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Ein wesentliches Therapiekonzept bei andrologischer Subfertilitat besteht darin, eine moglichst hohe Konzentration mobiler Spermatozoen am naturlichen Ort der Fertilisation am ampullo-isthmischen Ubergang der Tube zu erreichen. Das therapeutische Spektrum wurde erweitert durch die Moglichkeit, nach Sondierung der Tubenostien von der Vagina aus prapariertes Sperma direkt am ampullo-isthmischen Ubergang zu deponieren. Fur die Katheterisierung der Tuben steht ein von Jansen und Anderson [1] entwickeltes intratubares Transferset zur Verfugung. In einer prospektiven vergleichenden Studie sollten die theoretischen Vorteile einer homologen vaginalen intratubaren Insemination (VITI) gegenuber einer herkommlichen intrauterinen Insemination (IUI) hinsichtlich ihrer Erfolgsrate in einem Sterilitatskollektiv mit ausgepragter andrologischer Subfertilitat und mit cervikalem-immunologischem Faktor gepruft werden. Daruber hinaus sollte die Verlaslichkeit der Methode erprobt werden vor ihrem eventuellen Einsatz im Rahmen eines intratubaren Gametentransfers von der Vagina aus (TV-GIFT).

A contextual model of stress was employed to examine the impact of cochlear implantation on parents' levels of stress and psychological adjustment. This model provided a framework for identifying stressors tied directly to the situation, and pointed to important life roles that may be altered. Twenty-four mothers of children implanted with cochlear implants completed a series of questionnaires assessing stressors related to daily parenting tasks, time demands, and childhood deafness. Standardized measures of depression, anxiety, and somatic complaints were also administered. The results provided preliminary evidence that parents of children receiving cochlear implants experience higher levels of stress and poorer psychological adjustment than parents of normally hearing children. Greater parenting stress and emotional distress were reported by parents of children using multichannel as opposed to single-channel devices, with little evidence that this was related strongly to length of time using the devices. Finally, in analyses controlling for type of device and length of use, parenting stress as measured in the current study, accounted for substantial proportions of the variance in psychological distress. The implications of these findings, as well as directions for future research, are discussed.

The purpose of this study was to identify predictors of effective use of a cochlear implant in a sample of 29 profoundly deaf children, who had been using their devices an average of 2 years. The relationship between the variables of age of onset of deafness, etiology, and communication mode measured prior to implant surgery were correlated with a behavioral measure of cochlear implant use in everyday situations. In addition, in a subset of the full sample, nonverbal intelligence subtest scores calculated prior to implant surgery were evaluated for their contribution to subsequent use of the cochlear implant. The results suggested that communication mode, time using the implant device, and performance on two subsets from the Wechsler Intelligence Scale for Children-Revised (WISC-R) accounted for substantial proportions of the variance in parent ratings of implant usage. The implications of these findings, as well as directions for future research, are discussed.

Eine Erhohung des CA 125-Serumspiegels bei Patientinnen mit Endometriose war Anlas, in einer retrospektiven Analyse mogliche Zusammenhange mit dem Ausmas der Erkrankung zu verifizieren.

Gamete intrafallopian transfer (GIFT) is performed currently using laparoscopy. We report on a pilot-study from 1.1.1987 to 31.12.1987 and from 1.5.1988 to 30.4.1989, in which we used hysteroscopy instead of laparoscopy for the GIFT-procedure. The entering conditions were: unexplained (idiopathic) infertility, failure of previous treatments, proven fertilization capability of the gametes in at least one IVF attempt, and request of the married couple to dispense with laparoscopy during GIFT procedure. Hysteroscopic GIFT was initially performed on hysterectomy specimens, using the Chorionoskop. Continuous flow CO2 through the fallopian tubes did not result in loss of gametes. Twenty-four treatment cycles were performed in 16 patients. In 19 cycles, gametes were transferred into one tube, and in two cycles they were transferred into both tubes. Four of 16 women conceived: one patient delivered at term, three pregnancies ended in a first trimester abortion. These results demonstrate that the hysteroscopic approach to intrafallopian gamete transfer can be successful. However, the technique is demanding and requires extensive training. We conclude that further improvements of hysteroscopic GIFT are needed.

