Prognostic value of serum progesterone and LH values on the day of hCG administration in IUI GnRH antagonist cycles.

OBJECTIVE: to evaluate the effect of LH surge and progesterone rise in IUI cycles under gonadotropin stimulation with GnRH antagonist coadministration on pregnancy rates (PR). STUDY DESIGN: The population under study consisted of 152 women prospectively studied and subjected to IUI. RESULTS: The higher the progesterone cutoff value, the lower the PR were 26.5% and 10.9% when the cutoff was 1 ng/mL, 26.0% and 8.6% when the cutoff was 1.2 ng/mL, 25.6% and 7.1% when the cutoff was 1.4 ng/mL and 25.3% and 0% when the cutoff was 1.6 ng/mL. CONCLUSION: In IUI cycles under GnRH antagonist coadministration, serum progesterone levels over 1.0 ng/mL are associated with lower PR, the higher the progesterone levels, the lower the PR.

Human chorionic gonadotropin (hCG) plasma levels at oocyte retrieval and IVF outcomes.

PURPOSE: The aim of our study was to ascertain the influence of hCG levels at oocyte pick-up on IVF outcomes, and their relationship with clinical parameters. METHODS: A prospective study was performed including 473 women undergoing IVF, aged under 40 years. Blood samples to analyze hCG levels were obtained at the time of follicular aspiration, 36 h after the administration of 250 µg of recombinant hCG. RESULTS: Neither the numbers of oocytes obtained or fertilized, nor the pregnancy rate, were correlated with hCG levels. Moreover, hCG values were very similar in women who did and did not become pregnant (123.3 ± 48.7 and 117.5 ± 44.7 mUI/mL). Cases in which no oocytes were recovered after follicular aspiration had similar hCG levels to those in which more than 1 oocyte was obtained. On the other hand, hCG levels were negatively related to body mass index, weight, and age. CONCLUSIONS: These data indicate that after the administration of 250 µg of recombinant hCG, hCG levels are not responsible for failure to recover oocytes. Specifically, there was no correlation between plasma hCG levels and the number of oocytes obtained or other markers of IVF outcome. There was, however, an inverse relationship with BMI, body weight and age.

Brief cognitive tests as a decision-making tool in primary care. A population and validation study.

INTRODUCTION AND OBJECTIVES: Brief cognitive tests (BCT) are used in primary care (PC) for the detection of cognitive impairment (CI). Still, there are little data on their diagnostic utility (DU) in a community setting. This work evaluates the DU at the population level of Fototest, T@M, AD8 questionnaire and MMSE. It provides new cut-off points (CoP) validated in a CI early detection program. MATERIAL AND METHODS: In the population and validation samples, the evaluation was carried out in two phases, a first of screening and administration of BCT and a second of clinical diagnosis, blinded to the results of the BCT, applying the current NIA-AA criteria. The DU of BCT in the population sample was evaluated with the area under the ROC curve (aROC). Youden index and the CoP with the best specificity that ensured a sensitivity of 80% were used to decide on the most appropriate CoP. The sensitivity, specificity, and predictive values for these CoP were calculated in the validation sample. RESULTS: 260 participants (23.1% with CI) from the population sample and 177 (42.4% with CI) from the validation sample were included. The Fototest has the best UD at the population level (aROC 0.851), which improves with the combination of Fototest and AD8 (aROC 0.875). The proposed CoP are AD8 ≥ 1, Fototest ≤ 35, T@M ≤ 40, and MMSE ≤ 26. CONCLUSION: BCT are helpful in detecting CI in PC. This work supports the use of more demanding PoC.

[Bilateral chylothorax in a case of metastatic adenocarcinoma of unknown primary]. / Quilotórax bilateral en un caso de adenocarcinoma metastásico de primario desconocido.

We present a case of bilateral chylothorax and lung carcinomatous lymphangitis. Clinical evolution was unfavorable, leading to death due to respiratory insufficiency. Necropsy showed widespread metastatic adenocarcinoma of unknown primary. From this case, we review the etiology, diagnosis and therapeutic options available in chylothorax.

