Pulmonary cryptococcosis: manifestations in the era of acquired immunodeficiency syndrome.

To examine the clinical manifestations, treatment, and outcome of pulmonary cryptococcosis, we reviewed the medical records of all patients treated for Cryptococcus neoformans infection at our hospital from January 1988 through September 1998. Sixty-three patients were included in the analysis, 10 (16%) of whom had acquired immunodeficiency syndrome (AIDS). Thirty-four of the 53 non-AIDS patients, including 19 men and 15 women had pulmonary cryptococcosis, including 31 with isolated pulmonary cryptococcosis and three with disseminated disease. Of the 10 AIDS patients, seven presented with disseminated cryptococcosis (including one patient with lung involvement) and one had isolated cryptococcal lung disease. The age (mean +/- SD) of the 34 non-AIDS patients with pulmonary cryptococcosis was 52.1 +/- 15.2 years (range, 19-75 yr). Cough was the most common symptom (58%). Diabetes mellitus (12%) and malignancy (12%) were two major underlying diseases. Nodules and masses were the predominant manifestations of pulmonary cryptococcosis in non-AIDS patients (79%). The most frequently used diagnostic modality for pulmonary cryptococcosis was biopsy with/without aspiration under ultrasound guidance (56%). Antifungal therapy (20/34) was the most common treatment for non-AIDS patients, followed by surgical resections with antifungal therapy (9), surgical resections alone (3), and no treatment (2). Antifungal therapy and/or resection yielded excellent outcomes (total recovery, 27; improvement, 4). Of the 18 patients who underwent lumbar puncture, only two had positive cerebrospinal fluid (CSF) cultures for C. neoformans, both had symptoms and signs of increased intracranial pressure. There was no clinical evidence of meningitis in the other 32 patients. Our findings indicate that pulmonary cryptococcosis in non-AIDS patients tends to be a more localized and benign process than in AIDS patients. Ultrasound-guided lung biopsy or aspiration is an effective tool for diagnosis. CSF examination may not be mandatory as an initial routine procedure for pulmonary cryptococcosis in non-AIDS patients.     

Hematological and biochemical factors predicting SARS fatality in Taiwan.

BACKGROUND/PURPOSE: Severe acute respiratory syndrome (SARS) has a high fatality rate worldwide. We examined the epidemiologic and clinical factors associated with death for all laboratory-confirmed SARS patients in Taiwan. METHODS: Using initial data in medical records reported by hospitals to the Center for Disease Control in Taiwan, we analyzed whether hematological, biochemical and arterial blood gas measures could predict fatality in 346 SARS patients. RESULTS: Both fatalities (n = 73; 21.1%) and survivors had elevated plasma concentration of initial C-reactive protein (CRP), but the mean CRP concentration was higher in fatalities (47.7 +/- 43.3 mg/L) than in survivors (24.6 +/- 28.2 mg/L). Initial lymphocyte counts were low in both fatalities (814 +/- 378/microL) and survivors (1019 +/- 480/microL). After controlling for age and sex, multiple logistic regression analysis showed that hematological factors significantly associated with fatality included initial neutrophil count > 7000/microL (odds ratio [OR] = 6.4), initial CRP concentration > 47.5 mg/L (OR = 5.8) and lactic acid dehydrogenase (LDH) > 593.5 IU/L (OR = 4.2). Factors significantly associated with initial CRP concentration > 47.5 mg/L included dyspnea (OR = 4.3), red blood cell count < 4.1 x 106/microL (OR = 4.3) and serum aspartate aminotransferase > 57 IU/L (OR = 3.1). CONCLUSION: Initial neutrophil count, CRP and LDH levels are important predictors of mortality from SARS.     

Sarcoidosis in Taiwan: clinical characteristics and atypical mycobacteria.

