A modified method of intracytoplasmic sperm injection without the use of polyvinylpyrrolidone.

In a controlled study we compared the outcome of intracytoplasmic sperm injection (ICSI) performed by two different methods. The oocytes from 20 patients were equally divided into two groups and injected either by conventional ICSI using polyvinylpyrrolidone (PVP) or by a modified PVP-free ICSI procedure. While in the conventional ICSI method the spermatozoon is aspirated into the injection pipette, in the modified ICSI procedure the spermatozoon is attached to the end of the narrow micropipette by aspirating its tail. The sperm head is never drawn into the pipette. Accordingly, even a fast-moving spermatozoon can be 'caught' easily. As a result of such an aspiration the spermatozoon loses its motility. Therefore, PVP is required neither to slow down the movement of the spermatozoon nor to facilitate the movement of the solution in the injection pipette. A total of 230 mature oocytes were injected by both methods and the results were analysed. No differences were observed in survival rate between the two ICSI procedures (89% and 91%, respectively). However, the proportion of normally fertilized oocytes was significantly higher after microfertilization by modified ICSI (74%) when compared with the outcome of the conventional ICSI method (62%). The frequency of abnormal fertilization was not influenced by the method of ICSI used. The cleavage rate and quality of resulting embryos were also comparable. In conclusion, we have demonstrated a modified ICSI method which does not require the use of PVP. When compared with the conventional ICSI procedure, even better fertilization rates can be achieved. The proposed ICSI modification may provide an alternative procedure for elimination of the potentially harmful effects which may be associated with conventional ICSI.

Critical care in South America. The new tradition.

This article offers a brief discussion of some of the aspects of clinical and academic realities of critical and intensive care medicine in South America. Organizational efforts of collaborating physician and nursing intensivists from South American countries, Spain, and Portugal are outlined. Discussion includes the issues of funding and support of health care delivery of the critically ill, and some of the clinical syndromes not commonly seen in North America and Europe, but seen by intensivists in South America.

[Adrenal cortex hormones in the mother and fetus in premature labor]. / Hormóny nadoblickovej kôry matky a plodu pri predcasných pôrodoch.

In a group of 126 pregnant women with imminent premature delivery between the 20th and 37th week of gestation where after weekly intervals the serum cortisol and corticosterone levels from the cubital vein was assessed, it was revealed that in the group of women who aborted or had a premature delivery, as well as in women who had the delivery in term the corticoid values vary greatly: cortisol between 370 and 500 nmol/1 and corticosterone 70 to 240 nmol/1. In both groups there is a marked difference in final values. The latter have in women with premature deliveries a rising trend and in the group where pregnancy proceeded successfully to term a declining trend. Glucocorticoid blood levels from the umbilical arteries in the group of women who had an abortion or premature delivery, as compared with women who delivered their baby in term, no significant differences were recorded. However, the glucocorticoid blood levels from the umbilical veins were significantly higher in women who had premature deliveries or abortions, as compared with women who gave birth to their babies in term. The glucocorticoid levels in amniotic fluid collected during delivery did not manifest significant differences between the two groups of pregnant women.

Cost containment: the Americas. Argentina.

For many years, the evolution of Argentina's healthcare system has been influenced by political and economic instability. Inflation and hyperinflation have led to anarchic development of both health administration systems and hospitals. Critical care grew in a similar manner, resulting in a mix of > 500 critical care units with very different levels of technology and trained personnel. Cost-containment policies have been implemented mainly by health administration systems. Public institutions (university and large provincial and county hospitals) have suffered hard budget cuts that have resulted in a decrease in the quality of care and the loss of trained human resources. Union organizations, which cover the healthcare costs of > 60% of the population, implemented a low reimbursement policy that resulted in low standards of care for critically ill patients. The country's private hospital system is extremely heterogenous, ranging from little, simple institutions with a 20- to 30-bed capacity to great private institutions with international standards of care. Cost-containment efforts have been sporadic and isolated, and statistical data to analyze the results are lacking. In order to formulate a strategy of cost-containment in the near future, accreditation and categorization of critical care units and human resources training are being implemented by health authorities and the Argentine Society of Critical Care Medicine.

[The significance of color [Collor] flowmetry in the differential diagnosis of adnexal tumors]. / Význam Collor-Flowmetrie (CFI) v diferenciálnej diagnostike adnexálnych tumorov.

OBJECTIVE: to specify the diagnostic importance of arteria ovarica flowmetry, in relation to morphological ultrasonic criteria in the diagnosis adnexal masses. SETTING: The authors measured arteria ovarica flow in women suffering from adnexal masses, and compared flowmetry with the morphological ultrasound score for extrauterine mass evaluation acord Sassone. SUBJECTS: Open group of 25 women with diagnosis of adnexal mass in a prospective non-comparative study, underwent laparotomy for this diagnosis. INTERVENTION: The SSD-680 Aloka scanner with Collor Doppler facility, using transvaginal 5.5 MHz probe. MAIN OUTCOME MEASURES: Arteria ovarica flow on the side of adnexal mass is significantly higher in solid and mixed ovarian tumours (Sassone index > 7). Cystic tumours and functional ovarian cysts (Sassone index < 7) were responsible for lower than average flow in the a. ovarica. RESULTS: an indirect relation of the arteria ovarica flow on the side of the adnexal mass and the grade of morphological changes evaluated acording Sassone scoring system was found. Significantly lower value of Pulzatility index, Rezistence index and S/D ratio related with higher haemoperfusion of adnexal region, was found in solid and mixed ovarian tumours.

Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients.

Falls in gastric intramucosal pH (pHi) are associated with morbidity and mortality in patients admitted to intensive-care units (ICU). We tested the hypothesis that ICU outcome can be improved by therapy guided by changes in pHi and aimed at improving systemic oxygen availability. We studied 260 patients admitted to ICUs with APACHE II scores of 15-25. After insertion of a gastric tonometer, each patient was randomly assigned to a control or protocol group within the admission pHi category (normal = 7.35 or higher; low = below 7.35). The control groups were treated according to standard ICU practices. The protocol groups received, in addition, treatment to increase systemic oxygen transport or to reduce oxygen demand, whenever the pHi fell below 7.35 or by more than 0.10 units from the previous measurement. The protocol was used, because pHi fell, in 67 (85%) of the protocol group with normal pHi on admission. There were no significant differences between protocol and control groups in demographic characteristics, admission blood gases or haemoglobin concentration, number or type of organ system failures, or the intensity of ICU care. For patients admitted with low pHi, survival was similar in the protocol and control groups (37% vs 36%), whereas for those admitted with normal pHi, survival was significantly greater in the protocol than in the control group (58% vs 42%; p less than 0.01). Therapy guided by pHi measurements improved survival in patients whose pHi on admission to ICU was normal. pHi-guided resuscitation may help improve outcome in such patients by preventing splanchnic organ hypoxia and the development of a systemic oxygen deficit.

[Antioxidative enzymes in red blood cells in women with late gestosis]. / Antioxidacné enzýmy v cervených krvinkách zien s neskorou gestózou.

The authors investigated a group of 30 pregnant women with severe late gestosis and focused attention on assessment of the glucose-6-phosphate dehydrogenase and catalase activity in red blood cells of these patients. They found a statistically significant decline of G6PD activity in red blood cells, as compared with controls, i.e. healthy pregnant women. The decline of catalase activity is smaller and not statistically significant. Based on the assembled results they assume that the equilibrium between oxidation processes and anti-oxidation protection of red blood cells is impaired and this has an impact on their functional capacity and may play an important role in the development of various pathological conditions during pregnancy, incl. late gestosis.

Clasificación mapuche y fracasos orgánicos precoces: resultados del estudio multicéntrico / MAPUCHE classification and precocious organic failure results of multicentral study

Se presentan los resultados referentes a la mortalidad en terapia intensiva en función de la determinación de niveles de gravedad MAPUCHE y fracasos orgánicos precoces en el marco del estudio multicéntrico de la SATI. En el mismo se recogieron los datos de dos mil doscientos pacientes provenientes de 22 centros de terapia intensiva de diversos puntos del país. La distribución de los enfermos mostró que la mayoría se hallaba en el nivel II. La mortalidad general fue del 30,9 por ciento y ella se incrementaba significativamente a medida que lo hacían los niveles MAPUCHE, siendo mayor en pacientes clínicos en el nivel I y II. Los subniveles demostraron idéntica correlación con la mortalidad. La presencia de fallas precoces determinó una mortalidad significativamente mayor y el número de las mismas se correlacionó significativamente con la mortalidad. Los resultados muestran la utilidad de los sistemas empleados en la determinación de los niveles de gravedad en pacientes críticos asistidos en centros diferentes. Se recalca la importancia de la realización de estudios multicéntricos para valorar la utilidad de uno o más indicadores (AU)

Clasificación mapuche y fracasos orgánicos precoces: resultados del estudio multicéntrico / MAPUCHE classification and precocious organic failure results of multicentral study

Se presentan los resultados referentes a la mortalidad en terapia intensiva en función de la determinación de niveles de gravedad MAPUCHE y fracasos orgánicos precoces en el marco del estudio multicéntrico de la SATI. En el mismo se recogieron los datos de dos mil doscientos pacientes provenientes de 22 centros de terapia intensiva de diversos puntos del país. La distribución de los enfermos mostró que la mayoría se hallaba en el nivel II. La mortalidad general fue del 30,9 por ciento y ella se incrementaba significativamente a medida que lo hacían los niveles MAPUCHE, siendo mayor en pacientes clínicos en el nivel I y II. Los subniveles demostraron idéntica correlación con la mortalidad. La presencia de fallas precoces determinó una mortalidad significativamente mayor y el número de las mismas se correlacionó significativamente con la mortalidad. Los resultados muestran la utilidad de los sistemas empleados en la determinación de los niveles de gravedad en pacientes críticos asistidos en centros diferentes. Se recalca la importancia de la realización de estudios multicéntricos para valorar la utilidad de uno o más indicadores