Proximal renal tubular acidosis in pregnancy. A case report and literature review.

Renal tubular acidosis is usually associated with chronic renal conditions and is rarely encountered in pregnancy. It may be inherited causing osteomalacia and rickets in children or acquired following autoimmune diseases or following exposure to nephrotoxic agents. It is known to worsen during pregnancy and if left untreated may cause maternal and foetal morbidity or death. We report a 28-year-old woman, gravida 3 para 2, who presented at 30 weeks gestation with lethargy, weakness and generalized myalgia. Investigation revealed severe hypokalaemia and a systemic metabolic acidosis due to proximal renal tubular acidosis. Her previous pregnancies were both complicated by foetal losses at term. Following prompt correction of her electrolyte disturbance and metabolic acidosis, she went on to deliver a healthy female infant at term. Regular evaluation up to 1 year post-partum revealed mild persistence of her hypokalaemia. At 1 year, the infant showed no signs of the disorder and is growing normally.

High dose chemotherapy with ifosfamide, carboplatin, and etoposide combined with autologous bone marrow transplantation for the treatment of poor-prognosis germ cell tumors and metastatic trophoblastic disease in adults.

BACKGROUND: A Phase I-II trial to assess the toxicity and efficacy of a tandem high dose chemotherapy combining ifosfamide, carboplatin, and etoposide in germ cell tumors and metastatic trophoblastic disease was performed. METHODS: Thirty-nine patients, with a total of 22 testicular tumors, 9 extragonadal germ cell tumors, 3 ovarian germ cell tumors, and 5 cases of metastatic trophoblastic disease, received tandem high dose therapy combining ifosfamide (7500-12,500 mg/m2), carboplatin (875-1225 mg/m2), and etoposide (1000-1250 mg/m2), followed by bone marrow reinfusion. Among the 39 patients, 33 were refractory to cisplatin- or carboplatin-based regimen and the response of 37 could be evaluated; 69 cycles of this tandem high dose therapy were administered. RESULTS: The overall response rate was 46%, including a complete response (CR) rate of 35%. Of 21 patients with testicular tumors who could be evaluated, 10 (47%) achieved a CR. No CRs were obtained in patients with refractory extragonadal germ cell tumors. Nine partial responders after the first cycle became complete responders after the second. Nine (23%) of the patients were long term survivors (> 18 months), 7 of them in continuous CR. Side effects primarily were renal toxicity and enterocolitis. Seven patients (18%) died of therapy-related be explored and the maximum tolerated doses of this three-drug regimen remain to be determined. CONCLUSION: This tandem therapeutic regimen is able to overcome resistance to a platinum-based regimen in highly refractory germ cell tumors and gestational trophoblastic disease and to cure a number of patients.

Nutrition education of young women.

White women aged 25-34 years (n 264) from the lower socio-economic classes (C2, D and E) were classified according to their motivation in respect of health and their educational attainment and arithmetical ability. They were randomly allocated to three groups. One group (test) was given a course in basic nutrition consisting of a video and booklet, each embellished with motivational material. Those classed as of low ability also received the training material in simplified format. A second group (control) received a video and booklet with no motivational or simplified materials. The third group (baseline) received no tuition and represented a control of publicly available information during the period of the experiment. The participants answered a series of questions by administered questionnaire to measure their nutritional knowledge before and one week after they viewed the video programme. All participants achieved significantly higher scores at the second questionnaire. The test and control groups achieved significantly higher scores than the baseline group but there was no significant difference between the test and control groups. The presentation of motivational or simplified materials had no significant effect on learning ability though those classified as more highly motivated and of higher ability achieved higher scores at each questionnaire. The results indicate that young adult females can be taught basic nutrition irrespective of their motivation or ability.

[Hyperstimulation for in vitro fertilization with the "step-down" technique. Preliminary results from a prospective randomized study with and without LHRH agonists]. / Hyperstimulation en vue de FIV selon la technique du "step-down". Résultats préliminaires d'une étude prospective randomisée avec ou sans agonistes de la LHRH.

Twenty six normo-ovulatory patients < 38 years with tubal or idiopathic infertility and normal sperm were treated for IVF by FSH +/- hMG and randomized into four groups: with and without LHRH agonist, "step-up" or "step-down" stimulation. In the step down protocol, after 4 days with 4 amps plasmatic FSH reached its top level, then decreased. Despite reduction to only two amps, estradiol continued to increase in all the 5 women without agonist, whereas 3/7 with the long protocol were considered as low responders and stopped. The fertilization/cleavage rate was 69.2% in step-down and 45.7% in step-up (p < 0.04) with the short protocol, and respectively 65.6% and 41.9% (p < 0.03) with the long one. The pregnancy rate was equivalent in all groups.

