Pyrocarbon versus cobalt-chromium in the context of spherical interposition implants: an in vitro study on cultured chondrocytes.

In the context of shoulder surgical replacement, a new generation of spherical interposition implants has been developed, with the implant being a mobile spacer rubbing against the glenoid cartilage and humeral bone cavity. The aim of the present study was to compare pyrocarbon (PyC) versus cobalt-chromium (CoCr) implants, regarding preservation and regeneration of the surrounding tissues. The effect of the biomaterials on chondrocytes was analysed in vitro. Murine primary chondrocytes were grown on discs made of PyC or CoCr using two culture media to mimic either cartilage-like or bone-like conditions (CLC or BLC). Chondrocytes did grow on PyC and CoCr without alteration in cell viability or manifestation of cytotoxicity. The tissue-like cell membranes grown under BLC were examined for the chondrocyte's ability to mineralise (by alizarin red matrix staining, calcium deposit and alkaline phosphatase activity) and for their mechanical properties (by rheological tests). For the chondrocytes grown under CLC and BLC, extracellular matrix components were analysed by histological staining and immunolabelling. Under CLC, PyC promoted type II collagen expression in chondrocytes, suggesting that they may generate a more cartilage-like matrix than samples grown on both CoCr and plastic control. In BLC, the tissue-like cell membranes grown on PyC were more mineralised and homogenous. The mechanical results corroborated the biological data, since the elastic modulus of the tissue-like cell membranes developed on the PyC surface was higher, indicating more stiffness. Overall, the results suggested that PyC might be a suitable biomaterial for spherical interposition implants.

Idiopathic premature ovarian failure: what is the most suitable ovarian stimulation protocol?

OBJECTIVE: To evaluate the ovarian response to ovarian stimulation in women with idiopathic premature ovarian failure (POF) in a prospective, controlled, and sequential crossover pilot study. MATERIALS AND METHODS: Ten women with idiopathic premature ovarian failure and normal karyotype were included in the study. Phase I was comprised of three consecutive control cycles consisting each of estrogen progestin sequential therapy. Phase II was comprised of three consecutive treatment cycles combining the use of gonadotropin-releasing hormone agonist (GnRHa) in the background of estrogen priming, followed by gonadotropin ovarian stimulation and corticosteroid immunosuppression. RESULTS: Ovulation rates in the treatment cycles (0/10; 0%) did not differ from control cycles (0/10; 0%). CONCLUSIONS: The findings of this pilot study showed that the combination of estrogen priming, corticosteroid immune-suppression, GnRHa pituitary desensitization, and followed by gonadotropin ovarian stimulation is ineffective in restoring ovarian function in women with idiopathic POF.

Induction of final follicle maturation with a gonadotropin-releasing hormone agonist in women at risk of ovarian hyperstimulation syndrome undergoing gonadotropin stimulation and intrauterine insemination: proof-of-concept study.

OBJECTIVE: To evaluate the reproductive performance and safety of gonadotropin-stimulated intrauterine insemination (IUI) cycles in women at risk for ovarian hyperstimulation syndrome (OHSS) when final follicle maturation was induced using a gonadotropin-releasing hormone (GnRH) agonist. MATERIALS AND METHODS: Thirty-three women presenting with a history of cancelled ovarian stimulation for fear of OHSS, underwent repeat gonadotropin ovarian stimulation for IUI. They were all found to be at high-risk for OHSS once more, and were counseled to receive a GnRH agonist to trigger final follicle maturation before insemination. GnRH agonist trigger of ovulation (triptorelin) was given subcutaneously every 12 hours in three repeated doses: 0.3, 0.2, 0.2 mg, respectively. RESULTS: Induction with the agonist was associated with a 30.3% take-home pregnancy rate and 20% miscarriage rate. Multiple pregnancy rates were 26.7%. There were no reported cases of clinically significant moderate/severe ovarian hyperstimulation syndrome. CONCLUSIONS: The use of a GnRH agonist to trigger final follicle maturation in stimulated cycles of hyper responders was associated with a favorable reproductive outcome and no incidence of OHSS. The rate of multiple pregnancies nevertheless was found to be uncontrollably elevated, raising serious concerns regarding the safety of this protocol in standard clinical practice in the context of IUI.

In vitro fertilization in a patient with ovarian cancer (stage IC) following conservative surgery and chemotherapy: a case report.

A 30-year-old female underwent left salpingo-oophorectomy followed by chemotherapy for Stage IC adenocarcinoma of the ovary. Three years later she had ovarian hyperstimulation and in vitro fertilization (OH-IVF) resulting in a singleton pregnancy. During cesarean section peritoneal washings and biopsies were negative for recurrence. Seven years after the initial diagnosis, the patient is still free of any disease. In conclusion, OH-IVF may be considered in young patients with early ovarian cancer treated with conservative surgery and chemotherapy.

