[A case of tracheal fistula after operation for esophageal cancer]

We have experienced a case of mediastinal abscess and tracheal fistula after operation for esophageal cancer and successfully closed by using intercostal muscle pedicle flap. A 61-year-old male underwent esophagectomy for advanced esophageal cancer. On the 12th postoperative day, mediastinal abscess caused by leakage was detected, and drainage of the mediastinal and thoracic cavity was performed. On the 29th postoperative day, tracheal fistula was detected, and operation was performed in order to close the fistula by using of intercostal muscle pedicle flap. His postoperative course was fair and general condition was improvement, esophageal reconstruction using of free jejunal graft was performed and oral ingestion was started.

Localization of a locus responsible for the bovine chondrodysplastic dwarfism (bcd) on chromosome 6

A hereditary chondrodysplastic dwarfism caused by an autosomal recessive gene has been reported in a population of Japanese Brown cattle. Affected calves show an insufficiency of endochondral ossification at the long bones of the limbs. In the present study, we mapped the locus responsible for the disease (bcd) by linkage analysis, using microsatellite markers and a single paternal half-sib pedigree obtained from commercial herds. Linkage analysis revealed a significant linkage between the bcd locus and marker loci on the distal region of bovine Chromosome (Chr) 6. The bcd locus was mapped in the interval between microsatellite markers BM9257 and BP7 or BMS511 with a recombination fraction of 0.05 and 0.06, and a lod score of 8.6 and 10.1, respectively. A comparison of genetic maps between bovine Chr 6 and human Chr 4 or mouse Chr 5 indicates possible candidate genes including FGFR3 and BMP3 genes, which are responsible for human chondrodysplasias and associated with bone morphogenesis, respectively.

[Surgical management of chest wall tumors]

Twenty-four patients with chest wall tumors underwent resection during the past twenty years. There were 12 female and 12 male patients with ages ranging from 7 months to 78 years (mean 44 years). Five patients had primary malignant neoplasms, 7 had metastases, and 12 had benign tumors. The tumor was located in the soft tissue in 14 patients and in the ribs and the sternum in 10. Ninety-two percent of tumors were diagnosed correctly if they were benign or malignant before resection, however the final diagnosis was made in only 25% of benign tumors and 54% of malignant tumors before surgery. Thirty-one operations were performed in 24 patients and 10 reconstruction with prosthetic materials were done. Concerning malignant neoplasms patients with primary tumors had better prognosis than those with metastases and patients underwent reconstruction had better prognosis than those underwent resection only. We conclude that wide resection with reconstruction is potentially curative treatment.

Treatment for accidental occlusion of the hepatic artery after hepatic resection: report of two cases

Two patients in whom accidental hepatic artery occlusion (HAO) occurred after hepatic resection (Hx) were reported. A 59-year-old female who underwent Hx for hepatocellular carcinoma with underlying liver cirrhosis developed HAO on postoperative day (POD) 14 and died of hepatic failure on POD 23. The autopsy findings showed multiple necrosis in the remnant liver and an extraluminal hematoma of the hepatic artery, suggesting an injury caused by Pringle's maneuver. The second case was a 53-year-old male who underwent Hx for cholangiocarcinoma without any underlying liver disease. He developed HAO on POD 6, and radiological studies indicated a pseudoaneurysma formation and severe stenosis of the hepatic artery. It was speculated that the cause of the HAO was intraluminal injury of the hepatic artery during an angiographic study conducted prior to Hx. Partial arterialization of the portal vein was performed, following which his liver function test results improved. In both cases, measuring the serum hepatocyte growth factor level and the hepatic vein oxygen saturation proved useful, not only for determining the degree of liver injury, but also for predicting the outcome after treatments for HAO. Furthermore, the partial arterialization of the portal vein for HAO after Hx may rescue the normal remnant liver.

Vascular endothelial growth factor inhibits apoptotic death in hematopoietic cells after exposure to chemotherapeutic drugs by inducing MCL1 acting as an antiapoptotic factor

We reported previously that vascular endothelial growth factor (VEGF) inhibits the apoptotic death of hematopoietic cells that is induced by exposure to ionizing radiation (O. Katoh et al., Cancer Res., 55: 5687-5692, 1995). In this study, we show that VEGF also inhibits apoptotic cell death that is induced by exposure to the chemotherapeutic drugs etoposide and doxorubicin. To elucidate the molecular mechanisms underlying this inhibitory effect of VEGF, we examined expression levels of BCL2 family proteins in CMK86, a human leukemia cell line, after treatment with VEGF. Northern blotting and immunoblotting analyses revealed that the expression level of MCL1, a member of the BCL2 family, was increased by VEGF. Moreover, to examine the effects of MCL1 on apoptotic cell death induced by exposure to etoposide, we generated a clonal U937 myeloid leukemia cell line transfected with vectors that promoted the constitutive expression of MCL1. MCL1 decreased the caspase 3 activity induced by exposure to etoposide and increased the viability of the transfected cells after etoposide exposure. Therefore, MCL1 may be involved in the inhibitory effect of VEGF on apoptotic cell death.

