Ovarian hyperstimulation following the sole administration of agonistic analogues of gonadotrophin releasing hormone

Ovarian hyperstimulation following the sole administration of gonadotrophin-releasing hormone agonists (GnRHa) is exceedingly rare. We hereby report on two infertile patients undergoing in-vitro fertilization-embryo transfer who developed ovarian hyperstimulation under such circumstances. In both patients, GnRHa were administered using the 'long protocol' regimen. The first patient developed ovarian hyperstimulation on two occasions, with mid-luteal depot administration of triptorelin and with early follicular triptorelin, administered as daily subcutaneous injections. In both cycles, within 2 weeks of triptorelin therapy, massive ovarian multifollicular enlargement occurred, concomitant with high serum oestradiol concentrations, which resolved spontaneously following expectant management. The second patient developed ovarian hyperstimulation following daily injections of leuprolide acetate starting at the mid-luteal phase. The final stage of ovulation was triggered by human chorionic gonadotrophin (HCG) and 11 oocytes were retrieved. In-vitro fertilization resulted in embryo formation, but failed to result in pregnancy. The same phenomenon recurred in a subsequent cycle despite preventive pretreatment with an oral contraceptive. A negative GnRH test, performed just before HCG administration, suggested than an ongoing 'flare-up effect' was unlikely to cause ovarian stimulation. Ovarian hyperstimulation can occur following the sole administration of GnRHa irrespective of the preparation used and the administration protocol. Although spontaneous resolution is the rule, once this condition has developed, HCG administration and oocyte retrieval are feasible. This rare entity probably represents an exaggerated form of ovarian cyst formation following GnRHa administration, the underlying pathophysiology of which remains unresolved.     

Klippel-Trenaunay-Weber syndrome with adrenal pseudocyst: characterization by blood pool and adrenocortical iodocholesterol scintigraphy

A 44-year-old woman with Klippel-Trenaunay-Weber syndrome (KTWS) was evaluated for an adrenal mass incidentally discovered on CT. An NP-59 scintigraph showed normal symmetric adrenal tracer uptake, and a Tc-99m labeled RBC scan showed no evidence for an adrenal hemangioma but did show characteristic dilated and tortuous vasculature at multiple other sites. The mass was removed and found to be an adrenal pseudocyst. The pseudocyst was believed to have arisen from a pre-existing, thrombosed and organized adrenal hemangioma. This case demonstrates the previously reported utility of RBC scintigraphy in the depiction of the vascular abnormalities in the diagnosis and treatment of patients with Klippel-Trenaunay-Weber syndrome, as well as the utility of NP-59 scintigraphy in evaluating patients with adrenal masses.     

Potent piperazine hydroxyethylamine HIV protease inhibitors containing novel P3 ligands

The 2-isopropyl thiazolyl group is a highly optimized P3 ligand for C2 symmetry-based HIV protease inhibitors, as exemplified in the drug ritonavir. Here we report that incorporation of this P3 ligand into a piperazine hydroxyethylamine series also yielded novel, highly potent inhibitors. In tissue culture assays, the presence of human serum was less deleterious to the activity of these inhibitors than to that of ritonavir. Furthermore, potent activity against ritonavir resistant HIV was observed.     

Testicular lymphoma: a population-based study of incidence, clinicopathological correlations and prognosis. The Danish Lymphoma Study Group, LYFO

In a Danish population-based non-Hodgkin's lymphoma registry, 2687 newly diagnosed patients were registered from 1983 to 1992. 39 had testicular involvement (TL) (incidence 0.26/10(5)/year). Median age was 71 years. 24 cases had localised and 15 had disseminated disease. Histologically, all cases were diffuse (65% diffuse centroblastic type). Of the 27 tested, 11% were of T- and 89% of B-immunophenotype. In localised cases, where surgery was supplemented by combination chemotherapy (CCT), the relapse rate was 15.4%. The relapse rate for cases with localised disease treated with other regimens (orchiectomy and/or radiotherapy) was 63.6% (P < 0.05). Median relapse-free survival was 28 and 14 months, respectively. Overall 5-year survival for all cases was 17%. Adverse prognostic factors at the univariate level were stage IV, constitutional symptoms, serum lactic dehydrogenase elevation and performance score (WHO 3-4). It is suggested that the treatment of stage IE/IIE TL should include early CCT and CNS prophylaxis.     

