Effects of controlled ovarian stimulation on vascular barrier and endothelial glycocalyx: a pilot study.

PURPOSE: Controlled ovarian stimulation significantly amplifies the number of maturing and ovulated follicles as well as ovarian steroid production. The ovarian hyperstimulation syndrome (OHSS) increases capillary permeability and fluid extravasation. Vascular integrity intensely is regulated by an endothelial glycocalyx (EGX) and we have shown that ovulatory cycles are associated with shedding of EGX components. This study investigates if controlled ovarian stimulation impacts on the integrity of the endothelial glycocalyx as this might explain key pathomechanisms of the OHSS. METHODS: Serum levels of endothelial glycocalyx components of infertility patients (n=18) undergoing controlled ovarian stimulation were compared to a control group of healthy women with regular ovulatory cycles (n=17). RESULTS: Patients during luteal phases of controlled ovarian stimulation cycles as compared to normal ovulatory cycles showed significantly increased Syndecan-1 serum concentrations (12.6 ng/ml 6.1125th-19.1375th to 13.9 ng/ml 9.625th-28.975th; p=0.026), indicating shedding and degradation of the EGX. CONCLUSION: A shedding of EGX components during ovarian stimulation has not yet been described. Our study suggests that ovarian stimulation may affect the integrity of the endothelial surface layer and increasing vascular permeability. This could explain key features of the OHSS and provide new ways of prevention of this serious condition of assisted reproduction.

[Polydipsia, increasing fatigue and a huge mediastinal tumor in a 49-year-old woman]. / Polydipsie, zunehmende Müdigkeit und große mediastinale Raumforderung bei einer 49-jährigen Patientin.

A 49-year-old woman presented with unspecific symptoms including polydipsia, increasing fatigue for several weeks, and vague abdominal pain. Serum calcium (5.30 mmol/l; normal range 2.00-2.60) and parathyroid hormone levels (> 2500.0 ng/l; normal range 15.0-68.0) were extremely elevated. Imaging studies showed a huge mediastinal tumor. Based on these findings a hypercalcemic crisis caused by primary hyperparathyroidism was diagnosed. After intensive care treatment and further diagnostic procedures, the patient's parathyroid adenoma was removed by parathyroidectomy. The postoperative course was uneventful.

[Antiplatelet therapy after coronary stenting and its importance in total joint arthroplasty]. / Thrombozytenfunktionshemmung nach koronarer Stentimplantation: Bedeutung in der Endoprothetik.

Coronary stenting is an effective treatment for reopening atherosclerotic occlusions of coronary arteries. Depending on the manifestation of coronary artery disease (stable CAD or acute coronary syndrome) and on the type of implanted stent, dual antiplatelet therapy is recommended for a period of 4 weeks to 12 months. In this period total joint replacement is associated with high blood loss and high perioperative morbidity. Therefore antiplatelet therapy is often discontinued and replaced by higher dosages of heparin for prophylactic anticoagulation. However, with this treatment regimen protection of the stent is doubtful and there is a high risk of stent thrombosis with myocardial infarction. The surgery should be scheduled after the dual antiplatelet therapy is replaced by lifelong aspirin therapy. On the other hand, if surgery cannot be postponed perioperative bridging of dual antiplatelet therapy can be conducted to minimize bleeding complications with the best possible stent protection. Lifelong therapy with aspirin should not be discontinued in any case.

[Splenic rupture as a complication of ventilation in the prone position and pneumococcal sepsis as a late complication]. / Milzruptur als Komplikation bei Beatmung in Bauchlage und Pneumokokkensepsis als Spätkomplikation.

We are reporting the case of a female patient who had to undergo splenectomy after she suffered splenic rupture as a result from "kinetic therapy" during the treatment for pulmonary failure secondary to sepsis. Four years later the patient was again admitted with a clinical picture consistent with sepsis. Two blood cultures were positive for pneumococci confirming the diagnosis of pneumococcal sepsis. This paper discusses the potential risks of kinetic therapy in patients with ARDS. After splenectomy there is increased risk of infection with certain bacteria, funghi, viruses and protozoa. The most common bacterial pathogen is pneumococcus. A polyvalent vaccine is available for prophylaxis. Although penicillin G is still commonly used as an antibiotic therapy for pneumococcal infection, increased resistance of pathogens to penicillin must be anticipated. Alternative antibiotic regimens are demonstrated.