The Krüppel-type zinc finger family gene, HKR1, is induced in lung cancer by exposure to platinum drugs

To investigate the molecular mechanism associated with the signaling pathway of platinum drug administration, we focused on the C2H2-type zinc finger (ZNF) transcription factor gene family. Here we show cloning of a Krüppel-type ZNF gene, HKR1, which contains Krüppel-associated box (KRAB) domain and ZNF motifs. We found that mRNA expression of the HKR1 gene was induced in lung-cancer cell lines by exposure to cisplatin using Northern blot analysis. Moreover, we also found that HKR1 mRNA expression levels in lung cancers were higher than those in normal lung tissues, and that high expression levels in lung cancers were associated with antemortem platinum drug administration. These results suggest that HKR1 may be associated with the regulation of a signaling pathway involved in the progression of lung cancer or the acquisition of resistance to platinum drugs.

Induction of ovarian tumors by heavy ion irradiation in B6C3F1 mice

Six-week-old B6C3F1 mice were exposed to 0.439 Gy heavy ion irradiation as a 290 MeV/u carbon-ion beam (LET 10 keV/micron) at 2 cm from the upper proximal point of a spread Bragg beam and autopsied 13.5 months after the irradiation. In males total tumor incidences, mainly liver tumors, were 37.0% in irradiated group and 25.0% in control (P>0.05). In females the total tumor incidences were 32.3%, mainly ovarian tumors, in the irradiated group and 0% in the controls. These results indicate that heavy ion irradiation induces ovarian tumors in females but does not target any organ in males.

No susceptibility of colon tissue implanted into the glandular stomach of rats to N-nitroso-N-methylurea carcinogenesis

The present study was undertaken to determine the response of colonic mucosa implanted into the stomach fundus in 6-week-old male F344 rats to oral administration of N-nitroso-N-methylurea (MNU). In graft + MNU, 15% animals had tumors in the implanted colon tissue whereas a 26% incidence of gastric tumors was observed for the pyloric mucosa. In MNU alone, 30% of rats demonstrated gastric tumors. In graft alone 10% of tumors were observed in the grafted site but none in the pylorus. Thus while graft tissue may intrinsically have an elevated risk of tumor development, no susceptibility to MNU was observed in the present study.

Effects of isoflurane on receptor-operated Ca2+ channels in rat aortic smooth muscle

We have investigated the effects of isoflurane on receptor-operated Ca2+ channels (ROC) in vascular smooth muscle. In isolated rat thoracic aortic rings denuded of endothelium, the effects of isoflurane on phenylephrine-induced contraction and Ca2+ influx were evaluated in the presence of supramaximal doses of nifedipine or verapamil. Under isometric tension recording, the aortic rings were precontracted by phenylephrine 300 nmol litre-1 and exposed to 1.2%, 2.3% or 3.5% isoflurane. Phenylephrine-induced precontraction was enhanced with 2.3% isoflurane by mean 8.1 (SD 9.3)% (P < 0.05 vs 0% isoflurane). The constrictor effect of 2.3% isoflurane was not inhibited by depletion of intracellular Ca2+ stores with ryanodine 20 mumol litre-1, but was abolished in a Ca(2+)-free solution or by SK&F 96,365 30 mumol litre-1, an ROC blocker. Isoflurane-induced contraction was accompanied by increased intracellular free Ca2+ concentration, monitored using fura PE3. Unidirectional 45Ca2+ influx measurement in phenylephrine-stimulated aortic strips revealed that the mean amount of Ca2+ influx was significantly (P < 0.05) enhanced by 1.2% and 2.3% isoflurane, which were 117.1% and 119.7% of control values, respectively. Our results strongly suggest that isoflurane enhanced Ca2+ influx through ROC that had been submaximally activated by phenylephrine.

