Evaluation of low-dose letrozole addition to ovulation induction in IVF

PURPOSE

The aim was to investigate the impact of low-dose letrozole usage along with gonadotropin treatment in vitro fertilization (IVF) cycles in comparison to gonadotropin treatment alone.

MATERIALS AND METHODS

Fifty patients were prospectively included in this randomized study and were divided into two groups. Age, demographic features, causes, and period of infertility were adjusted and matched for both groups. Group 1 included 25 patients who received gonadotropin treatment and letrozole along with gonadotropin-releasing hormone (GnRH) antagonist protocol; group 2 included 25 patients who received gonadotropin treatment along with GnRH antagonist protocol.

RESULTS

Total follicle-stimulating hormone (FSH) and daily FSH doses were lower in group 1, although not statistically significant (p > 0.05). The period of ovulation induction was significantly shorter in group 2. While numbers of retrieved oocytes and transferred embryos were lower in group 1, they were not statistically significant (p > 0.05). Number of clinical pregnancies per embryo transfer, number of clinical pregnancies per cycle, and number of ongoing pregnancies (> 16 gestational weeks) were similar in both groups (p > 0.05).

CONCLUSIONS

Addition of low-dose letrozole to gonadotropin treatment in GnRH antagonist protocols may result in a lower dose of gonadotropin administration. However, routine clinical practice remains questionable due to no evident positive effect on pregnancy rates.

Relevance of anti-Müllerian hormone on in vitro fertilization outcome

PURPOSE

The aim of this study was to investigate the relevance of serum and follicular anti-Müllerian hormone (AMH) concentrations on ovarian reserve and clinical pregnancy.

MATERIALS AND METHODS

Thirty patients were prospectively included in this study. Serum AMH levels were quantitatively measured on the follicle aspiration day. Retrieving less than five oocytes was defined as poor response. Eleven days after embryo transfer, beta-human chorionic gonadotropin (beta-hCG) level in the blood was measured. Two weeks after the beta-hCG test, a clinical pregnancy was confirmed by transvaginal ultrasound (TVUS).

RESULTS

There was a statistically significant correlation between serum AMH and number of retrieved oocytes (p = 0.024). There was a correlation between the number of retrieved oocytes and baseline antral follicle count (AFC), between ovarian reserve and baseline follicle-stimulating hormone (FSH), and between ovarian reserve and serum AMH (p < 0.05). Serum AMH cut-off value for the normal ovarian reserve was calculated as 0.37ng/ml (sensitivity 71.43%, specificity 66.67%, positive prediction 83.33%, negative prediction 50%).

CONCLUSION

Increasing use of serum AMH will be of considerable benefit. Consequently, the observed positive correlation between serum AMH and ovarian reserve will require larger sampling to refine the role of AMH.

Relevance of thrombophilia and impact of office hysteroscopy on recurrent in vitro fertilization failures: a case series

The study evaluated the validity of office hysteroscopy (OH) in 51 infertile women and whether congenital or acquired thrombophilia is more prevalent in women with recurrent IVF failures.

XPD and XRCC1 gene polymorphism in patients with normal and abnormal cervical cytology by pap smear

AIM

The purpose of the present study was to identify the role of abnormalities in DNA repair pathways by measuring the XPD and XRCC1 gene polymorphisms.

MATERIALS AND METHODS

Thirty-five patients with abnormal cervical cytology (study group) and 10 women with normal cytology (control group) were included in the study. The polymorphisms of XRCC1 Arg194Trp, XRCC1 Arg399Gln and XPD Lys751Gln genes were investigated from the blood samples.

RESULTS

There was no statistically significant difference in allele frequencies of XPD gene among the groups (p = 0.097), while XRCC1R399Q gene polymorphism was strikingly more frequent in the study group than that of control cases (p = 0.029). The prevalence of XRCC1R194W gene polymorphism on the other hand, was similar between the groups (p = 0.579).

CONCLUSIONS

Patients with abnormal and normal cervical cytology have similar XPD gene polymorphism. However, the frequency of gene polymorphism in XRCC1 Arg 399 Gln codon was significantly higher in abnormal cervical cytology group.

