Valores de hormona antimülleriana (HAM) y recuento de folículos antrales (RFA) en casos con fallo reproductivo previo / Anti-Müllerian hormone values and antral follicle count in patients with prior reproductive failure

Objetivo. Determinar si la HAM y el RFA pueden emplearse para predecir reserva ovárica. Sujetos y métodos. Se compara el RFA y los valores de la HAM en FIV/ICSI: bajas, normo y altas respondedoras, las primeras con fallos de TRA previos (un FIV/ICSI). El RFA se llevó a cabo con US 3D con modos superficie, inverso y AVC. Resultados. Existió correlación entre HAM y RFA. Ambos reflejan la reserva ovárica. Las diferencias entre normo y bajas respondedoras fueron significativas. RFA, HAM y edad mostraron ser los mejores parámetros. Las diferencias entre normo y altas respondedoras fueron igualmente significativas, mostrando ser predictivos de hiperestimulación. El grupo de número de ovocitos recuperados (<=5 vs >5) mostró ser predictivo de maduración, no de calidad embrionaria ni de pronóstico reproductivo. Conclusiones. La determinación de HAM y RFA no permite negar un nuevo intento FIV, pero obligan a informar a la pareja de las bajas probabilidades de éxito. Valores de HAM y RFA superiores a 27,21pmol/L y 15 folículos son riesgo de hiperestimulación. El pronóstico reproductivo muestra alto índice de cancelaciones (22% de ciclos iniciados) muy bajo de gestaciones (16,7%), con solo un 6,2% de embarazos evolutivos. Valores bajos de HAM (<9,28pmol/L) predicen mal pronóstico con un 72,7 y 64,5% de sensibilidad y especificidad. La mejor aproximación predictiva es la combinación HAM más RFA, con un área bajo la curva de 82% (AU)

Objective. To determine whether anti-Müllerian hormone (AMH) and antral follicle count (AFC) could be used as predictors of ovarian reserve. Subjects and methods. We compared AFC and AMH values in IVF/ICSI in low, normal and high responders. Low responders had undergone previous assisted reproduction technologies (ART) and had experienced at least one IVF failure.AFC was carried out with US 3D surface, inverse mode, and automatic volume calculation. Results. AMH and AFC were correlated and reflected the actual ovarian reserve. Differences between normal and low responders were significant. The best predictors of ovarian reserve were AMH, AFC and age. Differences between normal and high responders were also significant and were predictors of hyperstimulation. Grouping patients according to oocyte recovery (<= vs. >5) was predictive of maturation but was not predictive of embryo quality or reproductive outcome. Conclusions. Low AMH values (<9.28pmol/L) predicted poor outcomes with a sensitivity and specificity of 72.7% and 64.5%. The best predictive approach was the combination of AMH plus AFC, resulting in an area under the curve of 82.2%. AMH and AFC above 27.21pmol/L and 15 follicles indicated a high risk of hyperstimulation. The reproductive outcome showed a very high cancelation rate (22% of initiated cycles), very low pregnancy rates (16.7%) and only 6.2% of ongoing pregnancies. Determination of AMH and AFC levels should not be used to reject candidates for IVF treatment but to inform patients with low levels of the very poor probability of success and the use of other alternatives (AU)

Fetal megacystis: differential diagnosis.