Thiopental attenuates relaxation and cyclic GMP production in vascular smooth muscle of endotoxin-treated rat aorta, independent of nitric oxide production

As thiopental (thiopentone) suppresses cyclic GMP (cGMP) formation produced by nitric oxide donor drugs, we have tested if it suppresses cGMP formation and increases vascular tone after induction of calcium-calmodulin-independent nitric oxide synthase (iNOS). Rat aortic rings were treated with Escherichia coli lipopolysaccharide (LPS) 1 microgram ml-1 for 4 h, and the effects of thiopental on tension, cGMP concentrations and nitrite accumulation were determined. Thiopental 0.3 mmol litre-1 reduced the tension of phenylephrine-precontracted aortic rings before LPS treatment, but caused no significant effects on tension in the presence of L-arginine 10 mumol litre-1 after LPS treatment. L-Arginine 1 mumol litre-1 to 1 mmol litre-1 increased concentrations of cGMP in LPS-treated aorta in a concentration-dependent manner. This was reduced by thiopental 0.3-1 mmol litre-1. Treatment with L-arginine 1 mmol litre-1 increased concentrations of nitrite, the end product of nitric oxide; this was not affected by thiopental 1 mmol litre-1. We conclude that thiopental suppressed cGMP formation in iNOS-induced vascular smooth muscle without affecting nitric oxide production.

[Decongesting effect of tramazoline on nasal airway patency and nasal symptoms as evaluated by acoustic rhinometry: an objective study in 30 allergic and six non-allergic subjects]

In this prospective clinical study, we investigated the effect of the nasal decongestant tramazoline on nasal airway patency in 30 subjects with perennial nasal allergy to housedust mites and in six non-allergic volunteers who served as controls. The allergic subjects were further subdivided into groups, the severe group and the moderate group, according to the level of specific IgE. We used acoustic rhinometry as an objective method, and the nasal cavity volume (NCV) and the minimum cross-sectional area (MCA) were measured before and 10 minutes after nasal spraying. Before mucosal decongestion, the average NCV in the severe group was 5.94 cm3, which was significantly lower than those in the other two groups: 7 cm3 in the control group and 8.13 cm3 in the moderate group, respectively (P = 0.02). A more significant difference was found when the first 3-cm area of the NCV was evaluated (P = 0.009). Pharmacologic decongestion caused an increase in nasal patency by 54% from the baseline NCV values in the control group, 38% in the moderate group and 48% in the severe group. There was no significant difference among the three groups. Changes in nasal symptoms were also determined by questionnaire. The degree of improvement in subjective nasal congestion was more pronounced in the allergic groups than in the control group.

Effects of azoxymethane on X-ray induced intestinal metaplasia in Donryu rats

The present study was undertaken to determine the effect of azoxymethane (AOM) administration on intestinal metaplasia induced by X-irradiation in male Donryu rats. Five-week-old animals were X-irradiated with two doses of 10 Gy each at a 3-day interval or three X-ray doses of 10 Gy at a 2-day interval and then received AOM injections i.m. at a dose of 15 mg/kg body weight once weekly for 3 weeks, 6 months after irradiation. Alkaline phosphatase positive foci were decreased after AOM treatments, but aberrant crypt like-foci appeared within areas of intestinal metaplasia. In contrast no induction was observed in normal-appearing gastric mucosa.

Sequential changes in cardiac structure and function in patients with Duchenne type muscular dystrophy: a two-dimensional echocardiographic study

BACKGROUND

Most patients with progressive muscular dystrophy of the Duchenne type (DMD) die of respiratory failure at approximately 20 years of age. However, some patients with DMD die of heart failure in relatively short periods of time. We investigated the long-term progression of cardiac impairment in patients with DMD by two-dimensional echocardiography.

METHODS

We monitored 74 patients for 4 years with two-dimensional echocardiography. Patients were classified into four groups according to the 8-grade Swinyard-Dever system. We also evaluated the echocardiographic features of 22 other patients with DMD with studies performed within 1 year before their deaths.

RESULTS

During the 4-year follow-up the left ventricle expanded, and regional left ventricular wall motion abnormalities developed in the posterior wall and apex. Almost all patients had myocardial dysfunction that progressed in parallel with their Swinyard-Dever stage. However, in a few patients who died of congestive heart failure, left ventricular dilation and circumferential left ventricular wall motion were severely impaired.

CONCLUSIONS

Myocardial impairment is accelerated in patients with DMD who died of heart failure. Two-dimensional echocardiography is a useful tool for the early diagnosis of left ventricular dysfunction and provides useful information for the treatment of patients with DMD.