5030 Background: Topotecan combined with etoposide (GINECO 1998) and gemcitabine (NOGGO 2001) proved effective for second-line treatment of recurrent ovarian cancer. It is, however, unclear whether combined treatment improves survival and tumor control compared to topotecan alone. Methods: Women with recurrent ovarian cancer after primary surgery and platinum therapy were enrolled in an open-label randomized phase-III trial at 93 German institutions. Stratifying for treatment-free intervals (TFI) of less or more than 12 months, subjects were centrally allocated to topotecan 1.25 mg/m2/d (TM), topotecan 1.0 mg/m2/d plus oral etoposide 50 mg/d (TE) on day 6–12, or topotecan 0.5 mg/m2/d plus gemcitabine (TG) 800 mg/m2/d1 and 600 mg/m2/d8 every three weeks. Local institutional review boards approved this study, and all patients provided written informed consent. With 145 subjects each arm, this study yielded 90% power to detect a Hazard Ratio (HR) of 0.60 in overall survival (OS) at a two-sided alpha of 0.01. We employed Cox regression for primary endpoint analysis, and addressed progression-free survival (PFS) and toxicity descriptively. Results: Between September 1999 and November 2004, 3036 courses were administered to 505 patients (mean age 60.4 [SD 11.3] years), 208 of whom had a TFI No significant financial relationships to disclose.

5089 Background: Despite of the effectiveness of radical surgery and first-line chemotherapy, most patients (pts) with advanced ovarian cancer will relapse. Paclitaxel (P) in combination with C as second-line treatment improves the outcome of pts with platinum-sensitive ROC in comparison to C monotherapy. Due to polyneuropathy and alopecia this regimen can not be offered to all pts. Therefore, other platinum-combinations are required. We conducted a phase I/II study to define the dose limiting toxicities (DLT) and the tolerability of combination therapy with T and C. Methods: Pts with platinum-sensitive ROC and primary standard therapy were stratified according to treatment-free interval (TFI): 6–12 months (A) and ≥12 months (B). Following dose regimens were analysed: T 1mg/m2/d1–3 + C AUC5/d3 and T 0.75 mg/m2/d1–3 + C AUC5/d3, q21d. DLT was based on the first 4 courses and defined as: CTC grade 3/4 hematological and grade 2 non-hematological toxicity (excepted alopecia, vomiting), treatment delay >7d. Primary endpoints were DLT and tolerability. Secondary endpoints were remission rate (RR) and progression-free survival (PFS). Results: From 06/04 to 08/05, 28 pts were enrolled, 26 pts (A:13 pts, B:13 pts) were eligible. Median age was 61.5 years. A total of 141 cycles were analysed, median number of cycles was 6 (range A:2–8, B:1–10). DLTs were: leucopenia (n = 5) and thrombocytopenia (n = 1). MTD was reached at dose: T: 0.75mg/m2 and C: AUC5. Overall, grade 3/4 hematologic toxicities (in% of all cycles), for (A) and (B) respectively, were: anemia 4% vs. 4%, leucopenia 34% vs. 13%, neutropenia 30% vs. 31%, thrombocytopenia 7% vs. 6%. Febrile neutropenia 4.3% vs. 0%. Darbepoetin alfa was given in 13.5% of all cycles. Overall, grade 3/4 non-hematologic toxicities were infrequent (< 5%). Overall RR (95% CI) was 50% (29.7–70.1) [A: 30.8% (0.1–61.1), B: 69.3% (38.7–90.9)]. Median follow-up was 5.8 mo, median PFS (95% CI) was 7.7 mo (1.3–9.4) [A: 6.2 (1.3–7.2), B: 8.0 (7.3–9.4)]. Median overall survival was not reached. Conclusions: TC is a feasible and effective chemotherapy regimen for platinum sensitive ROC. Tolerability is not associated to TFI. The recommended dose for subsequent studies is T:0.75 and C:AUC5. No significant financial relationships to disclose.

Typical inversion of limb-sounding measurements assumes local horizontal homogeneity of the atmosphere. This simplification corresponds to spectral radiance errors that can exceed the noise level of a typical infrared instrument by a factor of 10 and causes errors in retrieved state parameters. To avoid these errors and to take the horizontal structure of the atmosphere into account, a two-dimensional (2D) tomographic sequential estimation approach is described. Application to temperature retrievals from simulated measurements yields typical retrieval errors of the order of 1 K, and a one-dimensional retrieval with the same synthetic measurements shows differences to the true values up to 10 K in regions with strong horizontal inhomogeneities. The horizontal resolution of the 2D retrieval is even better (up to 40 km) than the horizontal tangent point spacing.

8140 Background: Bone metastases in cancer patients may lead to severe bone pain, pathological fractures, and hypercalcemia. The development of osteolytic destruction is due to activation of osteoc...

