Ectopic pregnancy risk factors for ART patients undergoing the GnRH antagonist protocol: a retrospective study.

BACKGROUND: In-vitro fertilization is a known risk factor for ectopic pregnancies. We sought to establish the risk factors for ectopic pregnancy in GnRH antagonist cycles examining patient and stimulation parameters with an emphasis on ovulation trigger. METHODS: We conducted a retrospective, cohort study of 343 patients undergoing 380 assisted reproductive technology (ART) cycles with the GnRH antagonist protocol and achieving a clinical pregnancy from November 2010 through December 2015. RESULTS: Significant risk factors for ectopic pregnancy in the univariate analysis included prior Cesarean section (CS), endometriosis, mechanical factor infertility, longer stimulation, elevated estradiol and progesterone levels, GnRH agonist trigger, higher number of oocytes aspirated, and insemination technique. Independent risk factors for ectopic pregnancy in the multivariate analysis included GnRH agonist trigger, higher number of oocytes aspirated, insemination technique, and prior Cesarean section. CONCLUSION: Excessive ovarian response, IVF (as opposed to ICSI), prior Cesarean section and GnRH agonist trigger were found to be independent risk factors for ectopic pregnancy. Caution should be exercised before incorporating the GnRH agonist trigger for indications other than preventing OHSS. When excessive ovarian response leads to utilization of GnRH agonist trigger, strategies for preventing ectopic pregnancy, such as a freeze all policy or blastocyst transfer, should be considered. Further studies should elucidate whether adjusting the luteal support can reduce the ectopic pregnancy risk.

Elevated physiological arousal is associated with larger but more variable neural responses to small acoustic change in children during a passive auditory attention task.

Little is known of how autonomic arousal relates to neural responsiveness during auditory attention. We presented N = 21 5-7-year-old children with an oddball auditory mismatch paradigm, whilst concurrently measuring heart rate fluctuations. Children with higher mean autonomic arousal, as indexed by higher heart rate (HR) and decreased high-frequency (0.15-0.8 Hz) variability in HR, showed smaller amplitude N250 responses to frequently presented (70%), 500 Hz standard tones. Follow-up analyses showed that the modal evoked response was in fact similar, but accompanied by more large and small amplitude responses and greater variability in peak latency in the high HR group, causing lower averaged responses. Similar patterns were also observed when examining heart rate fluctuations within a testing session, in an analysis that controlled for between-participant differences in mean HR. In addition, we observed larger P150/P3a amplitudes in response to small acoustic contrasts (750 Hz tones) in the high HR group. Responses to large acoustic contrasts (bursts of white noise), however, evoked strong early P3a phase in all children and did not differ by high/low HR. Our findings suggest that elevated physiological arousal may be associated with high variability in auditory ERP responses in young children, along with increased responsiveness to small acoustic changes.

Vascular graft infection.

This article presents a discussion of the management of vascular prosthetic infections. The emphasis is on aortic graft infections, but other peripheral graft infections are also discussed.

Arterial regeneration over polydioxanone prostheses in the rabbit.

We analyzed histologic, ultrastructural, and functional characteristics of rabbit aortic conduits regenerated over absorbable polydioxanone prostheses. Twenty-eight polydioxanone-elicited prosthesis/tissue complexes harvested two weeks to 12 months following implantation were analyzed grossly; photographed; sectioned for light, scanning, and transmission electron microscopy; and studied for compliance, bursting strength, and prostacyclin and thromboxane metabolite contents. No aortic-related deaths or hemorrhages occurred. Smooth regenerated conduits without stenoses were seen in 27 of 28 specimens, with one small aneurysm. Transprosthetic myofibroblast migration and proliferation paralleled the kinetics of macrophage-mediated prosthetic dissolution, which was consequently delayed compared with polyglycolic acid prostheses. Confluent endothelial-like luminal surfaces were present after two weeks. Progressive inner capsular thickening ended after three months at 420 micron. Ex vivo compliance curves resembled arterial elasticity. Regenerated tissue withstood 1200 mm Hg of systolic pressure, and 6-keto-prostaglandin F1 alpha to thromboxane B2 ratios did not differ from normal control specimens.

Individual implantation rate: proposal for a new index for evaluation of assisted reproduction results.