Natural behaviour and surgical treatment of appendiceal carcinoids: an analysis of 2,376 consecutive emergency appendectomies

OBJECTIVE

Carcinoid tumor of appendix is a rare condition. Its rarity may give rise to variances in its management. We aimed to demonstrate the occurrence and form of presentation of carcinoid tumor of appendix, as well as variations in its treatment.

METHODS

All appendicectomies that took place between 2000 and 2008 were considered for study.

RESULTS

A total of 2,376 appendicectomies were performed during this period while carcinoid tumours were diagnosed in 27 patients (1.13%). The mean age of patients with carcinoid tumor (26.7 years) was almost the same as that of patients with non-carcinoid pathology (28.1 years). The incidence of male patients was higher than that of females amongst the carcinoid tumor group (female/male ratio: 1/4). None of the carcinoid tumors were identified at operation. One patient (3.7 %) required right hemicolectomy. This patient was followed-up in an inconsistent manner.

CONCLUSIONS

Carcinoid tumour of the appendix remains an incidental diagnosis. Patients with carcinoid were significantly younger than those with non-carcinoid conditions in the study. Re-operation rate was low. The interval to definitive surgery was very short and only one patient was followed up. No consideration as to whether the surgery was complete or not was done in the study (Tab. 1, Fig. 1, Ref. 29).

Anti-apoptotic and growth-promoting markers in adult medulloblastomas

AIM

the aim of this study was to investigate the pathologic features, proliferation potential and expression of some anti-apoptotic and growth-promoting markers in adult medulloblastomas.

METHOD

we analyzed the immunohistochemical expression of survivin, c-KIT, Bcl-2, fascin, p-53 and Ki-67 in 18 adult medulloblastomas (> 16 years of age).

RESULTS

study included 14 males and 4 females (mean age: 22.9 ± 8.2). 14 cases were classical, 2 desmoplastic/nodular and 2 large cell medulloblastomas. Moderate-to-high nuclear survivin expression was observed with high percentages (55 - 100%) in all medulloblastomas while Bcl-2 was mildly positive in only 1 case. Interestingly, mild-to-moderate cytoplasmic c-KIT expression was demonstrated in 16 cases (89%) without membranous accentuation. Fascin expression was observed in 13 medulloblastomas (72%), 9 of which showing moderate to high immunoreactivity. Mild p53 expression was present in only 4 cases (22%). Mean Ki-67 index was 20.6% (range 8 - 55%).

CONCLUSION

frequent nuclear survivin expression implies the predominance of anti-apoptotic factors in pathogenesis of adult medulloblastomas. It may also be a potential therapeutic target for adult medulloblastomas. Although Blc-2 immunoreactivity was previously reported in approximately 30% in medulloblastomas, we have observed that it is rarely expressed in the present series of adult medulloblastomas. To our knowledge, this is the first study evaluating fascin expression in medulloblastomas. Its presence may be related to the neuronal differentiation. Mild-to-moderate cytoplasmic c-KIT immunoreactivity without membranous staining in adult medulloblastomas may support the previous studies reporting low level of c-KIT protein expression with lack of activating mutations in medulloblastomas. It seems p53 is rarely involved in the course of develepment of adult medulloblastomas.

Cervical length and maternal factors in expectantly managed prolonged pregnancy: prediction of onset of labor and mode of delivery

OBJECTIVE

To examine the value of combining cervical length and maternal characteristics in a prolonged-pregnancy clinic in the prediction of the probability of firstly, spontaneous onset of labor within the subsequent 10 days and secondly, the need for Cesarean section.

METHODS

This was a prospective study of women with singleton pregnancies attending an ultrasound-based prolonged-pregnancy clinic at 40 + 4 to 41 + 6 weeks of gestation. The policy was to delay induction of labor by 7-10 days unless there was evidence of a specific medical or obstetric indication or the mother wanted earlier delivery. The measurement of cervical length was not given to the obstetrician, midwife or patient. Regression analysis was used to determine which of the following factors had a significant contribution in predicting induction of labor: maternal age, body mass index (BMI), ethnic origin, parity and cervical length. Regression analysis was also used to determine which of the factors amongst the maternal characteristics, onset of labor and cervical length provided significant prediction of Cesarean section.