[Prognostic value of preovulatory elevations of plasma progesterone during in vitro fertilization using LHRH agonists in a long protocol]. / Valeur pronostique des élévations pré-ovulatoires de la progestérone plasmatique au cours des fécondations in vitro sous agonistes de la LHRH en protocole long.

We retrospectively analyzed the prevalence and prognostic significance of plasma progesterone rises during in vitro fertilization (IVF) protocols including pituitary down-regulation by LHRH agonists in a long protocol and stimulation by hMG (n = 1,116: Group A) or pure FSH (n = 178: Group B). On the day of hCG injection, plasma progesterone level was in the 0.60-0.99 ng/ml range in 7.1% of group A patients and 6.2% of group B patients (NS) and above 1 ng/ml in respectively 4.0% and 3.4% of the cases (NS). On the same day, plasma progesterone was strongly correlated with plasma estradiol (r = 0.26 - p < 0.001 in group A; r = 0.21 - p < 0.01 in group B). However, increased progesterone levels were not associated with changes in plasma LH levels, falls in plasma estradiol levels after hCG injection, or significant modifications in biological and clinical results of IVF. The cause of this pattern of progesterone rise remains to be elucidated.

Comparison of plasma and follicular fluid hormone profiles following stimulation with HMG, with or without LHRH agonists, for in-vitro fertilization.

Plasma and follicular fluid (FF) hormone assays for follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), oestradiol (E2), progesterone (P), delta-4-androstenedione (A4) and testosterone (T) were performed on the day of oocyte retrieval in two groups of normo-ovulatory women enrolled in an in-vitro fertilization (IVF) programme: 24 were treated using the decapeptyl agonists DTRP6, of luteinizing hormone-releasing hormone (LHRH) in the long protocol associated with human menopausal gonadotrophin (HMG) (49 FF) and 14 were stimulated with HMG alone (33 FF). In both FF and plasma the mean concentration of P was greater, and the E2/P ratios as well as the LH levels were lower in the agonist-treated group. In this group the follicular concentration of P was greater and the E2/P ratio lower when pregnancy occurred following IVF. The hormonal modifications may be due to greater functional maturity of the granulosa cells.

[Ovarian stimulation for in vitro fertilization using LHRH agonists: comparison of plasma and intra-follicular hormone profiles using "short" and "long" protocols]. / Stimulation ovarienne pour fécondation in vitro utilisant les agonistes de la LHRH: comparison des profils hormonaux plasmatiques et intra-folliculaires des protocoles "courts" et "longs".

Plasmatic estradiol (E2), progesterone (P) and LH were measured during the follicular phase of 343 cycles induced for in vitro fertilization (IVF) using a LHRH agonist in a "long protocol" (Group I) and 76 cycles in a "short protocol" (Group II). Moreover measurements in the plasma and follicular fluid (FF) of E2, P, LH, Delta-4-androstenedione (A), Testosterone (T) and prolactin (PRL) were performed on the day of oocyte retrieval (DO) in 46 women of the group I (111 FF) and 27 of the group II (67 FF). In the group I, plasma LH always remains below 3 mUl/ml, whatever the type of agonist (Buserelin or DTRP6-LHRH) and the type of stimulation (HMG or FSH) are used. On the other hand in the group II, mean plasma LH and P levels from D-5 to D-2 and those of FF LH, T and A on DO are significantly higher than in the group I. These changes are associated with a significant decrease of retrieved oocytes (5.8 versus 7.8 p less than 0.0001), pregnancy rate (15% versus 30%, p less than 0.01) and ongoing pregnancy rate (10% versus 22%, per oocyte retrieval, p less than 0.01). They suggest that the pituitary desensitization could be unsatisfactory with the short protocol use of agonist.

[Evaluation criteria of the condition of the endometrium in relation to the presence of ovocytes]. / Critères d'appréciation de l'état de l'endomètre dans le cadre du don d'ovocytes.

18 patients with ovarian failure received cyclic steroid replacement therapy including estrogens and progesterone for embryo transfer. Hormonal results and endometrial histology are reported. The temporal window of endometrial receptivity 13 discussed, shedding some light on the respective role of embryo and endometrium in the implantation process.

Prognostic value of pre-ovulatory serum progesterone, LH and oestradiol-17 beta levels in stimulated cycles for in-vitro fertilization.