OBJECTIVE: To assess whether implantation in assisted reproductive technology (ART) cycles is a random event. DESIGN: Retrospective analysis of results. SETTING: Division for Reproductive Endocrinology and ART, Department of Obstetrics and Gynecology, Haemek Medical Center, Afula, Israel. PATIENT(S): A cohort of all cycles reaching ET from July 1, 1995, through June 30, 1996, and a cohort of all pregnancies recorded from January 1, 1995, through October 31, 1996. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Rate of multifetal pregnancy in relation to overall pregnancy rate. The number of gestational sacs observed by sonography, out of transferred embryos in conception cycles, was defined as the individual implantation rate. RESULT(S): Of 367 ETs, 75 (20.4%) yielded pregnancies, of which 31 (41%) were multifetal. Considering the mean number of embryos transferred (3.67), if implantation would have been random, multifetal gestation rate should have been only 14.8%, significantly less than the observed rate. In 110 pregnancies recorded between January 1995 and October 1996, individual implantation rate was 49.4% +/- 27.1% in intracytoplasmic sperm injection cycles compared with 40.5% +/- 20.4% in IVF cycles. CONCLUSION(S): Embryo implantation is not a random event. The index of individual implantation rate may help shed light on mechanisms underlying implantation.

The role of extraanatomic bypass in the management of bilateral aortoiliac occlusive disease.

Axillofemoral bypass is a hemodynamically inferior reconstruction that should be performed only in high-risk patients. In view of the apparent inferior patency and hemodynamic performance when compared with aortofemoral bypass, axillofemoral bypass should not be performed for claudication except in truly disabled, low-risk patients whose contraindication to aortofemoral bypass is a "hostile abdomen." Some of these patients might be candidates for extraperitoneal iliofemoral bypass, thoracofemoral bypass, or other procedures that would probably provide hemodynamically superior results. Axillofemoral bypass produces acceptable hemodynamic results, patency, and limb salvage in high-risk patients with limb-threatening ischemia and limited life-expectancy. Despite overall inferior results, relief of initial symptoms is nearly always achieved and few patients require amputation before death. Axillofemoral bypass will remain an important option in such patients. In general, we continue to favor axillobifemoral reconstructions when symptoms are significantly bilateral. However, we do not hesitate to perform axillounifemoral bypass when symptoms and disease are unilateral and alternative unilateral inflow operations are not appropriate. Outcome of operations is clearly influenced by patient selection, and this must be considered when interpreting published results. It is likely that axillofemoral bypass will continue to be a critical tool for vascular surgeons faced with desperately ill patients at risk of limb loss due to bilateral aortoiliac inflow disease. As the operative risk of aortofemoral and iliofemoral bypass continues to decrease, the admonition that a significant number of long-term survivors should prompt the surgeon to ask whether she or he is performing axillofemoral bypass when another procedure might be more appropriate is probably more true today than when DeLaurentis et al first made the following statement: If indeed this operation is designed for poor risk cardiopulmonary patients threatened with loss of limb and a short life expectancy rate, we should not expect to see reports of patients with long term survival rates.

Shabbes burn, a burn that occurs solely among Jewish orthodox children; due to accidental shower from overhead water heaters.

From January 1990 to January 2000, 35 children were treated in our department for Shabbes burn, a unique scald burn that occurred mainly among orthodox Jews during the Sabbath. A retrospective review was conducted to determine the extent of the problem, to understand the burn mechanism and to suggest a prevention program. A shower of hot water from the Sabbath heater is the cause of this burn. Among the Shabbes burn cases, 27 patients were female (77%) and 17 children (48%) were between 3 and 6 years old. It is suggested that this is a common burn that occurs among orthodox Jewish families and affects mainly females. Education programs using the media directed to the Jewish orthodox population have been conducted, this combined with redesigned of the heater, have reduced significantly the incidence of the burn as seen in our institute. However, even though efforts have been supported widely, there remains a need for educational and governmental regulations on a national level. This could aid orthodox Jews not only in Israel but globally, as well.

Electrical burn injury of the scalp--bone regrowth following application of latissimus dorsi free flap to the area.

A large defect of the scalp was observed soon after debridement of a high-tension electrical burn of the scalp. Bone scan revealed no uptake of radioactive material to the parietal bone below the necrotic tissue of the scalp. Consecutive bone scans after latissimus dorsi free flap transfer revealed progressive regrowth of the bone.