BACKGROUND AND PURPOSE: Sarcoidosis is rare in Taiwan, although increasingly more cases are being diagnosed. The purpose of this study was to further characterize the clinical features of all biopsy-proven cases of sarcoidosis diagnosed between 1988 and 2002 in a national teaching hospital in southern Taiwan, and to detect mycobacterial DNA in sarcoid lesions. MATERIALS AND METHODS: A total of 28 biopsy-proven cases of sarcoidosis were reviewed. Formalin-fixed, paraffin-embedded tissues were used as template for nested polymerase chain reaction (PCR) detection of the mycobacterial hsp65 gene. This was followed by direct DNA sequencing to identify the species in positive cases. RESULTS: Eleven males and 17 females, aged 19 to 79 years (mean, 50 yr) were enrolled. Bilateral hilar lymphadenopathy, pulmonary lesions or both, were detected in 14 patients (50%). Of the 22 patients (78%) with skin involvement, nine manifested angiolupoid lesions on the face, a rare form of cutaneous sarcoidosis. Eight patients had papular lesions and five had plaque lesions, usually widespread on the extremities and trunk. No patients presented with erythema nodosum. Fifteen of the 22 patients with skin involvement had had the disease for more than 2 years. The hsp65 gene was detected in seven cases, four of which showed greater than 90% homology to four different species of atypical mycobacteria. CONCLUSION: Our study showed that sarcoidosis tended to affect women older than 40 years, often manifested angiolupoid lesions on the face, and ran a subacute to chronic course. Atypical mycobacteria might play a role in the etiology in a minority of our patients, but more cases and other potential etiologic agents need to be studied.     

二甲双胍与复方醋酸环丙孕酮联合应用对多囊卵巢综合征患者内分泌及代谢的影响

目的　观察二甲双胍与复方醋酸环丙孕酮 (复方环丙孕酮 )联合应用 ,对多囊卵巢综合征 (PCOS)患者内分泌及代谢的影响。方法　对 4 5例患者进行前瞻性研究 ,为观察组 ;2 0例非PCOS不孕妇女为对照组。测定体重指数 (BMI)、腰臀围比值 (WHR)、多毛评分 (F G评分 )及生殖内分泌激素、糖、脂代谢指标等。观察组根据随机应用不同药物又分为复方环丙孕酮组、二甲双胍组及二甲双胍与复方环丙孕酮联合用药组 (联合用药组 ) ,每组各 15例。经 12周治疗后 ,比较上述各项指标的变化。结果　观察组治疗前BMI、WHR、F G评分、黄体生成激素 (LH)、睾酮 (T)、空腹胰岛素 (FI)、胰岛素抵抗 (IR)及甘油三酯等均较对照组增高 ;高密度脂蛋白胆固醇 (HDL C)较对照组降低 (P <0 0 1)。观察组 3组治疗前各项指标差异均无显著性 (P >0 0 5 )。治疗 12周后 ,联合用药组及二甲双胍组LH分别从 (13 9± 5 9)IU/L降低为 (5 8± 2 2 )IU/L ,从 (13 8± 7 6 )IU/L降低为 (11 8±6 5 )IU/L ;T分别从 (2 1± 0 8)nmol/L降低为 (1 2± 0 4 )nmol/L ,从 (2 2± 1 1)nmol/L降低为(1 8± 0 8)nmol/L ;游离睾酮 (FT)分别从 (2 8± 2 3)nmol/L降低为 (0 8± 0 5 )nmol/L ,从 (2 5±1 9)nmol/L降低为 (1     

Clinical manifestations, disease course, and complications of adult-onset Still's disease in Taiwan.

BACKGROUND AND PURPOSE: Data on the disease course and ultimate outcome of adult-onset Still's disease (AOSD) are limited. We analyzed the clinical manifestations, disease course, and complications of patients with AOSD in Taiwan. METHODS: A retrospective cohort design with prospective follow-up was used. Eighty two patients with AOSD diagnosed between 1983 and 2003 were evaluated. Their clinical features and laboratory findings at presentation, disease course, and complications were analyzed. RESULTS: Fifty nine patients (72%) were female and 55 (67.1%) were aged between 16-35 years at onset. The most common clinical manifestations were fever (100%), articular symptoms (100%), evanescent rash (87%), and sore throat (84%). Dermatographism was noted in 59% of patients. Elevation of erythrocyte sedimentation rate and C-reactive protein, which were significantly correlated with disease activity score (both p < 0.01) occurred in more than 90% of AOSD patients. Elevation of serum ferritin, which was significantly correlated with disease activity score and hepatic enzyme levels, was present in 91% of patients. Polycyclic systemic course was the most common (45%), followed by monocyclic systemic course (34%); only 20% of patients progressed to chronic arthropathy. CONCLUSIONS: The multisystemic involvement and various patterns of disease course in this series illustrate the heterogenic nature of AOSD. Serum ferritin levels can be used as a marker for monitoring disease activity in AOSD.     

