[Comparison of human chorionic gonadotropin (Pregnyl 10 000 IU i.m.) versus GnRH agonist (triptorelin 0,2 mg s.c.) for final oocytes maturation in the same egg donors--clinical and embryological characteristics]. / Srovnání lidského choriového gonadotropinu (Pregnyl 10 000 IU i.m.) s GnRH agonistou (triptorelin 0.2 mg s.c.) pro maturaci oocytu u stejných dárkyn vajícek--klinické a embryologické charakteristiky.

OBJECTIVE: To compare clinical and embryological characteristics in donor cycles triggered for final oocytes maturation with Pregnyl 10 000 IU i.m. versus triptorelin 0.2 mg s.c. in the same patients in two sequential stimulation cycles. The aim of the study is to decrease the risk of the development of ovarian hyperstimulation syndrome (OHSS) at high response donors by the replacement of Pregnyl 10 000 IU i.m. vs. triptorelin 0.2 mg s.c. The administration of a single dose of gonadotropin-releasing hormone agonist (triptorelin 0.2 mg s.c.) induces release of LH from the pituitary gland similarly to a spontaneous LH surge. SUBJECT: Prospective cross-over trial. SETTING: Sanatorium Pronatal, Praha. SUBJECT AND METHOD: From August 2009 to July 2010 we analysed 24 stimulation cycles in 12 egg donors treated with GnRH antagonist protocol with recombinant FSH (follitropin beta). We identified patients with more than 15 follicles during examination by transvaginal ultrasound. When at least 3 leading follicles reached 17 mm in diameter we administrated Pregnyl 10 000 IU i.m. for final oocytes maturation and triptorelin 0.2 mg s.c in the subsequent treatment cycle. RESULTS: The primary outcome measure was number of oocytes, proportion mature oocytes and fertilized oocytes. The secondary outcome were duration of FSH stimulation, total dose of gonadotropins and mean daily dose of gonadotropins. Data was analysed by paired t-test. We retrieved 17.2 +/- 8.6 vs. 15.8 +/- 5.3 (ns) oocytes, 12.6 +/- 7.3 vs. 13.0 +/- 5.4 (ns) metaphase II oocytes, proportion of metaphase II oocytes (%) was 73 vs. 83 (ns), number of fertilized oocytes 11.5 +/- 6.7 vs. 11.7 +/- 4.5 (ns), fertilization rate (%) 91 vs. 90 (ns) in Pregnyl's vs. triptorelin's group, resp. Duration of FSH stimulation (days) 12.2 +/- 0.8 vs. 12.4 +/- 0.7 (ns), total dose of gonadotropins (IU) 1744 +/- 277 vs. 1740 +/- 276 (ns), mean daily dose of gonadotropins (IU) 238 +/- 43 vs. 221 +/- 36 (ns), were not statistically different in both groups. CONCLUSIONS: Number of mature oocytes and subsequent embryonic cleavage is comparable to standard hCG treatment. There are no differences in clinical and embryological characteristics in both groups. Only one patient with administration of Pregnyl 10 000 IU i.m. was treated for OHSS grade II by vaginal paracentesis. Administration of triptorelin 0.2 mg s.c. is a safe and effective approach to achieve mature oocytes in egg donation programme, where we do not take care of implantation, which has got some limitations based on several studies.

[The diagnostic value of hysterosalpingography in the diagnosis of tubal disease]. / Význam hysterosalpingografie v prukazu tubárního faktoru neplodnosti.

OBJECTIVE: To present an overview of trials and discussion focused on the diagnostic value of hysterosalpingography in the diagnosis of tubal disease. SUBJECT: Review article. SETTING: Sanatorium Pronatal, Prague. CONCLUSIONS: Hysterosalpingography may be a screening test for tubal patency. Data demonstrates high specificity of hysterosalpingography for diagnosis of proximal tubal occlusion or hydrosalpinx and low sensitivity in cases with peritubal adhesions. Routine use of diagnostic laparoscopy should be delayed for asymptomatic women. It is expected hysteroscopy and transvaginal hydrolaparoscopy for asymptomatic women may decrease indications for diagnostic laparoscopy with complete visualization of the pelvic cavity.

Stress-induced rise in endothelaemia, von Willebrand factor and hypothalamic-pituitary-adrenocortical axis activation is reduced by pretreatment with pentoxifylline.

Stress is considered to be a risk factor of several diseases. The following hypotheses were tested: (1) single exposure to an intensive stressor is followed by endothelial stimulation and/or damage to endothelial cells, (2) potential stress-induced endothelial cell damage is reduced by repeated pretreatment with pentoxifylline and (3) pentoxifylline treatment modifies neuroendocrine activation during stress reflected by changes in hypothalamic-pituitary-adrenocortical (HPA) axis function. Rats were treated with saline or pentoxifylline (20 mg/kg, s.c.) once daily for 7 days and then exposed to single immobilization stress for 20 or 120 min. In saline pretreated rats, stress exposure was followed by a rise in endothelaemia, von Willebrand factor concentrations, adrenocorticotropic hormone (ACTH) and corticosterone release, as well as by enhanced gene expression of hypothalamic corticotropin releasing factor (CRH). Stress-induced changes were reduced by pretreatment with pentoxifylline. Significant inhibition was observed in endothelaemia, plasma ACTH and corticosterone concentration in the adrenals. Thus, signs of endothelial injury as well as stress-induced hormone levels were reduced by pretreatment with pentoxifylline, although there is no evidence for a causal relationship. This protective action of pentoxifylline might be of benefit in the prevention and therapy of some stress-related disorders.