A new technique for treating the exposed cardiac pacemaker wires in the supraclavicular region.

Exposure of pacemaker wires has become a common challenge in plastic surgery. Suggested techinques for dealing with this problem include removal and reintroduction of the entire pacemaker system or coverage with local flaps. We propose a new technique, which in addition to local flap coverage, eliminates the problem future pressure necrosis by placing the wires in the clavicle rather than about it.

Extensive sebaceous nevus.

An unusual patient with extensive sebaceous nevus lesions is presented. The lesions were found on the scalp and face and extended into the mouth and anal region. They were associated with premature eruption of three teeth, a cleft in the secondary palate, and a deformation of the upper third of the right auricle. Skeletal deformities were not found. Neurologic defects were not present during first months. The definitive treatment was postponed because of the patient's young age and the magnitude of the lesions.

Congenital fusion of the gums with bilateral fusion of the temporomandibular joints.

A newborn baby with congenital bilateral complete fusion of the gums and the temporomandibular joints is presented. It seems to be the second case reported in the literature. The embryology, clinical features, and treatment of this rare disorder are described.

Pre- vs postoperative pharmacologic inhibition of platelets: effect on intimal hyperplasia in canine autogenous vein grafts.

Several clinical studies have shown that pharmacologic inhibition of platelets can increase the patency of vascular grafts, but only if platelet-inhibition is initiated before surgery. This study was performed to compare the efficacy of pre- vs postoperative platelet-inhibition on the development of intimal hyperplasia in canine autogenous vein grafts. Reversed femoral veins were used to bypass the ligated femoral arteries in 15 dogs. End-to-side anastomoses were constructed. Eleven dogs were treated with aspirin (325 mg QD) and dipyridamole (25 mg BID). In six dogs treatment was begun 48 hours preoperatively and continued for 3 months. In five other dogs treatment was begun 48 hours after surgery and was continued for 3 months. In 4 control dogs no antiplatelet treatment was given. Excision of the vein grafts 3 months after surgery disclosed reduced intimal hyperplasia (p < 0.05) in the grafts excised from all of the treated animals as compared with those obtained from the control animals. However, there was no difference in intimal hyperplasia observed in the dogs treated both pre- and postoperatively (11 grafts) as compared with those treated only postoperatively (9 grafts). These data demonstrate that it is not necessary to begin antiplatelet therapy preoperatively in order to inhibit intimal hyperplasia. They also suggest that preoperative antiplatelet therapy may improve early graft patency by directly preventing thrombosis, not by inhibiting the development of intimal hyperplasia.

Cystic hamartoma of Brunner's glands.

A 64-year-old white man was operated on for acute gastrointestinal bleeding. The patient was known to have a duodenal polyp for 15 years. Surgery revealed a small duodenal ulcer and a large cystic hamartoma of Brunner's glands. Incidence, aspects of pathogenesis, clinical features and treatment of this rare tumor are discussed.

High origin of the ulnar and radial arteries in humans.

High division of the brachial artery was found in 4 human cadavers. In all cases the brachial artery divided into main branches within the medial bicipital sulcus. Both the ulnar and radial arteries descended within the sulcus to the elbow. In one case the musculocutaneous nerve was fused with the median nerve, giving off branches to the anterior group of arm muscles.

Pulmonary arteries dimensions and their dependences on the age, the height and body weight.

The studies were carried out on 100 right and 100 left lungs taken from human corpses of both sexes whose age varied from 1 month to 80 years. The material was divided into 3 age groups. The pulmonary arteries were injected 65% duracryl and then digested in sulfuric acid. The specimens obtained were examined to measurement the length and the diameter of the interlobar portion of the pulmonary arteries and their correlation indexes to the age, the length and the body weight. It was certain, that the pulmonary arteries dimensions still grows during man's extrafetal life; the diameter of the right pulmonary artery is usual greater than the left artery. The length of the interlobar portion of the right pulmonary artery varied in both sexes from 5 to 43 mm, and from 6 to 43 mm on the left pulmonary artery. The diameter of the some part of pulmonary arteries varied from 3 to 21 mm on the right side, and from 4.5 to 20 mm on the left side.