The purpose of our retrospective observational series was to determine whether the sonographic characteristics of fetal megacystic bladders can be used to reliably establish the most likely diagnosis in fetuses with this condition. The sonographic records of pregnant patients referred to our institutions over a 10-year period who were found on initial 2-dimensional sonography to be carrying fetuses with megacystis were examined for evidence of a keyhole sign, bladder thickness, amniotic fluid index, and fetal sex. When available, 3-/4-dimensional sonography, Doppler angiography, tomographic ultrasound imaging, virtual organ computer-aided analysis, and automatic volume calculation were used as part of the detailed fetal anatomic survey. Twenty fetuses with megacystis were identified. Seventeen were male; 2 were female; and 1 had ambiguous genitalia. All male fetuses with megacystis originally had a diagnosis of prune belly syndrome. The diagnosis for 10 male fetuses with a keyhole sign was changed to megacystis secondary to posterior urethral valves. The fetus with ambiguous genitalia had prune belly syndrome. One of the female fetuses had a diagnosis of urethral atresia, and the diagnosis for the other female fetus was megacystis-microcolon-intestinal hypoperistalsis syndrome. In conclusion, in fetuses with megacystic bladders, it is possible to distinguish between cases with prune belly syndrome, posterior urethral valves, urethral atresia, and megacystis-microcolon-intestinal hypoperistalsis syndrome by a detailed anatomic survey using 2- and 3-/4-dimensioinal sonographic techniques.

Multiple congenital contractures (congenital multiple arthrogryposis).

Arthrogryposis, is the occurrence of joint contractures of variable etiology that start prenatally. Arthrogryposis may result from neurologic deficit, neuromuscular disorders, connective tissue abnormalities, amniotic bands, [figure: see text] or fetal crowding. Arthrogryposis may result from no apparent hereditary causes (neuropathic, for example) or may be the result of hereditary factors (myopathic form, for example). Ultrasound diagnosis depends on observation of scant or absent motion of fetal extremities. Prognosis depends on the specific etiology of the contractures.

Gravidez ectópica abdominal: diagnóstico ultrassonográfico e anátomo-patológico - relato de um caso / Abdomonal ectopic pregnancy: anatomy-pathologic and ultrasonographic diagnosis - a case report

Os autores fizeram um relato sobre a gravidez ectópica abdominal com revisäo de literatura enfocando aspectos da etiologia, fisiopatologia, incidência, diagnóstico e tratamento. Apresentaram um caso raro em que a ultrassonografia e anatomia patológica foram de fundamental importância para o diagnóstico

Itraconazol no tratamento da candidíase vaginal: estudo comparativo entre 1 e 3 dias / Itraconazole in the treatment of vaginal candidosis: comparative study between 1 and 3 days treatment

Foram estudadas 140 pacientes portadoras de candidíase vaginal, confirmadas micologicamente em um estudo multicêntrico aberto, comparativo e randomizado com dois esquemas terapêuticos: 200 mg duas vezes ao dia, por um dia ou 200 mg uma vez ao dia, por três dias. Uma semana após o final do tratamento, os resultados mostraram que 87 por cento e 92 por cento, respectivamente para um e três dias de tratamento, estavam curadas clínica e micologicamente. A tolerabilidade foi considerada boa, ocorrendo efeitos colaterais leves, transitórios, que desapareceram espontaneamente, restritos ao trato gastrintestinal. Os autores concluem pela eficácia do esquema de um dia de tratamento com itraconazol para candidíase aguda e crônica

Secnidazol em dose única no tratamento da tricomoníase vaginal: comparaçäo entre a administraçäo matinal e a noturna / Single-dose of secnidazole in the treatment of vaginal trichomoniasis: a comparison between matinal and evening dosis

Este foi um estudo comparativo, simples-cego, com grupos paralelos, onde se avaliou a eficácia e a tolerabilidade do secnidazol, administrado em dose única de dois gramas (4 comprimidos de 500 mg) no tratamento da tricomoníase vaginal. Uma populaçäo de 111 pacientes foi incluída no estudo, dividida em dois grupos: um grupo de 68 pacientes recebeu o secnidazol no café da manhä e duas cápsulas de placebo no jantar, enquanto que o outro, com 43 pacientes, teve tratamento invertido. O mesmo esquema foi adotado para os parceiros sexuais. A eficácia do secnidazol foi considerada excelente, tendo havido cura da tricomoníase em 100% das pacientes no 7§ dia após o tratamento. A tolerabilidade foi melhor no grupo que recebeu secnidazol no período vespertino em relaçäo ao número e intensidade de reaçöes colaterais, quando comparado ao grupo matinal de tratamento