Evaluation of endothelium-protective effects of drugs in experimental models of endothelial damage.

Endothelium-protective properties of pharmacological agents may be assessed by using different experimental models of endothelial dysfunction or injury. The model of endothelial dysfunction induced by vessel perfusion with polymorphonuclear leukocytes (PMN) was used for evaluation of pentoxifylline (PTX) effects on vasoconstrictor responses to noradrenaline (NA) in the rabbit renal artery. Addition of PMN into the perfusion solution significantly increased the responses to NA at all doses. PTX administration (10(-5) mol x l(-1)) significantly diminished the constrictor responses to NA in vessels perfused with PMN+PTX when compared to the responses in PMN-perfused vessels (at dose 0.1 microg: 32.25 vs. 14.25, at dose 1 microg: 51 vs. 27.75 (p<0.01), at dose 10 microg 74.25 vs. 39.75 (p<0.05), all values expressed as median of perfusion pressure in mm Hg). The model of endothelial damage induced by repeated NA administration in 5 doses (10-50 microg of NA) was used for evaluation of the endothelium-protective effect of sulodexide (SLX). It was found that SLX (120 U/l) significantly decreased the number of desquamated endothelial cells (EC) compared to the control group (controls: 131.4+/-20.1 EC, +SLX: 83.3+/-13.8 EC, p<0.01). These results confirmed the favorable endothelium-protective effects of pentoxifylline and sulodexide in the two experimental models.

[Climate therapy of uveitis in a mountain environment]. / Klimatoterapia uveitíd vo vysokohorskom prostredí.

Climatotherapy as part of treatment of intraocular inflammatory diseases has a worldwide renaissance due to recent research. The stimulating climate in high mountains leads to induction of defence mechanisms in the organism. In these mechanisms participates in particular the neurovegetative, cardiovascular, thermoregulating and immune system. An important effect of climatotherapy is marked vascularization of tissues and increased ACTH and glucocorticoid secretion, and this along with the immunosuppressive action of light during heliotherapy leads to physiological immunosuppression. This fact is significant in particular in the treatment of uveitis and raises hope of reduced doses of corticoids and immunosuppressive drugs which reduces the risk of undesirable side-effects of this treatment. The results of climatotherapy is in many instances a reduced number of relapses of inflammatory diseases, shortening of the period of the acute attack and a milder course of the attack.

[Ophthalmic complications in general corticoid therapy]. / Ocné komplikácie celkovej kortikoterapie.

The authors investigated in a group of 850 patients the influence of long-term general corticotherapy on the transparency of the lens and intraocular pressure in relation to the length of therapy, dosage, age and sex of the patient. The presence of posterior subcapsular cataract was revealed in 5.2% of the patient, a raised intraocular pressure in 12.8%. The authors reached the conclusion that the duration of corticotherapy did not influence in a substantial way the development of posterior subcapsular cataract nor of cortisone glaucoma. A dose of 10-15 mg per day may be considered marginal for the development of cataract; dosage has no basic effect on the development of glaucoma. The maximum incidence of complications was in advanced age groups. No predisposition as regards sex was observed. A significant role in the development of cortisone cataract and cortisone glaucoma is played by individual sensitivity to corticoids.

[Intermediate uveitis]. / K problematike intermediárnej uveitídy.

In a group of 50 patients with intermediary uveitis (IU) the authors evaluated the clinical finding, diagnosis with which the patients were referred to the institute and considered the problem of corticotherapy. The majority of patients was referred with a vague and inaccurate diagnosis: uveitis chronica (34%) and uveitis posterior (20%). 96% patients were treated by locally applied corticosteroids which are justified only in case of marked participation of the anterior segment of the eye. The development of posterior subcapsular cataract in 20% of the patients is according to the authors associated with overdosage of local corticotherapy. They recommend general and parabulbar corticotherapy only if cystoid oedema of the macula and oedema of the papilla develops, or in case of massive formation of an exudate on the pars plana. In patients with IU corticosteroid treatment should be indicated with great care, as complications may develop which are more serious than the disease.

The influence of 1-month sex hormones administration on the isolated rabbit vessels reactivity.

Hyperestrogenemia and change in the estrogen-androgen level ratio in men are supposed to be possible risk factors for several cardiovascular diseases. To study the male rabbit spiral strip reactivity (aorta, renal artery, femoral artery) after 1-month sex hormone administration (estradiol or testosterone twice per week) the method of isomeric contraction was used. The maximal response to noradrenaline, 5-hydroxytryptamine (5-HT) and angiotensin was evaluated. Using RIA method the estradiol and testosterone levels in serum were examined. The estradiol application caused a significant increase of the estradiol level in serum with decrease of testosterone level. The increase of the maximal aorta response to noradrenaline and renal artery response to 5-TH was simultaneously observed. After the testosterone administration an increase of the testosterone level in serum, but without significant change in estradiol level was found. The inhibitory effect of testosterone on the femoral artery was shown by the decrease of the response to 5-HT and angiotensin.