In neonates with esophageal atresia and distal tracheoesophageal fistula (EA/TEF) it should be possible to undertake repair without esophageal anastomotic complications. The aim of this study was to evaluate the role of planned ventilation after surgery. In 72 consecutive cases of EA/TEF the defect was repaired and followed by non-reversal of anesthesia and graded withdrawal of ventilatory support in the post-operative period. If the anastomosis was considered to be under undue tension, muscle relaxant was used 48 to 72 hours. Clinical information was obtained retrospectively by a chart review. No leaking anastomosis was identified, and no recurrent TEF developed. The survival rate of infants undergoing definitive surgical repair of EA-TEF was 95.8%. Fifty-one of them (71%) were extubated within five days after surgery. Eleven neonates with associated prematurity and/or cardiac diseases needed re-intubation but, in all but one, weaning from the respirator was achieved. Routine planned respiratory care immediately after repair of EA-TEF protects the esophageal anastomosis, and by reducing anastomotic complications, results in an improved outcome of treatment.
The technique of assisted reproduction have recently become the most effective methods of treatment of infertility ; TESE (testicular sperm extraction) and MESA (microsurgical epididymal sperm aspiration). It has been increasingly successful, even above the average efficiency of classical IVF (in vitro fertilization). This study investigated that the sperm retrieval success rates, fertilization rates, and pregnancy rates of MESA and TESE in cases of azoospermia. Forty-six infertile couples with obstructive and non- obstructive azoospermia were included in this study. Twenty-three cycles each of MESA-ICSI and TESE-ICSI cycles were performed. A difference in the normal two-pronuclear (PN) fertilization rate was found between the two groups : 60% for epididymal spermatozoa and 33% for testicular biopsy spermatozoa. The cleavage rates were almost the same for epididymal 83% and testicular spermatozoa 90%. The ongoing pregnancy rate in this series were 35% and 19% respectively. Clinical data have confirmed that fertilization rate and pregnancy rate are not lower than conventional IVF. We conclude that epididymal spermatozoa and testicular spermatozoa gain different fertilization and ongoing pregnancy rates using ICSI. This technique could provide a useful alternative for the management of infertile men with azoospermia when compared with conventional IVF.
On the basis of the results of our investigation about the dialysed extract of Dermatophagoides farinae (Df) (Int Arch Allergy Clin Immunol 96 : 622-330, 1990), we studied the existence of low molecular weight fraction of Df (Df-LMN) in sera of the mite sensitive patients with bronchial asthma and with atopic dermatitis. ELISA inhibition assay and Western immunoblotting were used to compare the amount of Df-LMW in sera of 19 asthmatic patients with RAST positive for, Df, 9 asthmatic patients with RAST negative for Df, 11 patients with atopic dermatitis with RAST positive for Df, 10 healthy children with RAST negative for Df without any family history of allergic diseases. The levels of Df-LMW in sera of the asthmatic patients and atopic dermatitis patients with RAST positive for Df were significantly higher than that of healthy children with RAST negative for Df (p < 0.01). Furthermore, using Western immunoblotting, most sera from asthmatic patients with mite allergy showed positive bands, but didn't show any bands in patient without mite allergy and healthy children. Judging from maker protein, Df-LMW present around 66 and 34 Kd with coujugation of serum protein. The results of this study provide that Df-LMW may present in sera of patients with mite allergy.