specialized medical-grade gases or equipment. Development from insemination to the hatched blastocyst stage occurs undisturbed in a completely closed system that enables timed performance assessments for embryo selection in situ that, in this study, involved single-embryo transfers on day 3.

Sperm attachment and penetration competence in the human oocyte: a possible aetiology of fertilization failure involving the organization of oolemmal lipid raft microdomains influenced by the ΔΨm of subplasmalemmal mitochondria.

The roles of oolemmal lipid raft microdomains enriched in the ganglioside GM1 and the tetraspanin protein CD9 were investigated as causative agents in fertilization failure in human IVF where spermatozoa progress to the oolemma but fail to attach or, if attached, to penetrate. The findings show that specific configurations of GM1 lipid raft microdomains are consistent with attachment and penetration, while microdomains composed of CD9 lipid rafts, a protein known to be critical for penetration, do not appear to have a central role in the initial stages of attachment. The relative magnitude of the potential difference across the inner membrane (ΔΨm) in mitochondria localized to a stable subplasmalemmal domain appears to influence the organization of GM1 but not CD9 lipid raft microdomains in the corresponding oolemma.

Tracheal paraganglioma: an unusual neoplasm of the upper airway.

Paraganglioma of the trachea is a rare neoplasm, with fewer than 15 cases reported. A 40-year-old man presented with stridor and hemoptysis. Bronchoscopy demonstrated a tumor of the posterior trachea and biopsy initially suggested typical carcinoid.

Tools of the Trade: A Novel Bronchoscope With a Built-in Miniature Video Screen, Camera, and Light Source.

Objective: To evaluate the performance of a mobile bronchoscope with miniature video screen, light source, and a digital camera.

Design: Prospective study.

Setting: Inpatient and outpatient tertiary care center.

The forgotten pectoralis minor syndrome: 100 operations for pectoralis minor syndrome alone or accompanied by neurogenic thoracic outlet syndrome.

Background: Since 2005 when we became aware of pectoralis minor syndrome (PMS), more than 75% of patients diagnosed with neurogenic thoracic outlet syndrome (NTOS) also have neurogenic PMS (NPMS), and about 30% have only NPMS, without NTOS.

Methods: Diagnosis was made based on history, physical examination, pectoralis minor (PM), and scalene muscle blocks with lidocaine. Pectoralis minor tenotomy was performed as an outpatient procedure under local anesthesia with heavy sedation through a 5-7 cm transaxillary incision.

Testosterone replacement therapy in naturally and surgically menopausal women.

Introduction: Testosterone replacement therapy in naturally and surgically menopausal women is a complex and currently highly debated topic. Opposing guidelines for the use of testosterone exist, which create a therapeutic dilemma for clinicians confronted by severely distressed women who experience a decrease in sexual desire after surgical or natural menopause.

Aim: In this review, we will address the current knowledge on androgen physiology, conditions associated with a low androgen state, and risks and benefits of androgen therapy.

Use of screening colonoscopy in ambulatory HIV-infected patients.

Background: Colorectal cancer screenings are underused in HIV-infected patients, but reasons for underuse have not been examined.

Methods: Using a standardized questionnaire, HIV-infected patients aged > or =50 years were asked if they had a colorectal cancer screening and what factors influenced their decisions.

Results: Among 55 patients (53 [96%] male; mean age 57 years [range: 51-71]); 35 (64%) ever received colorectal cancer screenings, 2 (4%) were scheduled for screening, 16 (29%) had never been screened, and 2 (4%) provided unusable results.

Thoracic outlet syndrome: a review.

Background: : Arterial and venous thoracic outlet syndrome (TOS) were recognized in the late 1800s and neurogenic TOS in the early 1900s. Diagnosis and treatment of the 2 vascular forms of TOS are generally accepted in all medical circles. On the other hand, neurogenic TOS is more difficult to diagnose because there is no standard objective test to confirm clinical impressions.

Screening and management of osteoporosis in breast cancer patients on aromatase inhibitors.

Objective: Breast cancer patients are at an increased risk of osteoporosis due to age, cancer, chemotherapy, and aromatase inhibitor therapy. This retrospective review determined if patients treated with aromatase inhibitors received appropriate screening and management for osteoporosis.

Design: University of Colorado Cancer Center breast cancer patients treated with aromatase inhibitor therapy during July 2005 through July 2006 were studied.

First large, multicenter, open-label study utilizing HLA-B*5701 screening for abacavir hypersensitivity in North America.

A hypersensitivity reaction is associated with abacavir in approximately 2-8% of exposed patients. The frequency of the HLA-B*5701 allele varies across racial groups and significantly correlates with risk of hypersensitivity. Studies in Europe and Western Australia demonstrated that prospective screening can significantly reduce the rate of hypersensitivity by avoiding the use of abacavir in patients carrying the HLA-B*5701 allele.

Assessment of prognosis in acute liver failure.

Determining prognosis in acute liver failure (ALF) is vital to consideration of transplantation for these critically ill patients. Transplanting a likely survivor may be as unfortunate as not transplanting someone whose outcome is very poor. Prognostic scoring systems have largely failed to accurately portray outcomes, partly because the use of transplantation does not allow the true transplant-free outcome to unfold.

Medial antebrachial cutaneous nerve measurements to diagnose neurogenic thoracic outlet syndrome.

