Blocking effect of vitamin C in exercise-induced asthma.

OBJECTIVE: To determine if vitamin C (ascorbic acid) has a protective effect on the hyperreactive airways of patients with exercise-induced asthma (EIA). DESIGN: All the patients underwent pulmonary function tests at rest, before and 1 hour after receiving 2 g of oral ascorbic acid. They were then randomly assigned in a double-blind manner to receive 2 g of ascorbic acid or a placebo 1 hour before a 7-minute exercise session on a treadmill. Pulmonary function tests were performed after an 8-minute rest. This procedure was repeated 1 week later, with each patient receiving the alternative medication. SETTING: A university hospital. PARTICIPANTS: Twenty patients with asthma (13 males and 7 females), with ages ranging from 7 to 28 years (mean, 13.8 years). All patients who had a decline of at least 15% in their forced expiratory volume in 1 second after a standard exercise test on a motorized treadmill received a diagnosis of EIA. MAIN-OUTCOME MEASURES: All patients were advised to stop using their regular asthma medication or bronchodilator 12 hours before the test. Pulmonary function tests were performed in the same ambient conditions on all patients. RESULTS: All patients received a diagnosis of EIA. Ascorbic acid administration did not change the results of pulmonary functions at rest after 1 hour. In 9 patients, a protective effect on exercise-induced hyperreactive airways was documented. Four of 5 patients who received ascorbic acid and documented a protective effect on EIA continued to receive ascorbic acid, 0.5 g/d, for 2 more weeks with the same protective effect. CONCLUSIONS: The efficacy of vitamin C in preventing EIA cannot be predicted. However, vitamin C may have a protective effect on airway hyperreactivity in some patients with EIA.

Long-term loss of Warren's shunt selectivity. Angiographic demonstration.

Fifteen patients with a patent shunt after distal splenorenal shunt with gastrosplenic disconnection were prospectively studied by angiography three to 36 months after operation. In all patients a collateral circulation from the portomesenteric to the gastrosplenic system was developed through enlarged venous channels. In all patients the portal flow decreased, as suggested by the angiographically assessed degradation of the portal perfusion of the liver and/or the diminution of the diameter of the portal vein. In two patients the portal vein was thrombotic. We conclude that three months after operation distal splenorenal shunt with gastrosplenic disconnection is not hemodynamically different than portacaval laterolateral shunt.

Poor outcome with round spermatid injection in azoospermic patients with maturation arrest.

OBJECTIVE: To compare the outcome of intracytoplasmic sperm injection (ICSI) and round spermatid injection (ROSI), both obtained by testicular sperm extraction (TESE), and to compare the results of fresh versus frozen ROSI. DESIGN: Retrospective study. SETTING: An IVF unit at a university hospitalPatient(s): Eighteen infertile couples with nonobstructive azoospermia. INTERVENTION(S): TESE with ROSI or ICSI of mature spermatozoa into metaphase II oocytes was performed. The resulting embryos were transferred to female partners. The spare round spermatids were frozen. MAIN OUTCOME MEASURE(S): Fertilization and cleavage rates, embryo quality, and clinical pregnancy rates. RESULT(S): Seventeen ROSI cycles and six ICSI cycles were compared. Fertilization rate following ROSI (44.9%) was significantly lower than with ICSI (69%). A significantly higher rate of cleavage arrest occurred following ROSI (40.8%) as compared to ICSI (8.2%). The morphology of embryos resulting from ROSI was significantly poorer. No pregnancies were achieved following ROSI as compared to a 50% clinical pregnancy rate in the ICSI group. The fertilization and cleavage rates following ROSI with fresh versus frozen-thawed spermatids were comparable. CONCLUSION(S): In azoospermic patients with maturation arrest at the stage of round spermatids the efficiency of ROSI appears to be extremely poor. The role of ROSI in the treatment of nonobstructive azoospermia should be reevaluated.

