Luteal phase support with 17alpha-hydroxyprogesterone versus unsupported cycles in in vitro fertilization: a comparative randomized study.

This study was designed to determine the efficacy of 17alpha-hydroxyprogesterone caproate (17-OHPc) for luteal phase support in in vitro fertilization (IVF). For this purpose, a total of 86 IVF patients undergoing embryo transfer were randomly allocated to two groups as follows: (1) group A, including 43 patients who received the support of luteal phase through the intramuscular administration of 17-OHPc at a dosage of 341 mg every 3 days, and (2) group B, including 43 patients who received the intramuscular administration of a saline solution as placebo every 3 days. In both groups, the treatment was started within 24 h after embryo transfer until beta-HCG evaluation. In case of positive beta-HCG, it was extended until 12 weeks. Efficacy was assessed using the pregnancy rates, which was, per transfer, statistically significantly higher in group A than in group B (32.5 vs. 18.3% respectively). On the basis of our results, we emphasize the use of 17-OHPc for luteal phase support after IVF and embryo transfer.

Intramuscular versus vaginal administration of progesterone for luteal phase support after in vitro fertilization and embryo transfer. A comparative randomized study.

A total of 156 patients were randomly treated with exogenous natural progesterone (intramuscularly, 50 mg/day) and vaginal gel (90 mg/day) P or nothing (Controls) from the day before embryo transfer (ET) for two weeks. In case of positive beta-HCG, the treatment was continued for 12 weeks. Plasma P and 17 beta-Estradiol concentrations were estimated and compared with the control not supplemented group. Both treatments were able to increase significantly the luteal plasmatic values of P versus controls. The ongoing pregnancy and the living birth rates per transfer were significantly higher in the patients supplemented with intramuscular P than in those treated with vaginal gel P. The intramuscular natural P appears the most suitable route of administration for luteal phase support in IVF-ET procedures.

17-alpha-Hydroxyprogesterone caproate and natural progesterone in assisted reproduction: a comparative study.

The use of luteal phase support has been demonstrated in patients undergoing an IVF/ET procedure. This study was designed to compare the absorption and the efficacy of two different luteal supports: 17-alpha-hydroxyprogesterone caproate (Lentogest, AMSA, Italy) and natural Progesterone (Prontogest, AMSA, Italy). A total of 80 patients received luteal supplementation with 50 mg of natural P/day intramuscularly, until beta-hCG evaluation. Then, in case of positive beta-hCG, patients were randomly divided into two groups (A and B) in order to compare two different protocols: Group A, 17-OHPc (341 mg once a week) and Group B, natural P (50 mg/day) both intramuscularly and extended for 10-12 weeks. Our study showed that the treatment with 17-OHPc results in a higher percentage of pregnancy rate compared to natural P, but the differences are not statistically significant. Thus, we emphasize that 17-OHPc preparation for better acceptance appears to be the most suitable and comfortable method for luteal phase support.

Surgery for pulmonary metastases. Who are the 10-year survivors?

BACKGROUND: Surgical resection of pulmonary metastases (PMs) has been shown to produce approximately a 35% 5-year survival rate, but specific data about late survival are not available in the literature. METHODS: A retrospective review and survival analysis of 186 adult patients who underwent surgery for PMs at a single center before June 1984 is presented. RESULTS: Of the 186 patients who had surgery, of whom 34 (18%) had an incomplete resection, the 10-year survival rate (Kaplan-Meier) was 23% (95% CI, 16-30%), and 36 patients, with PMs from nine different primary sites, were still at risk at 10 years. Two patients died of their primary disease more than 10 years after the first thoracotomy, and two are alive with uncontrolled disease. Thirty-one patients are currently alive and disease free. Comparison between the 36 10-year survivors and the 150 nonsurvivors revealed that only the percentage of incomplete resections and the mean number of resections per patient were significantly different between the two groups (P < 0.001); the histologic type of the primary tumor, the disease-free interval, and the number of resected PMs at the first thoracotomy were not found to be statistically significant prognostic factors. CONCLUSIONS: The 23% 10-year survival and the high rate of disease free 10-year survivors in this study constitute support for complete resection as an efficient therapeutic approach in patients with isolated PMs. Relevant criteria to select more precisely those patients who will benefit from resection remain to be developed.

HBcAg identification in the placental cytotypes of symptom-free HBsAg-carrier mothers: a study with the immunoperoxidase method.

In this study the presence of HBcAg in placental tissue of symptom-free HBsAg-carrier mothers has been determined by the immunoperoxidase technique. The presence of HBcAg in the major placental cytotypes was mostly limited to the trophoblastic lineage. Moreover the activated macrophages with their strong cytoplasmic reaction to the antigen phagocytosis play a remarkable role in the immune response. Because there are continuous channels that link the human amnion through the trophoblastic lineage, including the endovascular trophoblast with maternal decidual vessels, a functional exchange system may be considered valid. This would influence the transmission of infection.

Immunocytochemical HBsAg evidence in placentas of asymptomatic carrier mothers.

We report three chronic asymptomatic HBsAg carrier mothers. We studied their placentas via application of the immunohistochemical method to identify HBsAg by peroxidase-antiperoxidase techniques. All three placental specimens showed a positive HBsAg reaction. Due to the strong cytoplasmatic reactivity of the cytotypes, we deduced their active participation in the infection, proving that virosis occurs via transplacental circulation.