[Epidemiological study of allergic rhinitis in different districts]

We investigated the morbidity of allergic rhinitis in downtown, rural area and fishing village by questionnaire in October, 1996. The morbidity rate of allergic rhinitis was 35.7% (370 subjects out of 1036) in downtown, 27.5% (266 out of 966) in rural area and 12.9% (273 out of 2112) in fishing village, and that of adult was 36.2% (314 out of 868) downtown, 28.9% (137 out of 474) in rural area and 12.07% (199 out of 1649) in fishing village, and that of child was 33.3% (56 out of 168) in downtown, 26.22% (129 out of 492) in rural area and 15.98% (74 out of 463) in fishing village. The morbidity of Japanese cedar pollinosis was 17.37% (180 out of 1036) in downtown, 13.77% (133 out of 966) in rural area and 2.60% (55 out of 2112) in fishing village. There was statistical difference (p < 0.001) between the each district respectively. It was proved that the morbidity of allergic rhinitis in downtown was higher than the rural area or fishing village, and that in fishing village was the lowest in these districts.

The multiple untranslated first exons and promoters system of the oestrogen receptor gene in the brain and peripheral tissues of the rat and monkey and the developing rat cerebral cortex

Recent studies on the human oestrogen receptor (ER) gene have revealed the complex system with the multiple untranslated first exons and promoters in the ER gene expression. Little information is however available on the system in the ER gene of the rat or nonhuman primate. The rat genomic library was first screened by the rat ER cDNA (0-1) probe. One of the four positive clones (lambda rEgE1) was subcloned and sequenced. The nucleotide sequence was found to contain the exon 0, the intron 0, and the exon 1 with its 3'-ends. The novel untranslated first exons, the exon ON and the exon OS, were further identified. These results indicated the presence of at least four subtypes of the rat ER mRNAs; the messages transcribed from promoter P-0 (ER mRNA (0-1)), putative promoter P-1 (ER mRNA (1-1)), promoter P-ON (ER mRNA (ON-1)) and promoter P-OS (ER mRNA (OS-1)). The P-O- or P-1 driven message (0-1) or (1-1) appeared to be expressed most strongly in major oestrogen central- (anterior pituitary, AP, hypothalamus-preoptic area, HPOA, and amygdala, AMG) and peripheral targets (uterus and ovary). The message (ON-1) was strongly expressed in the liver and kidney, but not in the HPOA, AMG, cerebral cortex, CC, and cerebellum, Ce. The OS-1 message was expressed variably but generally in the tissues examined except for the CC and Ce. Thus, the region- and tissue specific expression of the rat ER gene is likely to be regulated by the multiple untranslated exons and promoters system. Furthermore, when the ER mRNA subtypes were examined in the rat neonatal CC where the ER protein level rose transiently, considered as a model for the development of the ER or progestin receptor A and B isoforms, the expression of the ER mRNAs seemed to be differential postnatally, implicating some stage dependent usage of the promoters in the development. In the monkey, we identified the untranslated first exon OS, the homologue of the rat exon OS. Interestingly, the exon C was found to consist of two different exons, the exon OK and the exon OG. By the alternative usage of the promoters and the alternative splicing, at least six ER mRNA subtypes, that is, ER mRNAs (0-1), (1-1), (OS-1), (OS-OG-1), (OK-1) and (OK-OG-1) were identified in the monkey tissues. These messages were also differentially distributed in the monkey brain and other tissues. It was noteworthy that the P-OK driven messages were expressed almost exclusively in the monkey liver. These results have suggested that the systems of the multiple untranslated first exons and promoters and the alternative splicing are involved in the regulation of the region- and tissue specific expression of the ER gene in the brain and peripheral tissues of the rat and monkey. Stage-related usage of the promoters was also suggested in the ER gene expression in the CC of the postnatal rat in development.

Difference in incidence and transmission mode of methicillin-resistant Staphylococcus aureus among surgery, orthopedics, and pediatrics wards: a prospective study at a university hospital

The incidence and circumstances of colonization by methicillin-resistant Staphylococcus aureus were prospectively investigated. Among 404 patients, 15 (3.7%) were carriers on admission, and 43 (10.6%) became colonized, mainly after surgical operation. A different mode of transmission was suggested in each ward.