Zygote intrafallopian transfer in patients with tubal factor infertility after repeated failure of implantation with in vitro fertilization-embryo transfer.

OBJECTIVE: To evaluate the efficacy of zygote intrafallopian transfer (ZIFT) in terms of implantation and pregnancy rates in patients with tubal factor infertility and repeated implantation failure in IVF-ET cycles. DESIGN: Retrospective analysis of ZIFT cycles. SETTING: An IVF unit in a university hospital. PATIENT(S): Criteria for patient selection for ZIFT included at least four failures of implantation in IVF-ET cycles in which at least 3 embryos were replaced per transfer and a cause of infertility diagnosed as male, unexplained, or tubal factor with proof of one patient tube. INTERVENTION(S): Four to six zygotes were transferred by laparoscopy into the fallopian tube 24-26 hours after oocyte retrieval. MAIN OUTCOME MEASURE(S): Implantation and pregnancy rates were determined in 112 ZIFT cycles performed in 81 patients with repeated failure of implantation. Results were further stratified for patients with tubal factor (n = 15) and patients without tubal factor (n = 66). RESULT(S): The pregnancy and implantation rates for all ZIFT cycles were 35.1% and 11.1%, respectively. Pregnancy and implantation rates per cycle in patients with tubal factor versus patients without tubal factor were 26.6% versus 37.1% and 9.4% versus 11.4%, respectively. CONCLUSION(S): ZIFT can be considered as a mode of treatment for patients with repeated failure of implantation in IVF-ET and with tubal factor with proved patency of one tube.

Incubation with sperm enhances in vitro maturation of the oocyte from the germinal vesicle to the M2 stage.

OBJECTIVE: To evaluate the effect of sperm in the culture medium on the rate of oocyte maturation in vitro from the germinal vesicle to the M2 stage. DESIGN: Prospective randomized controlled study. SETTING: The IVF Unit, Wolfson Medical Center, Holon, Israel. PATIENT(S): All women in whom oocytes were retrieved at the germinal vesicle stage between December 1995 and March 1996. INTERVENTION(S): Oocytes retrieved at the germinal vesicle stage were divided prospectively and randomly into four groups of incubation conditions: group 1, intact germinal vesicle with cumulus; group 2, intact germinal vesicle with sperm cells in the culture medium; group 3, stripped germinal vesicle; and group 4, stripped germinal vesicle with sperm cells. Oocytes were observed 24 hours after retrieval, and the stage of maturation was recorded. Oocytes that reached the M2 stage underwent the intracytoplasmic injection procedure, and the fertilization rate in each group was recorded at 48 hours. MAIN OUTCOME MEASURE(S): Maturation rate from the germinal vesicle to M2 stage and fertilization rate. RESULT(S): Each group contained 20 germinal vesicle oocytes. In groups 1 and 2, 2 (10%) and 9 (45%) oocytes, respectively, reached the M2 stage at 24 hours; at 48 hours, 1 (5%) and 8 (40%) embryos developed, respectively. The results in group 2 were significantly higher than in group 1. In groups 3 and 4, 6 (30%) and 16 (80%) oocytes, respectively, reached the M2 stage at 24 hours; at 48 hours, 5 (25%) and 14 (70%) embryos developed, respectively. Results in group 4 were significantly higher than those in groups 1, 2, and 3. CONCLUSION(S): Both methods of oocyte activation (i.e., addition of sperm to the culture medium or removal of the cumulus) enhance oocyte maturation in vitro, but the sperm-incubation method has a more pronounced effect. A combination of both methods leads to an exceptionally high rate of oocyte maturation, followed by a high fertilization rate.

Birth of a triplet after transfer of four frozen-thawed embryos.

This is apparently the first triplet pregnancy after four freeze-thawed embryos that terminated in a birth of three healthy infants, with relatively good birth weights and uneventful follow-up.

Estradiol supplementation during the luteal phase may improve the pregnancy rate in patients undergoing in vitro fertilization-embryo transfer cycles.

