Faculty Bibliography

INTRODUCTION: Carbon monoxide poisoning is a very common cause of death in accidental, suicidal, or homicidal cases throughout the world. Fingernail bed manifestation is reported in survivors of carbon monoxide poisoning. CASE PRESENTATION: A 40-year-old Caucasian woman was exposed to carbon monoxide when she was sleeping alone in her one-bedroom apartment; fortunately, the beeps from her First Alert combination smoke and carbon monoxide detector woke her and she was saved from any extensive health issues. The most indicative symptoms experienced were a severe headache, blurred vision, agitation, and confusion. Following contact with the Emergency Responses Services, she was promptly transferred to the hospital via ambulance and was treated with high-flow oxygen on the way. She was discharged from the emergency department on the same day, but carbon monoxide exposure had already had adverse effects on her fingernail beds. The fingernail tips were altered and appeared as if a bite had been taken out of their distal borders. The changes in the tips of her fingernails were significant, but they completely disappeared eight weeks later without any additional treatment. CONCLUSIONS: Worldwide, carbon monoxide poisoning is a potentially lethal condition that is preventable with educational programs and installation of carbon monoxide detectors in the home setting. Exposure to carbon monoxide frequently goes unrecognized until it is too late and causes silent death. To the best of the authors' knowledge, this is the first report in the literature of fingernail bed manifestations in a survivor of carbon monoxide poisoning.

This pilot study was performed from March 2008 through February 2010 to demonstrate that pregnancy can be achieved in a uterine allograft in the sheep model with the guidance of assisted reproductive technology. Uterine allotransplantation was performed in 12 sexually mature African sheep (Sudanese and Ethiopian). All animals underwent uterine transplantation via a minilaparotomy incision using a Mobius retractor device. A control group of pregnant Romney Marsh sheep with nontransplanted uteri were used to compare fetal development, uterine and placental histologic findings, and blood samples of progeny of the uterine transplant recipient sheep. Fetal size was obtained from ultrasound measurements during the early (crown-rump length) and late (biparietal diameter and abdominal circumference) gestational periods. The primary end point variables included preoperative and postoperative management, embryo transfer protocol, intraoperative assessments, and physiologic cardiopulmonary changes in the lamb during the first 5 hours of life. Four months after the initial uterine transplantation, 5 of 12 uterine allografts were considered candidates for the embryo transfer procedure. Fresh and frozen blastocyst donors were transferred accordingly to the remaining 5 uterine allografts via a minilaparotomy incision. Three of these resulted in pregnancies. One was an ectopic gestation, 1 sheep carried the pregnancy to 105 days, and 1 delivered a fully developed lamb from the transplanted uterus that was delivered via cesarean section. Neonatal lamb blood gas values and chemistry, gross organ examination, and ventilation and respiratory compliance studies yielded results normal for gestational age. This first reported case demonstrates that pregnancy can be carried in an allotransplanted uterus, with the end result a successful delivery

Study Objective: To demonstrate that a pregnancy can be achieved in a uterine allograft in the sheep model with the guidance of assisted reproductive technology. Design: The primary endpoint variables included pre and post-operative management, embryo transfer protocol, intra-operative assessments and the physiologic cardio-pulmonary changes in the lamb during the first 5 hours of life. Setting: The study took place at the Universidad de La Salle Bogota', Colombia from March 2008 to February of 2010. Patients: We conducted a pilot study in a series of twelve sexually matured African sheep (Sudanese and Ethiopian). Intervention: A control group of pregnant Romney Marsh sheep with a nontransplanteduterus wereusedtocompare fetaldevelopment, uterine/placental histology and blood samples of progeny with the uterine transplanted sheep. Fetal sizes were obtained from ultrasound measurements during the early (crown-rump length) and late (biparietal diameter, abdominal circumference) gestational periods. Measurements and Main Results: Four months after the initial uterine transplant, five out of the twelve uterine allografts were considered candidates for the embryo transfer procedure. Fresh and frozen blastocysts donors were transferred accordingly to the remaining five uterine allografts through a mini-laparotomy incision. Three of these five resulted in pregnancies where one developed an ectopic gestation while the second carried a pregnancy to 105 days. The third delivered a fully developed offspring from the transplanted uterus by cesarean section. Neonatal lamb blood-gases, tissue histology, ventilation and respiratory compliance studies documented normal for gestational age. Conclusion: In this first reported case in the medical literature, we have demonstrated that a pregnancy can be carried in an allo-transplanted uterus with the end result of a successful delivery