Liver infarction in a woman with systemic lupus erythematosus and secondary anti-phospholipid and HELLP syndrome.

We report a 39-year-old primigravida, a case of systemic lupus erythematosus (SLE) and secondary anti-phospholipid syndrome (APS) with a smooth antenatal course who delivered by caesarean for non-reassuring foetal heart rate. On day 2 postoperatively, she developed a sudden severe colicky upper abdominal pain with tachypnoea, dyspnoea, and tachycardia, and blood pressure (BP) reaching 150/95 mmHg. Computed tomography of the abdomen revealed lesions consistent with liver infarction. She developed haemolytic anaemia, elevated liver enzymes, and low platelets (HELLP syndrome); heparin and methylprednisolone were started. On day 3, BP normalized, respiratory symptoms improved but abdominal symptoms persisted. Methylprednisolone was increased to 80 mg/day on day 8 when she had significant clinical response and was discharged on day 16. This case emphasizes that a morbid clinical course including liver infarction should be anticipated in patients with SLE and APS complicated with HELLP syndrome.

[Pneumococcal endocarditis in native valves. Three original observations in the adult]. / Endocardites à pneumocoque sur valves natives. Trois observations originales chez l'adulte.

The authors report three observations of acute pneumococcal endocarditis located in the aorta in one case, and mitral in the two other cases, admitted over a period of 4 years. Two of the three patients required surgical correction, with no surgical complications. Follow-up revealed a rare complication of infectious endocarditis linked to rupture of the head of the two anterior mitral pillars associated with an abscess. The severity of pneumococcal endocarditis is emphasised, concurring with the data from the literature. The role of echocardiography in pneumococcal septicaemia is clear; transthoracic examination is justified in every case of septicaemia, and transoesophageal echography complements this examination in case of diagnostic doubt or cardiovascular complication.

Effect of human follicular fluid on sperm survival.

OBJECTIVE: To study the effect of follicular fluid (FF) on sperm survival. METHOD: Swim-up sperm suspensions obtained from 20 men with normal semen analysis were incubated with Ham's F-10 only and Ham's F-10 supplemented with 20% FF or 20% serum. Sperm motility was recorded every 12 hours for 72 hours. RESULTS: Sperm motility was maintained in all media for 48 hours. However, significantly more sperm samples remained motile at 72 hours in medium supplemented with FF and serum as compared to Ham's F-10 only. CONCLUSION: FF has a positive effect on conserving sperm motility as a function of time.

The placenta in meconium staining: lesions and early neonatal outcome.

PURPOSE: To evaluate the immediate neonatal outcome and the presence of various placental lesions in 96 pregnancies with meconium-stained amniotic fluid. MATERIALS AND METHODS: The patients were divided into a group with acute (N = 41) and subacute and chronic (N = 55) meconium staining of the placenta. Apgar scores, arterial cord pH and admission to the neonatal intensive care unit (NICU) were determined in addition to the findings on gross and microscopic examination of the placentas. RESULTS: Of the 53 live births with subacute and chronic meconium staining, 13% had Apgar Scores < or = 7 at 5 minutes compared to 7% with acute meconium staining. Similarly, a significantly lower umbilical artery pH was determined in the former group [(32%) versus (7%)], (p < 0.01). When 9 different pathologic lesions of the placenta were evaluated microscopically, the frequency of villous vascular thrombosis (25.4%), infarcts (38%), acute chorioamnionitis (20%), villous edema (9.1%) and villitis (14.5%) was significantly higher in the group with longer meconium exposure compared to the other group (2.4%), (9.7%), (7.3%), (0%), and 1 (2.4%), respectively. In addition, when tested for 4 different lesions, cases with acute meconium were less likely to have one or more lesions. When one or more placental lesions were found, NICU admission rate was significantly higher in the patients with subacute and chronic meconium. CONCLUSION: Subacute and chronic meconium discharge is associated with significant placental lesions and an increased risk of adverse pregnancy outcome in the immediate neonatal period.

Failure of fertilization after intracytoplasmic sperm injection in a patient with Kartagener's syndrome and totally immotile spermatozoa: case report.

Patients with Kartagener's syndrome (KS) are invariably infertile with totally immotile spermatozoa. Intracytoplasmic sperm injection (ICSI) is considered to be the treatment of choice for patients with immotile spermatozoa. We report the second KS case in the literature from whom immotile spermatozoa from the ejaculate failed to fertilize mature oocytes after ICSI. The role of micromanipulation in the treatment of KS patients is discussed.

Artificial endometrial preparation for oocyte donation using synthetic estrogen and progestogen.