OBJECTIVE: To evaluate the effect of adding E(2) to progestin supplementation during the luteal phase on pregnancy and implantation rates in patients undergoing IVF cycles. DESIGN: Prospective, randomized study. SETTING: An IVF unit in a university hospital. PATIENT(S): Patients who were undergoing IVF with controlled ovarian hyperstimulation using a GnRH analog and who had E(2)2,500 pg/dL at the time of hCG administration. INTERVENTION(S): Serum concentrations of E(2) and progesterone were measured in all patients on days 7, 10, and 12 after ET. MAIN OUTCOME MEASURE(S): The E(2) and progesterone profiles of the luteal phase and the pregnancy and implantation rates were documented. Data were analyzed for the entire study population and further stratified according to the GnRH analog protocol used (short or long). RESULT(S): Significantly higher E(2) levels were found during the luteal phase in the group that received E(2) supplementation. This effect was more pronounced in the patients who were treated with the long GnRH analog protocol. Significantly higher pregnancy and implantation rates were recorded in the patients who received E(2) supplementation and were treated with the long GnRH analog protocol. CONCLUSION(S): For patients who are treated with the long GnRH analog protocol for controlled ovarian hyperstimulation and for whom luteal support with hCG is contraindicated, the addition of E(2) to the progestin support regimen may have a beneficial effect on pregnancy and implantation rates.

Follicle cysts after menstrual versus midluteal administration of gonadotropin-releasing hormone analog in in vitro fertilization.

The incidence and behavior of follicle cysts after different timing of gonadotropin-releasing hormone analog (GnRH-a) administration was studied in 321 in vitro fertilization (IVF) cycles. Group M included 198 cycles in which GnRH-a was injected at menstruation. Of these, 171 (88.6%) were without cysts (group M1) and 27 (13.6%) with cysts (group M2). Group L comprised of 123 cycles in which GnRH-a was administered in the midluteal phase. Of them, 70 (56.9%) were without cystic finding (group L1), 19 (15.4%) with follicle cysts (group L2), and 34 cases (27.6%) with visible corpus luteum at the time of GnRH-a initiation (group L3). Both groups with follicle cysts demonstrated a higher luteinizing hormone peak and continuous elevated estradiol (E2) levels. In group M2, the E2 rise and the cysts persisted longer compared with group L2. Gonadotropin treatment was accordingly postponed until the cysts regressed spontaneously. Only two cases of group M2 required aspiration of the cysts. Follicle cyst formation is not related to the timing of GnRH-a administration and their occurrence did not have adverse effects on IVF outcome.

Timing of testicular sperm retrieval procedures and in vitro fertilization-intracytoplasmic sperm injection outcome.

OBJECTIVE: To compare the outcome of IVF-intracytoplasmic sperm injection (ICSI) using testicular spermatozoa obtained on the day of ovum pick-up (OPU) or on the day before OPU. DESIGN: Retrospective study. SETTING: An IVF clinic in a university hospital. PATIENT(S): Forty-seven IVF-ICSI cycles using testicular spermatozoa in 28 couples with the male partner suffering from nonobstructive azoospermia. INTERVENTION(S): Sperm retrieval was performed either on the OPU day (23 cycles in 19 patients; group A) or on the day before OPU (24 cycles in 15 patients; group B). Testicular sperm aspiration (TESA) was performed and followed by testicular sperm extraction (TESE) if no spermatozoa could be found. MAIN OUTCOME MEASURE(S): The presence of motile spermatozoa at the time of ICSI and fertilization and clinical pregnancy rates. RESULT(S): A similar proportion of motile spermatozoa (60.9% vs. 62.5%), fertilization rate (61.7% vs. 58.9%), and clinical pregnancy rate per transfer (34.8% and 29.2%) were obtained for groups A and B, respectively. CONCLUSION(S): Testicular sperm retrieval can be performed on the day before OPU without compromising success. Considerable medical and practical advantages may be offered by further advancement of testicular sperm retrieval procedures to 48 hours before OPU. This approach should thus be further evaluated.