RESULTS

We examined 2316 pregnancies but we excluded from further analysis 452 (19.5%) cases because iatrogenic delivery was carried out within the subsequent 6 days, including 427 cases of induction of labor (340 at the request of the mother and 87 for medical indications) and 25 cases of Cesarean section. In the remaining 1864 cases there was spontaneous onset of labor and delivery within 10 days in 1536 (82.4%) and induction of labor in 7-10 days in 328 (17.6%). The rate of Cesarean section was 15.2% (233 of 1536) in those with spontaneous onset of labor and 36.0% (118 of 328) in those whose labor was induced. Regression analysis demonstrated that in the prediction of induction of labor there were significant contributions from cervical length, BMI, parity and gestational age, and in the prediction of Cesarean section there were significant contributions from onset of labor, cervical length, BMI, parity and ethnicity.

CONCLUSION

Ultrasonographic measurement of cervical length at 41 weeks together with maternal factors can define the patient-specific probability of spontaneous onset of labor in the subsequent week and the risk of Cesarean section.

Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment

OBJECTIVES

To evaluate the ability of combinations of cervical length and maternal history to assess the risk of spontaneous preterm birth, and to provide a simple procedure for the optimal estimation of risk.

METHODS

This prospective observational study was carried out between January 1998 and May 2006. Transvaginal sonographic measurement of cervical length at 20 + 0 to 24 + 6 weeks of gestation was carried out in 58 807 singleton pregnancies as part of routine antenatal care. The outcome measure was spontaneous extreme (< 28 weeks), early (28-30 weeks), moderate (31-33 weeks) and mild (34-36 weeks) preterm birth. Logistic regression analysis was used to derive models for the prediction of spontaneous preterm birth from the maternal obstetric history, demographic characteristics and cervical length.

RESULTS

The rates of extreme, early, moderate and mild spontaneous preterm birth were 0.23%, 0.24%, 0.57% and 2.93%, respectively. The best prediction of spontaneous preterm birth was provided by cervical length (area under the receiver-operating characteristics curve (AUC), extreme 0.903, early 0.816, moderate 0.784 and mild 0.617) and this was improved by adding obstetric history (AUC, extreme 0.919, early 0.836, moderate 0.819 and mild 0.650). Addition of other parameters was without material effect. For a 10% screen-positive rate, models using cervical length and obstetric history had a sensitivity of 80.6%, 58.5%, 53.0% and 28.6% for extreme, early, moderate and mild spontaneous preterm birth, respectively. These models were expressed as tables of adjusted likelihood ratios to allow simple estimation of the risk of spontaneous preterm birth.

CONCLUSIONS

A model combining cervical length and obstetric history provides a better prediction of spontaneous preterm birth than either factor alone, and the sensitivity of screening improves for increasing degrees of prematurity.

Learning curve for Doppler assessment of ductus venosus flow at 11 + 0 to 13 + 6 weeks' gestation

OBJECTIVE

To determine the number of scans necessary for training sonographers to examine accurately the ductus venosus at 11 + 0 to 13 + 6 weeks' gestation.

METHODS

Ten sonographers with prior extensive experience in the measurement of nuchal translucency thickness were given practical training in the accurate assessment of the ductus venosus. They were then asked to examine the ductus venosus during the routine 11 + 0 to 13 + 6 weeks' scan. Each scan was assessed by an experienced sonographer and classified as being successful or unsuccessful (failure to obtain a waveform, poor quality image with contamination or wrong classification of the A-wave). Each sonographer performed a total of 300 examinations, the data were analyzed in 15 groups of 20 examinations and in each group the percentage of unsuccessful examinations was calculated.

RESULTS

In the total 3000 cases examined by the 10 sonographers there were 2849 (95.0%) successful examinations and 151 unsuccessful, including 104 failures to obtain a waveform, 30 cases where the quality of the image was considered to be inadequate and 17 cases in which the classification of the A-wave was wrong. The overall frequency of unsuccessful examinations decreased significantly with the number of scans carried out (r = 0.982, P < 0.0001). The sonographers required an average of 80 examinations before they could successfully examine the ductus in at least 19 of a group of 20 scans. Although one of the 10 trainees achieved this standard within the first block of 20 scans some of the sonographers required training in 100 cases.

CONCLUSION

Competence in Doppler assessment of the ductus venosus is achieved only after extensive supervised training.