The adsorption of high concentrations of RAV-1 to chick embryo cells renders the cells resistant to infection by the pseudotype of Rous sarcoma virus designated RSV(RAV-1) which contains the RSV genome and the RAV-1 outer coat. The interfering RAV-1 particles may be added directly to the cell culture in high concentrations (early interference) or may be produced by the RAV-1 infected cells themselves (late interference). The degree of resistance can be reduced by treatment of cells with RAV-1 antibody or at pH 2.2 at all stages of RAV-1 infection. Early interference can be established by RAV-1 at temperatures low enough (4–8 °) to block penetration of the cell by the interfering virus. RAV-1 heated to 54 ° for 15 minutes loses its infectivity, but retains its capacity to induce early interference. After a 15-minute treatment of RAV-1 at higher temperatures both properties are lost, and at lower temperatures neither is lost.

zukommt. Im Durchschnitt wurde dieses Phfinomen 13 Monate vor der klinischen Manifestierung yon Metastasen oder Rezidiven beobachtet. Es konnte im tibrigen bei allen untersuchten Mammkarzinompatienten, unabhfingig vom klinischen Verlauf im gesamten Beobachtungszeitraum keine Beeintr/ichtigung der allgemeinen Immunkompetenz im Sinne einer verminderten Reaktivitfit gegen Recall-Antigene festgestellt werden. Die vorliegenden klinischen Daten unterstreichen die prognostische Bedeutung einer in vitro nachweisbaren tumorassoziierten Immunitfit. Die morphologische Einteilung des Mammakarzinoms kann somit durch immunologische Befunde ergfinzt werden, die m6glicherweise neben anderen etablierten Parametern eine Entscheidungshilfe beim Einsatz einer adjuvanten Chemotherapie oder immunrestaurativen Mal3nahmen sein kann. Eine unspezifische Immunstimulation, das zeigt der Nachweis einer intakten allgemeinen zellulfiren Immunitfit bei der Mehrzahl der untersuchten Patienten unabhfingig vom klinischen Verlauf, ist jedoch nicht indiziert.

A prospective study was designed to evaluate the efficacy of radionuclide hysterosalpingoscintigraphy using 99mTc-labelled human serum albumin macroaggregates in 17 patients (34 tubes). In normal females the macroaggregates migrate spontaneously through the female reproductive tract following application into the posterior vaginal fornix. They can be seen in the uterine fornix 20 min p.i. (range: 5-90 min) and as free pelvic activity 120 min p.i. (range 40-180 min). Free pelvic activity could also be demonstrated by culdocentesis. In infertile patients with failure of tubal patency images after 180 min offered no additional information. For the routine diagnosis camera images 5, 60 and 180 min p.i. are recommended. Using 5-10 MBq 99mTc the radiation exposure to the ovaries is about 1/9th of the exposure from a normal radiologic hysterosalpingogram. The reported data show results comparable with those of hysterosalpingography (HSG) in females with patent or with nonpermeable tubes, but in cases of high-pressure by patency by HSG the results of scintigraphy are superior to those of HSG. Moreover, this method provides new insights into sperm motility under various physiological and pathological conditions.

The advantages of using a synthetic data base for developing Automatic Target Recognition (ATR) algorithms are well recognized. Primarily, a synthetic data base allows the economical generation of images that represent scenarios from which it is difficult or impossible to obtain real data. Furthermore, synthetic imagery allows direct control of image parameters, such as target signal-to-noise ratio, which aids ATR algorithm evaluation. This paper describes Texas Instruments' (TI's) Synthetic Image Generation for Automatic Target Recognizer Evaluation (SIGNATRE) system.