Hypertrophic cranial pachymeningitis: assessment with CT and MR imaging.

Three patients with diffuse idiopathic cranial pachymeningitis with predominant involvement of the tentorium and falx are reported. Progressively increasing headaches were the usual symptoms, along with ataxia and various cranial nerve palsies. CT in all cases and MR imaging in two cases detected isolated thickened dura mater. In one case, MR depicted dural involvement as a very large, hypointense area with fine hyperintense edges on T2-weighted images. Microscopic examination of thickened dura revealed extensive fibrotic tissue with a chronic inflammatory infiltrate containing lymphocytes, plasma cells, and scattered eosinophils; these findings closely paralleled the MR features. Only four cases with similar pathologies have been described, all before the advent of CT and MR. We discuss the different causes of thickened dura mater as well as the significance of the fact that dural thickening can be responsible for occlusion of the dural sinuses. Cranial pachymeningitis is a rarely reported disease that can resemble other disorders associated with tentorial thickening; CT and MR can help differentiate it from these other disorders.

Sleep EEG studies during early and late partial sleep deprivation in premenstrual dysphoric disorder and normal control subjects.

In this study of 23 patients with premenstrual dysphoric disorder (PMDD) and 18 normal comparison (NC) subjects, we examined sleep EEG measures during baseline midfollicular (MF) and late luteal (LL) menstrual cycle phases and after early sleep deprivation (ESD), in which subjects slept from 03.00 to 07.00 h, and late sleep deprivation (LSD), in which subjects slept from 21.00 to 01.00 h. Each sleep deprivation night was followed by a night of recovery sleep (ESD-R, LSD-R) (sleep 22.30-06.30 h) and was administered in the late luteal phase of separate menstrual cycles. During baseline studies, sleep EEG measures differed significantly by menstrual cycle phase, but not group. Both PMDD and NC groups showed longer REM latencies and less REM sleep (minutes and percent) during the luteal compared with the follicular menstrual cycle phase. PMDD subjects, however, did not show sleep architecture changes similar to those of patients with major depressive disorders. Sleep quality was better during recovery nights of sleep in PMDD compared with NC subjects. REM sleep measures changed in association with clinical improvement in responders to sleep deprivation. Both early and late sleep deprivation may help to correct underlying circadian rhythm disturbances during sleep in PMDD, although differential sleep changes during ESD vs. LSD did not correlate with clinical response. Further sleep studies addressing additional circadian variables may serve to elucidate mechanisms mediating the therapeutic effects of sleep deprivation in PMDD.

[Prospective comparison between a clinical and biological score and ultrasonography for the diagnosis of benign or malignant hepatic lesions]. / Comparaison prospective d'un score clinique et biologique et de l'échographie pour le diagnostic de bénignité ou de malignité des masses hépatiques.

The purpose of this study was to compare ultrasound with a clinical and biological score to differentiate benign and malignant liver lesions. The study was carried out prospectively in 100 consecutive patients with liver masses of unknown origin. The accuracy of ultrasound and the score was 84% and 76%, respectively (P = 0.02). Ultrasound and the score gave the same results for the diagnosis of hepatic lesions in 68% of cases. When both ultrasound and the score were in agreement, the prediction of malignancy was 94% ant that of benignity was 100% accurate. Although ultrasound was superior to the score in this series, it is interesting to calculate the score because of the higher predictive values when both methods are associated.

[Surgical treatment of hepatocellular carcinoma in cirrhosis. Value of peroperative ultrasonography]. / Traitement chirurgical des carcinomes hépato-cellulaires sur cirrhose. Intérêt de l'échotomographie per-opératoire.

