[Heart failure in old age : Current recommendations in view of the revised national treatment guidelines on chronic heart failure]. / Herzinsuffizienz im Alter : Aktuelle Empfehlungen mit Blick auf die überarbeitete Nationale VersorgungsLeitlinie Chronische Herzinsuffizienz.

Clinical symptoms of heart failure in older patients can be similar to those of other diseases in geriatrics. Therefore, the diagnosis should be confirmed by echocardiography. The treatment of older patients with heart failure with reduced left ventricular ejection fraction (HFrEF) should be carried out in accordance with the guidelines with regular control of volume status, renal function and serum electrolytes. Due to the lack of effective treatment of heart failure with preserved ejection faction (HFpEF) blood pressure control as a measure of prevention is important. Patients can benefit from the new treatment options for secondary mitral regurgitation if the patient selection is correct. For older and frail patients a special management would be desirable, with the aim of reducing functional loss through hospitalization. In order to reduce the rehospitalization rate of older patients, it is necessary to improve the collaboration between outpatient and inpatient care providers and nursing personnel should be better qualified.

Outcome of intracytoplasmic sperm injection with and without polar body diagnosis of oocytes.

OBJECTIVE: To compare the reproductive outcome of women undergoing intracytoplasmic sperm injection (ICSI) with or without polar body diagnosis of oocytes. DESIGN: Nonrandomized retrospective study. SETTING: University-based human genetic institute in collaboration with a private fertility center. PATIENT(S): Six hundred seven women undergoing ICSI with polar body diagnosis and 591 women undergoing ICSI without polar body diagnosis at the same time in the same fertility center. INTERVENTION(S): Polar body testing of ICSI oocytes by five-color fluorescence in situ hybridization. MAIN OUTCOME MEASURE(S): Pregnancy rate (positive fetal heartbeats) and live-birth rate (of at least one child). RESULT(S): The pregnancy and live-birth rates were significantly lower in women undergoing ICSI with polar body diagnosis than in women without polar body diagnosis. The negative effects of polar body diagnosis were evident in all analyzed subgroups, that is, women of different age groups, with one ICSI cycle, with transfer of a high-quality embryo, and with male factor infertility as indication for ICSI. CONCLUSION(S): Within the legal restrictions of the German embryo protection law aneuploidy testing of oocytes may not improve reproductive outcome.

A high oocyte yield for intracytoplasmic sperm injection treatment is associated with an increased chromosome error rate.

OBJECTIVE: To compare the chromosome error rate among oocytes from stimulated ovaries after retrieval of 1-5 oocytes, 6-10 oocytes, and >10 oocytes. DESIGN: Retrospective cohort study. SETTING: A university-based human genetic institute in collaboration with a private fertility center. PATIENT(S): Nine hundred thirty-three women undergoing intracytoplasmic sperm injection (ICSI) with a poor prognosis. INTERVENTION(S): Oocyte collection with ovarian stimulation. Polar body testing of ICSI oocytes for common chromosome errors. MAIN OUTCOME MEASURE(S): Chromosome error rate in oocytes, as determined by five-color fluorescence in situ hybridization. RESULT(S): In women less than 35 years and women between 35 and 40 years undergoing the first ICSI cycle, oocytes from the high-yield group had an increased likelihood for detectable chromosome errors (50.9% and 54.6%, respectively), compared to the intermediate-yield group (34.9% and 43.8%) and the low-yield group (23.3% and 41.2%). The overall high rate (>or=50%) of chromosomally abnormal oocytes in women more than 40 years appeared to be mainly due to the maternal age effect and increased only slightly with oocyte yield. CONCLUSION(S): Oocyte yield may be considered as an indicator of ovarian response to hormone stimulation. In women up to 40 years a high yield of oocytes after superovulation is associated with an increased chromosome error rate.