A reliable objective test is still needed to confirm the diagnosis of neurogenic thoracic outlet syndrome (NTOS). Over the past 20 years, it has been suggested that responses to medial antebrachial cutaneous nerve (MAC) and C8 nerve root stimulation could be used for this purpose. Herein, we explore this thesis.

Diagnosis of thoracic outlet syndrome.

Thoracic outlet syndrome (TOS) is a nonspecific label. When employing it, one should define the type of TOS as arterial TOS, venous TOS, or neurogenic TOS. Each type has different symptoms and physical findings by which the three types can easily be identified.

Long-term experience with the use of fibrin sealant in aesthetic surgery.

The authors continue to study the use of fibrin sealant in aesthetic surgery, extending their clinical experience to include aesthetic breast and body procedures, as well as facial surgery in 957 patients. They conclude that fibrin sealant is efficacious in eliminating the need for drains and compressive dressings while reducing the incidence of hematoma and seroma.

Renal function in Tenofovir-exposed and Tenofovir-unexposed patients receiving highly active antiretroviral therapy in the HIV Outpatient Study.

Background: Cases of renal dysfunction have been reported in HIV-infected patients taking tenofovir (TDF), but few large studies have examined population-level changes in renal function associated with TDF use in patients in routine care.

Methods: The authors analyzed data from participants in the HIV Outpatient Study (HOPS) who had normal baseline renal function and received >1 month of TDF-containing (n = 593) or TDF-sparing (n = 521) HAART after November 1, 2001.

Results: Median baseline CrCl estimated by Cockcroft-Gault equation was 106 mL/min for TDF-exposed and 110 mL/min for TDF-unexposed patients (P = 0.

Cesarean birth in the morbidly obese woman: a report of 3 cases.

Background: Primary and repeat cesarean births are a frequent occurrence among morbidly obese women. Technical difficulties encountered in caring for these patients, coupled with physiologic differences, affect their operative management.

Cases: Three morbidly obese women (190-296 kg, body mass index 56.

Pectoralis minor obstruction of the axillary vein: report of six patients.

Purpose: Although the usual site of nonthrombotic venous obstruction of the upper extremity is the subclavian vein, other sites may be the cause of such obstruction. This study describes the diagnosis and treatment of six patients with partial axillary vein obstruction by the pectoralis minor muscle, a condition that can mimic subclavian vein obstruction.

Methods: A chart review of patients undergoing pectoralis minor tenotomies (PMT) between 2004 and 2006 revealed six patients (3 men and 3 women), aged 17 to 39, who underwent seven PMT procedures for symptoms of arm swelling, cyanosis, and pain or tightness.

Short-term safety and tolerability of didanosine combined with high- versus low-dose tenofovir disproxil fumarate in ambulatory HIV-1-infected persons.

Coadministration of didanosine (ddI) and tenofovir (TDF) results in increased ddI serum concentrations, which may lead to increased risk of ddI-associated toxicities. To evaluate the safety and tolerability of ddI/TDF, we performed a retrospective cohort analysis of patients seen in the HIV Outpatient Study, an ongoing dynamic cohort study of HIV-infected persons in clinical care. Study subjects were those who received at least 14 days of combined ddI/TDF before October 2003.

Management of dyspepsia and peptic ulcer disease.

An integrative approach to the therapeutic management of dyspepsia and ulcers may offer patients the best opportunity for resolution of disease and symptoms. Although antibiotics play a key role in the eradication of H Pylori infections, adding supplements appears to offer an edge in supporting overall gastric health. In addition to the aforementioned prescriptive antibiotic regimens, the use of supplements in the treatment of ulcers can improve healing rates and decrease the rate of recurrence.

Review: mixing new cocktails: drug interactions in antiretroviral regimens.

Current highly active antiretroviral therapy (HAART) for the treatment of HIV infection requires the concomitant administration of three or four different agents, often with a high potential for drug-drug interactions. Additionally, some HIV-positive patients still require concomitant treatment with drugs for opportunistic infections, some require medication to treat unrelated medical conditions and/or the metabolic complications of antiretroviral therapy, others may self-medicate with herbal formulations and/or over-the-counter drugs, and still others many take drugs for recreational reasons or to manage addiction. Therefore, the virtually limitless number of drug combinations that may be taken by patients undergoing treatment of HIV infection makes drug-drug interactions almost inevitable.

Subclavian vein obstruction without thrombosis.

Background: Unilateral arm swelling caused by subclavian vein obstruction without thrombosis is an uncommon form of venous thoracic outlet syndrome (TOS). In 87 patients with venous TOS, only 21 patients had no thrombosis. We describe the diagnosis and treatment of these patients.

Modification of the incidence of drug-associated symmetrical peripheral neuropathy by host and disease factors in the HIV outpatient study cohort.

Background: We sought to identify factors associated with the clinical diagnosis of symmetrical peripheral neuropathy (SPN) during the era of highly active antiretroviral therapy (HAART) in a retrospective, longitudinal cohort analysis.

Methods: Patients infected with human immunodeficiency virus type 1 were evaluated for clinical signs of SPN and its association with immunologic, virologic, clinical, and drug treatment factors by means of univariate and multivariate logistic regression analyses.

Results: Of 2515 patients, 329 (13.

Defining fetal station.

Objective: This study was undertaken to determine the definitions and beliefs regarding fetal station among pregnancy caregivers.

Study Design: Residents, nurses, and faculty at 5 teaching centers in Denver, Colo, were given surveys to determine what definitions were being used for fetal station and the perceived importance of these definitions.

Results: There were 243 responses from the 453 surveys.