Seit langem ist die Tatsache bekannt, das unbewegliche, inerte Substanzen aus der Vagina in kurzer Zeit die Tube und das Ovar erreichen konnen [1]. Die Hystero-Salpingo-Szintigraphie (HSS) ist ein nuklearmedizinisches Verfahren, beschrieben zuerst von Iturralde und Venter [2], zur Prufung der Transportvorgange in den genitalen Wegen. Die Methode demonstriert die passive Wanderung eines in das Scheidengewolbe eingebrachten Tracers von etwa Spermatozoen- grose in Richtung Uterus, Tuben und Peritonealhohle. Vom methodischen Ansatz her steht die HSS damit im Gegensatz zur Hysterosalpingographie (HSG), bei der das Kontrastmittel unter positivem Druck durch Uterus und Tube geprest wird. Hier soll uber unsere ersten Erfahrungen mit der HSS berichtet und die Aussagekraft der Methode diskutiert werden. Zur Durchfuhrung einer HSS markierten wir Humanalbumin-Makroaggregate (Partikelgrose 5–40 jim) mit Tc-99m (phys. HWZ 6 h). 8–10 MBq Aktivitat in 1–2 ml 0,9% NaCl wurden zur Zyklusmitte im Rahmen einer Speculumeinstellung vor die ausere Mundung des Zervikalkanals deponiert. Bei 10 Patientinnen wurden mit einer Gammakamera (hochauflosender Kollimator, 50000 Impulse) in a.p.-Projektion vom kleinen Becken uber 4 h dynamische Aufnahmen angefertigt (12 Bilder/h). Bei weiteren 13 Patientinnen wurden Aufnahmen nach 5 min, 30 min, 1 h, 2 h, 3 h und 4 h nach Applikation angefertigt. Bei einem Normalbefund stellte sich bereits auf den fruhen Aufnahmen uber der Aktivitat in der Vagina Aktivitat in der Endozervix und im Cavum uteri dar.

A prospective study in 38 patients was designed to evaluate the efficacy and reliability of radionuclide hysterosalpingoscintigraphy (HSS) using 99mTc labelled human albumin macroaggregates (HAMA). Following application in the posterior vaginal fornix at the time of ovulation, HAMA normally migrate spontaneously through the uterus and tubes and may be identified after 20 min (range 5-90 min) in the uterine cavity and after 2 hrs (range 40 min - 3 hrs) in the free pelvis, using a gamma camera. When correlated with the findings of conventional contrast hysterosalpingography (HSG), the radionuclide procedure yielded comparable results in females with patent or clearly obstructed tubes. Using 8-10 MBq 99mTc, radiation exposure was estimated to be 0.75 cGy per ovary, which is considerably less than the mean dose absorbed with HSG. As the HSS procedure imitates the migration of spermatozoa by the means of an inert tracer, it allows a direct insight in the mechanisms of passive transport taking place in the uterus and tubes at the period of ovulation. Thus, it reflects the physiological state of the female reproductive tract. On the basis of the scintigraphic findings, equivocal results on HSG have to be re-evaluated, as tubes, which are anatomically patent under high pressure, may be functionally deficient.

[1] Retrieval of abundances of atmospheric species from limb infrared emission spectra requires accurate knowledge of the pointing of the instrument in terms of elevation, as well as temperature and pressure profiles. An optimal estimation-based method is presented to infer these quantities from measured spectra. The successful and efficient joint retrieval of these largely correlated quantities depends strongly on the proper selection of the retrieval space, the selection of spectral microwindows, and the choice of reasonable constraints which force the solution to be stable. The proposed strategy was applied to limb emission spectra recorded with the Michelson Interferometer for Passive Atmospheric Sounding (MIPAS) on board the Envisat research satellite in order to validate the instrument pointing information based on the satellite's orbit and attitude control system which uses star tracker information as a reference. Both systematic and periodic pointing calibration errors were detected, which meanwhile have been corrected to a major part. Furthermore, occasional pitch jumps were detected, which could be assigned to parameter uploads to the satellite's orbit and attitude control system. It has been shown that in general, it is justified to assume local thermodynamic equilibrium below 60 km for these purposes. The retrieval method presented has been proven to be suitable for independent monitoring of MIPAS line-of-sight pointing.

The functionality and characteristics of six different data processors (i.e., retrieval codes in their actual software and hardware environment) for analysis of high-resolution limb emission infrared spectra recorded by the space-borne Michelson Interferometer for Passive Atmospheric Sounding (MIPAS) have been validated by means of a blind test retrieval experiment based on synthetic spectra. For this purpose a self-consistent set of atmospheric state parameters, including pressure, temperature, vibrational temperatures, and abundances of trace gases and aerosols, has been generated and used as input for radiative transfer calculations for MIPAS measurement geometry and configuration. These spectra were convolved with the MIPAS field of view, spectrally degraded by the MIPAS instrument line shape, and, finally, superimposed with synthetic measurement noise. These synthetic MIPAS measurements were distributed among the participants of the project "Advanced MIPAS level-2 data analysis" (AMIL2DA), who performed temperature and species abundance profile retrievals by inverse radiative transfer calculations. While the retrieved profiles of atmospheric state parameters reflect some characteristics of the individual data processors, it was shown that all the data processors under investigation are capable of producing reliable results in the sense that deviations of retrieved results from the reference profiles are within the margin that is consistent with analytical error estimation. © 2003 by the American Geophysical Union.