The prognostic value of a decrease in oestradiol-17 beta (E2) on the day after HCG injection in stimulated cycles has been related to a premature increase in plasma progesterone (P) on the day before HCG injection. This retrospective study was carried out on 363 patients who were divided into four groups. Patients in group A were given clomiphene citrate plus human menopausal gonadotrophin (HMG) to stimulate follicle growth, and they were subdivided into subgroups A1 and A2 who showed an increase or a decrease in E2 levels after HCG injection. The changes in E2 were greater than 10% of the levels on the previous day. Patients in group B were stimulated by HMG and were similarly subdivided into subgroups B1 and B2 according to their E2 levels. The number of oocytes recovered and the incidence of pregnancy was significantly higher in A2 as compared with A1, and higher but not significantly so in B2 versus B1. Moreover, in subgroups A1 and B1 the day before the decrease of E2 was marked by a significant rise in LH before the HCG injection. We suggest that oocyte recovery is deferred in these cases.

[Cytosolic estradiol and progesterone receptors of normal and pathologic Fallopian tubes]. / Etude des récepteurs cytosoliques de l'oestradiol et de la progestérone de trompes normales et pathologiques.

The study of tubal cytosol receptors for estradiol and progesterone shows that they are (in comparison with normal tubes) less in number in post-infection cases (proximal or distal) and increased in number in proximal endometriotic lesions. These variations are only significant for the progesterone receptors. These results are compared with those in the literature, and their implications, concerning hormone treatments used together with microsurgical tubo-plasties, are discussed.

[Characteristics of pregnancies obtained by in vitro fertilization]. / Caractéristiques des grossesses obtenues par fécondation in vitro.

193 patients had 212 cycles induced for in vitro fertilisation between May 1983 and May 1984. 20 pregnancies of which 10 are still in progress were obtained with 6 spontaneous abortions. There were 2 so-called biochemical pregnancies and 3 extra-uterine pregnancies. The figure of 17% pregnancies where embryos were replaced totals less than 10% if one considers those pregnancies that really carry on. The number of extra-uterine pregnancies is disturbing. Finally, 2 multiple pregnancies continued, one of them being a quadruple pregnancy. The authors have made a special study to see the parameters of the conditions under which the pregnancies were obtained and the prognosis for such pregnancies.

[Postovulatory hormones in plasma, peritoneal and follicular compartments]. / Etudes hormonales post-ovulatoires dans les compartiments plasmatique, péritonéal et folliculaire.

Eleven women with dysovulatory or unexplained sterility were treated by induction of ovulation and compared with a control group of seven normal women. Laparoscopy was carried out 48 hours after HCG had been injected or after the LH peak in the first group. 48 hours after the rise in temperature in the second group ovulation was presumed and aestradiol 17 beta, progesterone. Delta 4 androstenedione, FSH, LH, prolactin and cyclic AMP estimated in the plasma, the peritoneal fluid and fluid from the persistent follicles. A corpus luteum of recent formation was found in group 1, 5 out of 7 times, and only 7 out of 11 times in group 2. The question of whether non-ruptured luteinised follicles exist is discussed in view of these anatomical and hormonal level findings. These show that there is a good correlation in both groups between aestradiol 17 beta and progesterone, whether estimated in the plasma or in peritoneal fluid. On the other hand, there was poor evidence of correlation between the levels of steroids in each compartment as compared with the other. Finally, the curves for the different steroid levels are important when concentrations of hormones in the follicles, the peritoneal fluid and the plasma are compared. Conclusions have been suggested about the origin of the different steroids and their movement from compartment to compartment.

[Estimations of pregnanetriolone, pregnanetetrol, delta 5-pregnenetriol by spectrophotometry and by gas liquid chromatography (author's transl)]. / Dosages de prégnanetriolone, prégnanetétrol, delta 5-prégnènetriol par spectrophotométrie et par chromatographie gaz-liquide.

The author describes two methods of simultaneous estimation of pregnanetriolone, pregnanetetrol and delta 5-pregnenetriol. These estimations may be carried out at the same time as those of pregnanediol and pregnanetriol. The first method is based on spectrophotometry of derivatives obtained with 80 % sulphuric acid. The second demands gas chromatography. It permitted us to verify the specificity of the first. Its specificity was also verified by coupling with mass spectrometry. These estimations are used in the diagnosis of deficiencies of 21 hydroxylase and 3-beta hydroxysteroid oxidoreductase from the adrenal cortex. The values frequently obtained for delta 5-pregnenetriol are given.