From ethnographic record to system design

This paper explores the issues involved in moving from ethnographic explorations of work in context to a practical contribution to system design. It does so using the example of an interdisciplinary research project involving sociologists and computer scientists in the domain of air traffic control systems. It forms a pair with another paper (Sommerville et al., 1992) exploring these questions from the perspective of our computer science partners. We characterise ethnography as a research method, and consider the differences between undertaking it for strictly sociological or anthropological purposes by contrast with interdisciplinary and design purposes. We summarise some of our results in ethnographic explications of the work of air traffic controllers, and the sociality which it manifests. We describe the dialogues involved in rendering these observations informative for systems design, and the mutual translations implied in attempting to reconcile sociological with software engineering questions about supporting the work. We conclude by specifying some features of cooperative work which an engineering approach is in danger of overlooking; the ways, and limits, in which ethnographers can form a bridge between users and designers; and some of the conflicts of interest entrained in generating technical change.The research is funded by the UK MRC/SERC/ESRC Cognitive Science/HCI Initiative with the title Social Analysis of Control Systems for HCI Design, grant number SPG 8931598. The computer science partners are Professor Ian Sommerville, Dr Tom Rodden, Dr Pete Sawyer and Mr Richard Bentley. Thanks are due to Val King, Kjeldt Schmidt, Ian Sommerville and Tom Rodden for very helpful comments on earlier drafts of this paper.     

Multiway merge with constant delay in Concurrent Prolog

Multiway dynamic mergers with constant delay are an essential component of a parallel logic programming language. Previous attempts to defined efficient mergers have required complex optimising compilers and run-time support. This paper proposes a simple technique to implement mergers efficiently. The technique requires an additional data type and the definition of an operation on it. The operation allows multiple processes to access a stream without incurring the cost of searching for the end of stream. It is specified in Concurrent Prolog and is used to define multiple assignment variables using a monitor. The technique forms the basis for stream merging in Logix, a practical programming environment written in Flat Concurrent Prolog.     

Compiling OR-parallelism into AND-parallelism

This paper suggests a general method for compiling OR-parallelism into AND-parallelism. An interpreter for an AND/OR-parallel language written in the AND-parallel subset of the language induces a source-to-source transformation from the full language into the AND-parallel subset. This transformation can be identified and implemented as a special purpose compiler or applied using a general purpose partial evaluator. The method is demonstrated to compile a variant of Concurrent Prolog into an AND-parallel subset of the language called Flat Concurrent Prolog (FCP). It is also shown applicable to the compilation of OR-parallel Prolog to FCP. The transformation identified is simple and efficient. The performance of the method is discussed in the context of programming examples. These compare well with conventionally compiled Prolog programs.     

OCOG: A common grasp computation algorithm for a set of planar objects

This paper addresses the problem of defining a simple End-Effector design for a robotic arm that is able to grasp a given set of planar objects. The OCOG (Objects COmmon Grasp search) algorithm proposed in this paper searches for a common grasp over the set of objects mapping all possible grasps for each object that satisfy force closure and quality criteria by taking into account the external wrenches (forces and torque) applied to the object. The mapped grasps are represented by feature vectors in a high-dimensional space. This feature vector describes the design of the gripper. A database is generated for all possible grasps for each object in the feature vector space. A search algorithm is then used for intersecting all possible grasps over all parts and finding a common grasp suitable for all objects. The search algorithm utilizes the kd-tree index structure for representing the database of the sets of feature vectors. The kd-tree structure enables an efficient and low cost nearest-neighbor search for common vectors between the sets. Each common vector found (feature vector) is the grasp configuration for a group of objects, which implies the future end-effector design. The final step classifies the grasps found to subsets of the objects, according to the common vectors found. Simulations and experiments are presented for four objects to validate the feasibility of the proposed algorithm. The algorithm will be useful for standardization of end-effector design and reducing its engineering time.