Relationship between socio-demographic and clinical variables, and health-related quality of life in patients with inflammatory bowel disease.

OBJECTIVE: The principal aim of the present study is to evaluate the influence of socio-demographic and clinical variables on health-related quality of life (HRQL) in patients with inflammatory bowel disease. PATIENTS AND METHOD: This was a cross-sectional study. health-related quality of life was measured with the Inflammatory Bowel Disease Questionnaire (IBDQ). A total of 120 patients, 60 with ulcerative colitis and 60 with Crohn s disease, participated in the study. RESULTS: No significant differences were observed between ulcerative colitis and Crohn s disease patients in IBDQ dimensions. However, a multivariate analysis revealed that sex, type of treatment, extraintestinal symptoms, number of relapses in previous year, satisfaction with surgery, and need for psychological support were related to HRQL. CONCLUSIONS: The identification of these variables associated with HRQL in patients with inflammatory bowel disease shows them to be basically non-disease factors. Knowledge of such elements can turn out to be very useful in order to guide future research and modify specific factors in further interventions.

Pre- and postnatal aminopeptidase activities in the rat brain.

Research concerning the functional role of brain peptides is performed, in part, by studying peptidase enzymes which might be involved in brain peptide processing or inactivation. Aminopeptidase (AP) activity has been proposed as a candidate regulator of the degradation of these peptides. In this paper, changes in Lys- and Leu-aminopeptidase activities in rat brain hemispheres, cerebellum and medulla were examined in 20 day fetuses and one day postnatal subjects. Aminopeptidase activities were studied by measuring the rate of hydrolysis of the artificial substrates Lys- and Leu-2-naphthylamides (fluorimetrically detected in triplicate). Both enzyme activities increase from the last fetal stage up to the first day of birth in all the brain areas examined except for the case of Leu-AP activity in the medulla. It is suggested that these activities play a part in the neurochemical changes that take place during rat brain maturation, possibly by regulating the activity of several neuroactive peptides.

Demand pacemaker arrhythmias caused by intermittent incomplete electrode fracture. Diagnosis with testing magnet.

This report describes how the testing magnet was used to diagnose intermittent and incomplete electrode fracture in two patients with an implanted demand pacemaker. During fixed-rate pacing the interval between two consecutive pacemaker spikes intermittently doubled in length, suggesting that the pulse generator was continuing to fire on time into a transiently disrupted circuit. Attenuated pacemaker spikes occurring at the anticipated time of pacemaker discharge also provided a diagnostic clue. Ventricular electrograms from the defective electrodes registered small false signals.

Failure in the rate adaptation of the atrial refractory period: its relationship to vulnerability.

We evaluated the relationship of rate-dependent changes in atrial refractoriness to atrial vulnerability in 39 patients. Vulnerability was considered present when sustained atrial tachyarrhythmias, lasting longer than 1 minute, could be provoked with one to three extra stimuli. Adaptation of atrial refractory period duration to rate was defined as: normal: steep rate reduction with a linear correlation slope value of 0.08 or more; non-adaptation: absence of rate reduction, the slope value being 0 to 0.01; poor adaptation: slight reduction with rate, the slope having values of 0.02 to 0.07. Increased vulnerability was demonstrable in 16 of 17 patients with non-adaptation of the effective refractory period (ERP), and in 10 of 10 with a similar defect of the functional refractory period (FRP); in the intermediate category (poor adaptation) the results for ERP and FRP were 7/11 and 5/6. By way of contrast when both measurements showed normal adaptation, vulnerability was elicited in 2/9 patients. The significance between these groups showed P less than 0.005. Of 17 patients with atrial arrhythmia by Holter, 14 showed poor or non-adaptation of the ERP. It is suggested that poor or absent rate adaptation of the atrial refractory period, and a propensity to atrial fibrillation or flutter, constitute a clinical entity not previously described.

[Cardiac rehabilitation results at the physical, psychological, sexual and work levels]. / Resultados de la rehabilitación cardíaca a nivel físco, psicológico, sexual y laboral.