Physical compatibility and chemical stability of atracurium besylate and midazolam hydrochloride during intravenous coinfusion

The objective of this study was to evaluate the physical stability and chemical compatibility of midazolam hydrochloride and atracurium besylate for intravenous coadministration at concentrations normally encountered in clinical practice. Commercially available midazolam hydrochloride injection (Versed) and atracurium besylate injection (Tracrium, Glaxo Wellcome) were used to prepare four different drug combinations in 5% dextrose injection. The final concentration of midazolam (as the hydrochloride salt) and of atracurium (as the besylate salt) was 0.1 or 0.5 mg/mL and or 5 mg/mL, respectively. The chemical stability of midazolam and atracurium in combination was evaluated using a stability-indicating high-performance liquid chromatography assay, capable of simultaneous analysis of both compounds, developed in our laboratory Midazolam was detected using an ultraviolet detector and atracurium with a fluorescence detector. The analysis was done at room temperature under fluorescent lighting. All solutions were evaluated for physical stability by inspecting visually under normal fluorescent laboratory lighting for precipitate (against a black background) or gas formation and color change immediately following the admixture and then at one, two and three hours. The pH of these solutions was also measured at each time interval. Under the study conditions all test solutions retained greater than 90% of the initial concentration after three hours. There was no visible evidence of precipitation, color change, or gas formation in the test solution at any time following admixture; and the pH of the solutions was also unchanged during the three-hour study period. Midazolam hydrochloride and atracurium besylate are physicallly stable and chemically compatible for up to three hours at room temperature under normal fluorescent lighting at the concentrations used in this study and may be coinfused at a y-site without loss ofpotecncy.

[Intraoperative coronary artery spasm treated by percutaneous cardiopulmonary support in a patient with left lung cancer]

A 53-year-old man with left lung cancer underwent left upper lobectomy and extended mediastinal lymphadenectomy. Shortly before the end of the operation, electrocardiogram showed elevation of ST wave and multiple ventricular premature contractures first, then ventricular fibrillations, and finally cardiac arrest. Coronary artery spasm was strongly suspected. The patient was resuscitated by cardiac massage and countershock immediately, however, such attacks repeated several times. As medication and cardiac pacing were not effective, percutaneous cardiopulmonary support (PCPS) was established. The hemodynamics was stabilized with PCPS. He was weaned off PCPS the next day. He was discharged and has had no attack so far. PCPS is an excellent modality for intraoperative coronary spasm which is uncontrollable by medicines and other methods.

[The meaning of eat in home patients with end-stage cancer]

When a patient difficult to eat, he will not be only malnutrition, but loses a volition of his life and falls into depression. This time, we present a patient with relapse advanced pharynx cancer, who could not ingestion. Therefore she had said "DEATH". She tried eagerly rehabilitation of ingestion, swallowing and breathing, and she was able to eat again and could be positive posture. Ingestion is very important for human, and the patient found a meaning of her life and she was able to take home care nursing.

Mirizzi syndrome caused by xanthogranulomatous cholecystitis: report of a case

Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder. In severe cases, inflammation extends to adjacent structures, and XGC is sometimes confused with a malignant neoplasm. We recently diagnosed XGC as the preoperative cause of Mirizzi syndrome in a patient based on the clinical course. The patient was admitted because of obstructive jaundice, with gallbladder carcinoma as the suspected cause. The gallbladder was swollen with gallstones and the serum level of carbohydrate antigen 19-9 (CA19-9) was 3070 U/ml at admission. A percutaneous transhepatic cholangiodrainage (PTCD) was done, and the common hepatic duct as well as the right and left hepatic ducts were found to be obstructed. Later, the CA19-9 level and swelling of the gallbladder decreased and the obstruction of the bile ducts disappeared. A cholecystectomy was performed and the intraoperative pathohistological diagnosis of chronic cholecystitis was made from frozen sections. The pathohistological diagnosis of XGC was made from paraffin-embedded sections. Mirizzi syndrome such as that seen in our patient is a rare complication of XGC. XGC occasionally causes extensive inflammation; thus, performing a conventional cholecystectomy can be unsafe. However, in our opinion, a total, not subtotal, cholecystectomy should be done whenever possible because the incidence of gallbladder carcinoma accompanied with XGC is higher than that with ordinary cholecystitis or gallstones.