OBJECTIVES: The aim of this research is to study the complications of pregnancy associated with anencephaly. STUDY METHODS: Thirty-five mothers who delivered an anencephalic baby (as a case group) and forty-three mothers who delivered a non-anencephalic baby (as a control group)were included in this analytical research study. All cases and controls had singleton pregnancies. More than one matched control was chosen for each case when possible. The cases were selected by a survey of 149,000 births in six educational centers located in Tehran. The control group matched with the study group regarding birth date, maternal age, socioeconomic status and living environment. The outcomes for the control and study groups were studied and compared in the following areas: premature rupture of membrane, pregnancy length, fetal presentation, hydramnios, fetal death, sex ratio (male to female ratio) and other anomalies. RESULTS: Anencephaly increased the likelihood of premature rupture of membrane by a factor of seven (p < 0.001). Pre-term birth was six times more likely (p < 0.005) and acephalic fetal presentation was 46% (p < 0.0005). In the study group, sex ratio was 0.52 and in control was 1.68 (p < 0.025). Further, hydramnios appeared in 90% of the study group. Finally, the general likelihood of any abnormality was 19 times (p < 0.0005) greater in the study group than the control group. CONCLUSIONS: Considering the clear correlation between anencephaly and pregnancy complications, precise prenatal care, early diagnosis and treatment are strongly indicated in order to avoid serious maternal complications.

OBJECTIVE: To evaluate the success for gender selection using a sample of semen separated by a modified swim-up technique. DESIGN: We retrospectively compared the gender outcome of two treatments (A and B) for either a male or female offspring with those who conceived spontaneously. SETTING: Private practice of one author (M. A.K.). PATIENTS, PARTICIPANTS: The treatment groups consisted of 52 total pregnancies for couples who conceived by the separation technique. Of these 52 participants, 15 desired a female offspring and were placed into treatment A and 37 desired a male offspring and were placed into treatment B. The control groups consisted of 162 women who were presented with initial consultation for gender selection and conceived spontaneously. Control group A consisted of 80 women who initially chose a female offspring, and control group B consisted of 82 participants who initially chose a male. INTERVENTIONS: In treatment group A, one timed intrauterine insemination (I

With its increasing success, sex preselection has become a matter of general concern, and interest in it is growing. Three aspects of sex preselection in New York City were considered. Who is choosing the sex? Which sex is being chosen? Why have the choices been made? In this investigation, 178 couples were studied and all 57 non-American couples chose boys; however, 120 American couples chose boys and girls with equal frequency depending upon the gender of the children at home. Non-American couples chose boys for economic and business reasons (40%), cultural reasons (30%), and personal reasons (30%). Sex preselection is valuable in preventing sex-linked genetic disorders. Many are fearful of a sudden change in sex ratios should sex preselection be successfully and inexpensively carried out

Chronic endometritis and its association with cervical colonization by Ureaplasma urealyticum was investigated in a group of 28 infertile patients treated for infertility problems. Twenty had positive cervical cultures for U. urealyticum and eight had negative cultures. There was focal chronic endometritis in 11 of the endometrial biopsies of the 20 cases with positive mycoplasma cultures. Ten of these biopsies were in the secretory phase, and one was in proliferative phase. No case with a negative culture showed endometritis

Infertility with a broad etiological background has only been treated, but not prevented. With the exception of ovulation induction, the success rate of pregnancy in most cases has been rather dismal in view of the high socioeconomic burden. A questionnaire survey of the cost of infertility investigation and treatment has been undertaken, and it has been estimated that the cost of infertility due to the sequelae of sexually transmitted diseases ranges in the vicinity of $64 billion, which is to be compared with the prevention cost of $335,000. Recommendations on preventative aspects are discussed

The role of bacterial and protozoal infections in reproductive failure and fetal loss has been difficult to establish in humans. This study was done in 78 female primates to determine if ureaplasma urealyticum was present. The highest overall incidence of positive cultures (36.4%) occurred among the chimpanzees, who also had the highest number of breeders (i.e., sexually active females.) This suggests that the organisms may be transmitted sexually. An opportunity is now available to study the role of ureaplasma urealyticum in reproductive problems, to determine the exact nature of its pathogenicity.