Nowadays, the finality of the cardiac rehabilitation programs (CR) is fundamentally directed to improve the patient's life quality, connected to the functional capacity increase, symptoms improvement, psychological stability and correct social and labour reintegration. Physically, it is showed that CR programs increase the total effort capacity, decrease the HR and BP figures for a fixed submaximum effort level and decrease or eliminate the symptomatology, on myocardial ischemia cases, on cardiac insufficiency cases and on peripheral arterial disease. The physical improvement produce improvement at a psychological level, reflected on a physical and sexual self-esteem, depressive humor improvement, labour stress and on the participation on leisure and sexual activity. Physical and psychological comfort it is going to be a good support facing to the labour reintegration, although it will depend on the intellectual and study level, social status and family economical situation.

[Study of the cumulative survival of 1,697 cardiac pacemakers. Superiority of the totally hermetically sealed apparatus]. / Etude de la survie cumulée de 1697 stimulateurs cardiaques. Supériorité des appareils à herméticité totale

A comparison of the "cumulative survival" of 1073 totally sealed cardiac pacemakers with that of 624 unsealed models showed the marked superiority of the former group. Calculation of the "cumulative survival" is not only a method which allows a comparison of technological advantages, but also one which can yield the selective replacement time". This concept has direct implications for clinical practice for, once the "elective replacement time" is known for a particular model, it becomes possible to replace the pacemaker electively without having to wait for it to break down or run out, events which are in any case unpredictable and possibly sudden. Knowledge of the "elective replacement time" will also avoid changes being made too early, which is a source of unnecessary expense for the Social Security.

[Continuous electrocardiographic recording. Clinical, diagnostic and therapeutic value]. / L'enregistrement électrocardiographique continu intérêt clinique, diagnostique et thérapeutique

The interest of permanent electrocardiographic recording in ambulatory patients is not restricted to the demonstration of the cardiogenic origin of some functional disturbances. This method provides the proof of the often non fiable character of anamnesis for the diagnosis of arrhythmias. It shows the close relationship between "minor" (extra-systoles) and "major" (tachycardias) arrhythmias, and consequently the prognostic value of the former in relation with the latter. Continuous ECG follow-up affords in the assessment of anti-arrhythmic drugs efficiency a higher safety than that provided by the conventional simple clinical follow-up.

[Arrhythmia in patients with demand pacemakers caused by faulty conduction material in the electrode. 36 cases--Value of Holter monitoring]. / Arythmies des stimulateurs cardiaques à la demande par défauts du matériel de conduction sonde-électrode. 36 cas - Intérêt de la méthode de Holter.

36 cases of paroxysmal pacing failure in patients with demand pacemakers are reported. The possible causes of pacing lead problems, excluding inhibition by muscular contractions, are related to the distal extremity at the electrode itself, on the lead (rupture) or at the connection between the lead and the pulse generator. The recognition of the precise cause of the pacing failure leads to appropriate treatment. These arrrythmias are not always easy to detect and Holter monitoring is a very useful means of diagnosis.

[Computers in a center for cardiac stimulation]. / L'informatique dans un centre de stimulation cardiaque.

The authors describe a computer system with details of the hard ware and filing organisation. The sophistication and originality of the programme makes it a multipurpose tool base on a condensed dictionary. Its uses may be summarised under three headings: --The upkeep of medical case notes, a very successful application, resulting in improved safety in the long term follow-up of pacemaker patients. Statistical analysis of multiple parameters in larger series of patients is possible, a task which could not be carried out without a computer. --The system has the advantage of providing secretarial help in the booking of follow-up appointments, automatic print-out of follow-up reports and letters to the referring physician. This leads to better efficiency in correspondence. --The third advantage is the stocking and treatment of numeric data on a wide range of materials, leading to the creation of its own data bank. The programme as described has been adopted for cardiology and, in particular, cardiac pacing. It could, however, be applied in all fields of medicine, especially those using other materials (valvular prostheses, orthopedic appliances, etc).

[Incidence of atrial arrhythmia in patients with long term dual-chamber pacemakers. Contribution of the Holter function of pacemakers]. / Incidence des arythmies atriales chez les patients stimulés au long cours en mode double chambre. Apport des fonctions Holter du stimulateur.