OBJECTIVE: To evaluate the outcome of an oocyte donation program using synthetic estrogen and progestational agents for uterine preparation. METHODS: Conjugated estrogen, 1.25 mg per day at increasing doses and dydrogesterone, a synthetic progestogen, 30 mg per day were used for uterine priming. All embryo transfers were done on day 2 of progestogen supplementation. RESULTS: The pregnancy rates were 38% per embryo transfer. The ongoing pregnancy rate was 31% with an abortion rate of 20%. CONCLUSION: Endometrial preparation in an oocyte donation program using orally administered synthetic estrogen and progestogen gives pregnancy rates comparable to those reported with natural products.

Intrauterine insemination IUI: the effect of ovarian stimulation and infertility diagnosis on pregnancy outcome.

We determined the intrauterine insemination (IUI) pregnancy outcome in the same group of patients when applying different methods of ovulation induction. A group of patients with unexplained (no. 46) and male factor infertility (no. 101) consented to have the following treatment protocol at the American University of Beirut-Infertility Center: IUI to be performed in three natural ovulatory cycles in all patients, then in three clomiphene citrate (CC) stimulated cycles in the remaining non-pregnant patients, and then three cycles with controlled ovarian hyperstimulation (COH) in the remaining group. Of the total 147 patients 130, 138 and 123 underwent 273 natural, 278 CC and 266 COH IUI cycles, respectively. Semen processing for IUI was done by washing the sperm twice and using the swim-up technique. The chi-square test was used for statistical analysis. Pregnancy rate per cycle of IUI with COH (9.8%) was significantly higher than that of IUI in natural cycles (3.3%) but approached significance when compared to IUI with CC cycles (5.4%). Also unexplained infertility cases had a significantly higher pregnancy rate (58.7%) when compared to that of male factor cases (22.8%). IUI still has a place in the treatment of infertility due to selective causes. Combined with COH, IUI gives the best pregnancy rate although its benefit with natural or CC cycles remains obvious.

Clomiphene citrate challenge test: cycle to cycle variability of cycle day 10 follicle stimulating hormone level.

The clomiphene citrate challenge test (CCCT), a means of assessing ovarian reserve, was shown by several studies to have an excellent predictive value for achieving conception in natural cycles, during ovulation induction and in-vitro fertilization cycles. Accordingly we elected to study the cycle to cycle variability of CCCT so as to determine the reliability of a single CCCT result. Two groups of patients were studied, the first (n = 40) were those patients who were performing the test because it was indicated, and the second (n = 24) were those who were receiving clomiphene citrate for ovulation induction. In both groups CCCT intercycle variability was significant in 75% of the cases, but this variability altered the prognostic values of the test in only 40% of the first group. In conclusion, our study showed a high percentage of intercycle variability of CCCT but further studies are needed to evaluate the influence of this variability on potential conception.

Reproductive outcome following abdominal metroplasty.

OBJECTIVE: To evaluate pregnancy outcome following uterine unification procedures in patients with uterine anomalies. METHODS: A retrospective survey included all abdominal metroplasty procedures performed on 43 patients at the American University of Beirut Medical Center between January 1, 1974 and December 31, 1991. Age at metroplasty, type of anomaly and surgical procedures, as well as preoperative and postoperative reproductive performance were all recorded. RESULTS: Forty (93%) out of 43 patients who underwent metroplasty had postoperative live births compared with five (12%) prior to surgery. The fetal wastage rate dropped from 93% pre- to 16% postoperatively. All seven patients with a history of primary infertility conceived and had live births. CONCLUSION: Our data suggest a remarkable improvement following abdominal metroplasty in patients with both typical and uncharacteristic preoperative reproductive performance.

ABO and Rh(D) blood group distribution and their implication for feto-maternal incompatibility among the Palestinian population.

ABO and Rh(D) blood group distribution was evaluated among Palestinian women in the southern area of the West Bank and east Jerusalem. Eleven per cent of women were Rh(D) negative. The review of the last 12,169 deliveries at Makassed Hospital showed that 4.8% of Rh(D)-negative mothers gave birth to Rh(D)-positive infants with haemolytic disease of the newborn. Thirty per cent of A or B infants born to O Rh(D)-positive mothers had a positive direct antiglobulin test with the presence of allo-immune A or B antibody in infant serum. ABO incompatibility was a major reason for phototherapy during the 1st week of life. Results and possibilities for prevention are discussed.

Uterine unification procedures: post-operative obstetrical outcome.

Seventeen patients with different uterine anomalies underwent unification procedures for various indications. Preoperative obstetrical performance segregated them into three main groups: seven patients had only first trimester abortion (group A), seven patients had second trimester abortion with or without first trimester abortion (group B) and three patients were infertile (group C). Postoperatively, all seven patients in group A became pregnant with 100% viable pregnancy rate. Six patients in group B became pregnant (85.7%) and five (57%) had living children. All three patients with primary infertility (group C) became pregnant and two had living babies. The overall pregnancy rate was 94.1% and the viable pregnancy rate was 76.5%. Uterine unification procedures are recommended for patients with repeated first trimester abortions as well as for selected patients with infertility.