[A study on low grade malignant tumors arisen in the trachea and the bronchus]

Twelve patients who suffered from low grade malignant tumors arisen in the trachea and the bronchus (6 of carcinoid, 4 of mucoepidermoid carcinoma, and 2 of adenoid cystic carcinoma) underwent surgical treatment from 1977 to 1996 in our department. Operations included 1 sleeve resection of the trachea, 1 patch plasty of the trachea, 3 sleeve lobectomies, and 7 lobectomies. Lymph node dissection was performed in 9 of 12 cases. Metastases in lymph nodes were not found in all 12 cases. Five year survival rate of low grade malignant tumors arisen in the trachea and the bronchus was 78.8% and better than that of stage I lung cancers.

Prognostic value of Doppler transmitral flow velocity patterns in acute myocardial infarction

Doppler transmitral flow patterns are partially dependent on age. We investigated the correlations between the age-adjusted transmitral flow patterns, hemodynamic indexes, and the coronary and clinical outcome in 206 patients with acute myocardial infarction (AMI) and 102 normal control subjects. The peak flow velocity at atrial contraction was significantly lower in 50 of the 206 patients (24%) (low-A group) than in the 102 normal controls. Pulmonary capillary wedge pressure was significantly higher in the low-A group than in the remaining 156 patients with AMI (20 +/- 7 vs 11 +/- 5 mm Hg, p <0.001), and the cardiac index and left ventricular ejection fraction were significantly lower (2.2 +/- 0.6 vs 2.9 +/- 0.7 L/min/m2, p <0.001; 38 +/- 15% vs 52 +/- 13%, p <0.001). The incidence of cardiogenic shock was significantly higher in the low-A group than in the other patients with AMI (42% vs 19%, p <0.001). Regression analysis demonstrated a significant association between decreased atrial filling velocity and increased in-hospital mortality as well as the incidence of heart failure in AMI (p <0.001). The 5-year mortality rate was also significantly higher in the low-A group (p <0.001). The age-adjusted transmitral flow pattern in AMI can identify patients with left ventricular dysfunction, which can lead to a poor prognosis.

Structure of aromatase mRNA in the rat brain

In order to elucidate the mechanism of the region-specific expression of rat brain aromatase, we investigated the multiple promoter systems in the brain. Total RNA extracted from the amygdala (AMY) was subjected to a reverse transcription-polymerase chain reaction (RT-PCR) with the primers for mouse brain-specific exon I (exon I-f). The nucleotide sequence of the RT-PCR product had 89.4% homology to the corresponding region of exon I-f of the human aromatase cDNA. It was first demonstrated that aromatase mRNA with exon I-f was expressed in the rat brain. This type message was expressed in the hypothalamus-preoptic area (HPOA) but not in the cerebral cortex (CC). Furthermore, total RNAs from the HPOA, AMY and CC of the rat brain were analysed by RT-PCR with the primers for rat ovarian type message-specific exon II. Significant levels of the products were generated in the HPOA and AMY with no signals in the CC. Cortical aromatase mRNA seemed to be unique in that the tissue had no exon I-f and ovarian type mRNAs. We thus analysed the 5'-region of aromatase mRNA in the rat CC by 5'-rapid amplification of cDNA ends (RACE) with antisense primers for exon V. The upstream sequence from the 5'-end of exon IV of the aromatase RACE clones was completely different from that of the aromatase mRNA which encoded the full-translated region. These results indicated that the aromatase gene in the rat brain contained at least three promoters: hypothalamus type (exon I-f), ovarian type and cortical type, and that the region-specific expression of the brain aromatase seemed to be regulated, at least in part, by differential promoter usage.

Effect of oocyte retrieval from a small leading follicle in fixed-schedule in vitro fertilization program

OBJECTIVE

To evaluate the propriety of oocyte retrieval (OR) form a small leading follicle during a fixed-schedule in vitro fertilization (IVF) program.

METHODS

OR was fixed only to take place on Wednesdays. Gonadotropin-releasing hormone agonist treatment was initiated on the first day of the cycle, human menopausal gonadotrophin was given for 7 days starting on the next Monday, and human chorionic gonadotrophin (hCG) was given on the Tuesday before the OR. Patients were divided into 2 groups according to the follicular size observed before the day of hCG administration: Group 1 (141 cycles), with follicles > 16 mm in mean diameter; and Group 2 (38 cycles) with follicles of 10 to 16 mm in mean diameter.

RESULTS

Fertilization rates and the incidence of mature oocytes were higher in Group 1 than in Group 2. However, the mean number of oocytes recovered and pregnancy rates were similar in the 2 groups.

CONCLUSION

It is worthwhile to retrieve the oocyte from a small leading follicle in a fixed-schedule IVF program.