The extension of the RAM memories in the latest generation of pacemakers has enabled development of Holter function allowing continuous surveillance of the cardiac rhythm. Between October 1991 and February 1995, 213 patients implanted with a Chorus 6234 or 7034 (Ela Medical) pacemaker, functioning in the DDD (R) mode, were followed up using the implanted continuous Holter function. Of the patients with no documented supraventricular arrhythmia (SVA) before implantation (n = 154), 67 (43.5%) developed SVA during an average period of one year. Male patients (p = 0.01; OR = 7.5 on multivariate analysis), high degrees of AVB (p = 0.03) and the presence of isolated or bursts of atrial extrasystoles (p = 0.004) were independent risk factors for SVA. The average time to detection of SVA was 207 days. In patients with documented SVA before implantation (n = 59), 22 (37.3%) had no recurrence during follow-up; in the other 37 cases, the average period before recurrence was 127 days. Multivariate analysis did not reveal any independent risk factor for recurrence of the arrhythmias. On the other hand, persistent but delayed atrioventricular conduction (1 degree AVB, long H-V interval or bifascicular block), seemed to protect against SVA, independently of other variables and of antiarrhythmic therapy (p = 0.008). These results suggest a high prevalence of SVA in patients on long-term pacemaker therapy, most episodes being asymptomatic. The implanted Holter function would therefore seem to be an essential tool for investigating and following up the natural history of arrhythmias in these patients.

[Hemorrhoidectomy: conventional or by Nd:Yag contact laser? A prospective and randomized study]. / Hemorroidectomía: convencional o con láser Nd:YAG de contacto? Estudio prospectivo y randomizado.

OBJECTIVE: To assess whether hemorrhoidectomy done with the Nd:YAG laser was associated with less pain or fewer complications and sequels than with conventional surgery. DESIGN: A prospective comparative, randomized study. PATIENTS: Over a period of six months, a total of 35 consecutive patients, 13 females and 22 males, with symptomatic hemorrhoidal disease requiring surgery, were alternatively randomized to either laser hemorrhoidectomy (17 patients) or surgery (18 patients). The type of disease and the number of affected and treated hemorrhoids were prospectively recorded in each patient. Patients were monitored prospectively for postoperative complications, pain (assessed daily for five days using a standard 10 mm. linear analogue scale), wound healing, time until full recovery and sequelae 6 moths later. RESULTS: These two groups were well matched. No differences were seen between laser and non-laser groups for postoperative complications. Linear analogue pain scores were not significantly different between the two groups at any stage after operation. Healing time was longer in laser group. Two few patients returned at 6 months for rectoscopy for any meaningful conclusion to be drawn. CONCLUSIONS: This study has failed to confirm any reduction in postoperative pain, complications, or healing time laser when performing a hemorrhoidectomy.

[Colorectal carcinoma. Multifactorial analysis of prognostic factors following curative resection]. / Carcinoma colorrectal. Análisis multifactorial de factores pronósticos tras resección curativa.

Cox regression analysis was used in the study of 151 cases of surgically treated colorrectal carcinoma. A "curative" resection was performed in all of them. Clinical data from medical records, histology, biochemical determinations, and intraoperative findings were assessed. Four of the studied variables were significantly related to tumor recurrence: Dukes stage, tumor spread, histological variety and preoperative CEA level. Age, sex, tumor location, surgical technique, lymphocytes in the peripheral blood, preoperative levels of acute phase reactants and hepatic enzymes did not provide information about the final outcome of these patients. An index of prognosis was statistically obtained in order to identify a high risk of recurrence group of patients, who may benefit from adjuvant therapy.

Influence of several surgical techniques in peptic ulcer disease on the oral kinetic of a basic drug.