During the past three and half years, 19 patients with hepatocellular carcinoma associated with cirrhosis were operated on. Pain was present in seven patients while 12 were asymptomatic. Alpha foeto-protein was negative in 7 patients. Intraoperative ultrasonography was performed in the last 15 patients. Three right hepatic resections, 5 left hepatic lobectomies and 11 segmentectomies or subsegmentectomies were performed. The operative mortality was 5 p. 100 (one patient). The long term survival in the 3 patients who underwent palliative resection was 6 months. Among the 15 other patients, four died from causes unrelated to their tumor; three patients with tumors larger than 8 cm died from recurrence 12 to 26 months after surgery; and the remaining 7 are still alive without evidence of recurrence 3 to 18 months after surgery. We concluded that in patients with cirrhosis, resection of limited hepatocellular carcinoma is possible, using intraoperative sonography, with low operative mortality. Early detection by repeated ultrasonic examination of the liver in patients with cirrhosis could be the best way to improve the surgical treatment of hepatocellular carcinoma.

[Value of computed tomography and celiomesenteric angiography in assessing vascular involvement in cancer of the exocrine pancreas. Apropos of 31 cases]. / Intérêt de la tomodensitométrie et l'artériographie coelio-mésentérique dans le bilan d'extension vasculaire du cancer du pancréas exocrine. A propos de 31 cas.

The prediction of vascular involvement by computed tomography (CT) with intravenous bolus contrast medium enhancement was compared to that of angiography in 31 patients with pancreatic carcinoma. CT was performed in 29 patients, angiography in 18 patients, while 16 had both investigations. Results of both radiological investigations were reviewed and compared with surgical findings. Sensitivity and specificity of CT was 88 and 100 percent respectively. Sensitivity and specificity of angiography was 57 and 100 percent respectively. The four false-negative results of CT concerned the superior mesenteric and portal veins. The ten false-negative results of angiography concerned the superior mesenteric and portal veins in four cases, and the celiac and superior mesenteric arteries in six cases. Comparison of results of CT and angiography revealed that the two methods concurred in 12 patients, five without and seven with vascular involvement. In three other cases, CT detected more abnormal vessels than angiography. In another case, only CT demonstrated nonresectability. In conclusion, CT with enhancement seems to be more accurate than angiography in the prediction of vascular involvement of pancreatic carcinoma.

[Diagnostic quality control of hepatobiliary echography by autopsy correlation]. / Contrôle de la qualité diagnostique de l'échographie hépato-biliaire par corrélation autopsique.

A methodology to evaluate routine ultrasonography performed in liver pathology is described. The results of 62 autopsies, undoubtedly the most accurate anatomical reference, were compared to those of sonographic examination of the liver performed two months before death at the most. Discordance was found in 23 cases. False negative results in the detection of metastasis and thrombosis of hepatic veins or inferior vena cava were the major pitfalls. The reasons and the consequences of each error were determined for each case.

[Value of a score using clinical and biological variables for determining the benignity or malignancy of a hepatic mass]. / Intérêt d'un score utilisant des variables cliniques et biologiques pour déterminer la nature bénigne ou maligne d'une masse hépatique.

The purpose of this study was to show that clinical and biological data can help in the diagnosis of benignity and malignancy in liver tumors seen on ultrasound. Three hundred and ninety-four patients with liver masses detected by ultrasound (270 malignant, 124 benign) were prospectively studied. Clinical and biological data were tested by univariate and multivariate analysis. The most important variables were gamma-glutamyl-transferase, sedimentation rate, known primary cancer, proven cirrhosis, abnormal abdominal palpation, ascites and weight loss. A regression model was used and a score was defined with these variables. Using this score, 94.8 p. 100 of the liver masses were accurately classified as benign and malignant tumors.

[Imaging of peripheral cholangiocarcinoma. Comparison with pathological anatomy]. / Imagerie du cholangiocarcinome périphérique. Comparaison avec l'anatomie pathologique.