Prevalence and causative agents of superficial mycoses in a textile factory in Adana, Turkey

This study was carried out in a textile factory settled in the city center of Adana, Turkey. The workers were evaluated for the presence of superficial mycoses and the interaction of their working environment or working condition. A total of 431 textile workers were included in the study, with a male to female ratio of 378 (87.7%) to 53 (12.3%) and an age range of 19-52 (mean: 33.7 +/- 6.8). Direct examination and/or culture revealed superficial mycoses in 73 (16.9%) workers, among them 56 (76.7%) were classified as dermatophytoses, 8 (11.0%) as Pityriasis versicolor while in nine (12.3%) of the cases, no causative agent could be determined. Trichophyton rubrum (57.1%) and T. mentagrophytes (42.9%) were the two species isolated on culture. This study emphasized that textile workers should be admitted as a risk group for superficial mycoses, especially tinea pedis.

Characterization of modified low density lipoprotein subfractions by capillary isotachophoresis

Oxidative modification of low density lipoproteins (LDLs) is an important pathogenetic factor in atherosclerosis. The various steps in oxidative modifications of LDL can be monitored using different methodologies with varying degrees of complexity. In this study, we propose capillary isotachophoresis (CITP) as a suitable tool to detect and measure the degree of oxidation of LDL. LDL was isolated from pooled plasma of healthy volunteers by sequential ultracentrifugation, and oxidation was performed in vitro as well as in cell culture experiments. Native LDL and oxidatively modified LDL were characterized by apo B-100 fluorescence and conjugated diene formation. Samples were separated by CITP combined with sudan black B staining. To underline the inherent advantages of this approach, CITP was compared with classical lipoprotein electrophoresis using agarose gel. We demonstrate the CITP method to be highly sensitive, as changes in peak area of the separated LDL subfractions were detected after only 2 h of oxidation. The leading LDL peaks increased, while the terminating LDL peaks decreased in parallel throughout the duration of oxidation. The LDL samples, oxidized for 4-24 h, also exhibited an increased migration velocity of the fractions. In summary, we present the first study investigating LDL-subfractions separated by CITP and the alterations of these LDL-subfractions after gradual in vitro oxidation and after oxidative modification by monocyte-derived macrophages and vascular smooth muscle cells.

A case of prenatally diagnosed fetal neurenteric cyst

The combination of a thoracic cystic mass with vertebral anomalies on prenatal ultrasound suggests a neurenteric cyst. The outcome of such cysts mostly depends on the extent of the displacement and functional impairment of the adjacent organs and of the associated central nervous system defects. We present a case of a neurenteric cyst diagnosed on prenatal ultrasound at 34 weeks of gestation which was treated successfully in the early neonatal period.

Effect of transrectal ultrasonography of the prostate on serum prostate-specific antigen levels and free/total prostate-specific antigen ratio

To study the effect of transrectal ultrasonography (TRUS) on serum total prostate-specific antigen (PSA), free PSA and free/total (f/t) PSA ratio and to determine the reliability of serum total and free PSA levels and f/t PSA ratio after such interventions, serum free and total PSA levels and f/t PSA ratios were determined before, immediately after and 24 h after TRUS in 44 patients who were referred to our department by their general practitioner for prostate screening. The duration of TRUS procedure and prostate volume and age were evaluated to determine whether the serum PSA levels following TRUS had changed. The total PSA and free PSA levels and f/t PSA ratio did not show any significant rise immediately after DRE and TRUS. The duration of the TRUS procedure did not appear to affect the PSA values. Age and prostate volume were not correlated with the PSA levels. Our findings revealed no significant changes in f/t PSA ratio and serum free and total PSA level, suggesting that serum free and total PSA levels and f/t PSA ratio may be more reliable parameters in the early period after TRUS.

Effect of a dilacerated root on stress distribution to the tooth and supporting tissues

The configuration of the root of a prospective abutment tooth has a significant influence on its potential load-bearing capacity. Dilaceration is an angulation in the root or crown. This abnormality may also affect the stability and longevity of an abutment. Finite element stress analysis was used to investigate the effect of a root dilaceration on stress distribution to the tooth and its supporting structures. A normal and a dilacerated single-rooted tooth under three loads (axial, distooblique, and mesio-oblique) were analyzed and compared. The results indicated that a dilaceration concentrates the stresses in the supporting structures and may be taken into consideration as a risk factor in abutment selection.