The effect of gastric surgery on the absorption of a basic drug propranolol was studied in 11 patients. 80 mg of propranolol were administered orally before and after surgery. Irrespective of the surgical technique, there was only a significant decrease in the absorption constant Ka (1.10 +/- 0.14 vs 0.72 +/- 0.09) (p < 0.05), indicating a delay in the gastrointestinal absorption, which agreed with the delay in the urine excretion in the first six hours after surgery (6.8 +/- 0.8 vs 1.7 +/- 0.4) (p < 0.001). Patients with vagotomy but without gastric resection showed a significant increase in the time of attainment of peak concentration tmax (2.4 +/- 0.2 vs 3.2 +/- 0.3), and decrease in Ka (1.5 +/- 0.12 vs 0.73 +/- 0.17) (p < 0.05), indicating also a delay in the gastrointestinal absorption, that is not seen in patients with partial gastric resection. We conclude that vagotomy with gastric resection does not modify the absorption of propranolol, and vagotomy without resection delays its absorption but does not decrease it.

[Assisted respiration by stimulation of the diaphragmatic muscle. A case]. / La respiration assistée par stimulation diaphragmatique musculaire. Un cas.

Direct electrical stimulation of the diagram has resulted in physiological functioning in a quadriplegic patient. Mechanical ventilation could be partly withdrawn with 13-hour periods of "respiration". During the 2-month stay in hospital, 90 hours of respiration were obtained by stimulation. The patient died 8 weeks after the operation.

[The rehabilitation of chronic respiratory insufficiency]. / La rééducation-rédaptation des insuffisants respiratoires chroniques.

Respiratory rehabilitation is defined as a medical practice including a multidisciplinary medical program fitting each individual. Personalized retraining by means of exercises, is the master part of it, its aim is to improve the physical fitness in specialised institution then to maintain it when he becomes an out patient. In both cases, this retraining complies with strict rules concerning the mode of exercises (imposed power--duration of sessions--weekly frequency--progressiveness of overloading ...). This codification rests mainly on the recommendations of the American College of Sports Medicine. The choice of intensity at the beginning of the stay will be determined either by the maximal reserve of cardiac frequency or by the ventilatory threshold. This training has to involve extensive muscular mass and must not neglect the upper limbs. Ventilatory physiotherapy also plays an important part. The other components of rehabilitation concern optimisation of bronchodilator treatment, cessation of smoking, health education, physical education and relaxation, appraisal of nutritional status, assessment of therapeutic programs, of the quality of life and a long-term program for reinforcement of acquisitions. The therapeutic programs improve ventilatory performance, maximal oxygen intake, maximal tolerated power and quality of life. An adaptation of the St. George's Respiratory Questionnaire to patients hosted at the TOKI EDER Medical Center points out that the quality of life of patients with chronic respiratory failure is improved very highly significantly by this rehabilitation.

[First experience in treatment of terminal cardiac insufficiency using multisite stimulation]. / Première expérience de traitement de l'insuffisance cardiaque terminale par la stimulation multisite.

We hypothesized that the presence of an abnormal ventricular mechanical activation sequence and/or a delayed left ventricular (LV) contraction may have adverse hemodynamic effects in congestive heart failure (CHF) and could be improved by synchronous RV-LV pacing in a multisite (MS) configuration. 8 NYHA IV CHF patients were included with a LV delay due to 1/ preexistent pacemaker in 4 pts (2 VVI and 2 DDD); 2/ left bundle branch block in 2 pts; 3/ intraventricular conduction delays in 2 pts. An acute hemodynamic evaluation was performed. Hemodynamics were optimized in standard RV pacing by modifying RV lead position from apex to outflow tract (RVOT) in VVI for AF patients and in VDD for sinus rhythm patients at different AV delays. RV pacing did not change hemodynamics whatever the lead position. BV pacing improved CI by 25% (p < 0.006), V wave by 26% (p < 0.004) and PCWP by 17% (p < 0.01). Chronic implantation was performed in 7pts. LV lead was implanted via the coronary sinus in 2 cases and epicardial via a thoracoscopic approach in the remaining ones. 1 pt died during LV lead implantation. Hemodynamics were tested at 2 months followup (FU). Switching BV pacing off was associated with immediate deterioration. At 6 +/- 6 months Followup 4 pts are stable in Class II. 1 pt died of cardiac cause. 1 pt could be transplanted at 17 months FU. In conclusion, BV pacing through a multisite configuration is feasible and can help in CHF patients managing.