OBJECTIVE: Peripheral cholangiocarcinoma is a rare malignant intrahepatic tumor which originates in the distal bile duct. Our purpose was to identify the imaging characteristics of peripheral cholangiocarcinoma and to establish a correlation with surgical and histopathologic findings. METHODS AND MATERIALS: The imaging data of 16 patients with proven cholangiocarcinoma were retrospectively reviewed by sonography in 13 cases, computed tomography in 13 cases, magnetic resonance imaging in 6 cases, and angiography in 10 cases and correlated with surgical and histopathologic findings. RESULTS: In most cases peripheral cholangiocarcinoma appeared as a single, large (> 10 cm), heterogeneous, and non encapsulated mass. On precontrast computed tomography, the lesions were mostly low density. Enhancement was moderate in the bolus phase and increased in the delayed scan. With magnetic resonance imaging, lesion signals were low intensity in T1-weighted images and variable intensity in T2-weighted images. On angiogram, lesions were often hypovascular. Associated features were frequently observed: portal encasement (69%), lobar atrophy or capsular retraction (43%), dilated intrahepatic bile ducts (30%), extension into the hepatic capsule (23%), and inferior vena cava extension (15%). Radiopathologic comparison showed that imaging modalities accurately identified vascular encasement, but underestimated extrahepatic tumor extension. CONCLUSION: In most cases, peripheral cholangiocarcinoma has a typical appearance which may be helpful in differentiating this disease from other intrahepatic tumors.

[Use of cerebral computer tomography for the diagnosis of multiple sclerosis]. / Apport de la tomodensitométrie cérébrale au diagnostic de la sclérose en plaques.

The authors describe computer tomography findings in multiple sclerosis (MS)), and attempt an evaluation of the value of cerebral computer tomography for the diagnosis of this disease, especially those forms in which the clinical diagnosis is uncertain. A total of 33 patients, 15 men and 18 women, were studied. According to McAlpine's criteria, 21 patients had established MS, 2 were probably MS cases, and the other 10 were possible cases of the disease. The scanner used was an EMI 1010 apparatus giving 13 mm thick sections, with a matrix of 160 X 160. A contrast medium was injected systematically. Abnormal computer tomography results were noted in 28 of the 33 patients, including one or more low density areas in the white substance in 26 patients, taking up of the contrast medium after injection in 10 patients, and cerebral atrophy in 24 patients. Cases where only one of these anomalies was present are rare, and the various anomalies noted on computer tomography are usually associated in varying proportions. In most cases, the computer tomography findings were not related to any specific clinical picture. In cases of established MS, computer tomography can provide information on the extension and progression of the lesions at the time of examination. Out of the 12 cases in which clinical diagnosis was uncertain, 9 presented abnormal findings (low densities and/or taking up of contrast medium); the level of CSF gamma-globulins was normal in 4 of these 9 patients; visual evoked potentials were not altered in the 5 out of these 9 patients studied. In 3 patients with medullary signs, several low cerebral trunk and white substance of the cerebral hemispheres. When diagnosis is uncertain, cerebral computer tomography is the method of choice for demonstrating latent MS lesions of a certain type: it complements neurophysiological studies (visual, auditory, and somesthesic evoked potentials), used at the present time for the diagnosis of MS by exploration of the optic tracts and cerebral trunk.

MRI anatomy of the acoustic-facial bundle in vivo.

In this study performed on 5 healthy volunteers the authors used oblique axial, coronal and sagittal MRI sections suitable to be anatomical configuration of the acoustic-facial bundle and were able to individualize the nerves forming this bundle throughout their course, with the sole exception of the intermediate nerve (VII2). They also analysed the relations of these nerves between themselves and with the other elements of the cerebellopontine angle. In addition, a proton-density sequence (SE, 6,000/30 ms) made it possible to differentiate in vivo between the grey matter and the white matter sufficiently to individualize the principal nuclei and tracts of the brain stem, and in particular the main vestibulo-cochlear central pathways.