Short-term modulation of gonadotropin secretion by progesterone during the luteal phase

Progesterone (P) levels were acutely augmented by intravenous (IV) infusion in seven women in the midluteal phase to ascertain if short-term changes in P levels have an effect on gonadotropin secretion. During four 6-hour intervals of alternating control and IV P infusion, each subject underwent blood sampling for luteinizing hormone (LH), follicle-stimulating hormone (FSH), and P every 20 minutes for 24 hours. As a result of the P infusions, mean (+/- SE) P levels rose 72% from a control level of 26.24 +/- 2.13 to 45.22 +/- 3.47 nmol/L, whereas mean LH levels were reduced by 20% from a control level of 4.82 +/- 0.67 to 3.85 +/- 0.66 IU/L. During P infusions, mean LH pulse amplitude was reduced by 33% from 3.33 +/- 0.37 to 2.23 +/- 0.28 IU/L. The mean LH interpulse interval increased by 93% (2.56 +/- 0.14 to 4.92 +/- 0.15/h) when the interval between pulses was interdicted by the onset of P infusion. The infusion of P reduced mean FSH levels by 10% from 3.34 +/- 0.41 to 3.01 +/- 0.35 IU/L. These findings suggest that acute elevations in P levels within the physiological range have a short-term inhibitory effect on gonadotropin secretion during the midluteal phase.     

Maternal benefit of high-dose intravenous corticosteroid therapy for HELLP syndrome

OBJECTIVE: We compared maternal outcomes for patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome treated with or without high-dose corticosteroids to ameliorate maternal disease. STUDY DESIGN: An analysis of data for patients with HELLP syndrome (platelets, or=600 IU/L; aspartate aminotransferase and/or alanine aminotransferase level, >or=70 IU/L) who were treated during the 7-year epochs before and after the clinical trials in 1992 and 1993 demonstrated maternal benefit with high-dose dexamethasone. RESULTS: Corticosteroid use increased from 16% (39/246 patients) for fetal indication from 1985 to 1991 to 90% (205/228 patients) for maternal-fetal indications from 1994 to 2000. Significantly reduced composite maternal disease from 1994 to 2000 was evidenced by improvements in laboratory parameters, disease progression to class 1 HELLP syndrome, the degree of hypertension, the need for antihypertensive therapy, the use of transfusion, and the presence of maternal morbidity (P<.05). Indices of postpartum recovery also were shortened significantly (P<.001). CONCLUSION: Routine early initiation of high-dose intravenous corticosteroids for patients with HELLP syndrome significantly lessened maternal disease, reduced maternal morbidity, and expedited recovery.     

The study for the standard of the remission of the patients with trophoblastic disease (author's transl)

The recurrence of the patients who had obtained remissions once was studied and the standard of remission was reassessed. The comparison of the titers of hCG ranged the LH levels was studied by means of some methods of measurement. 1) During 7 years, from 1973-1979, 141 patients with trophoblastic disease in Chiba University Hospital were treated. The remission rate was 92.2% (130/141), the recurrence rate was 6.2% (8/130). In the high risk group, the recurrence rate was 23.1% (6/26), in the low risk, it was 1.9% (2/104). Four of 8 with recurrence were died, 4 (2 high risk and 2 low risk) obtained remissions again. 2) The mean HCG titers of patients with recurrence were 29.5 +/- 23.5 IU/L (HAR), 13.7 +/- 6.4 mIU/ml (HCG-RIA), 1.5 +/- 0.7 ng/ml (HCG-beta RIA) and that of patients with remission were 13.8 +/- 13.0 IU/L, 11.3 +/- 4.1 mIU/ml, 1.0 +/- 0.6 ng/ml, respectively. 3) The 2 patients whose HCG titers indicated all negative followed the recurrences. The HCG beta titers of the patients who were extirpated their bilateral ovaries indicated rather high in spite of getting their remissions. 4) The essential standard of remission was the equanimity of the HCG titers around the negative levels without disturbance by LH or other substances for a while. But it is not enough for a remission.     

Sarcoidosis in southern Taiwan.

PURPOSE: To investigate the disease characteristics of sarcoidosis in southern Taiwan, and to investigate diagnostic methods. METHODS: We retrospectively reviewed the medical records of all patients diagnosed with sarcoidosis at Chang Gung Memorial Hospital, Kaohsiung, from March 1988 to February 2002. RESULTS: A total of 12 patients (3 men, 9 women), with a mean age of 44.5 years, and a diagnosis of sarcoidosis by positive histology and either a typical chest roentgenogram or clinical presentation were included. All 12 patients had intrathoracic involvement (hilar or mediastinal lymph nodes, 12; lungs, 5), eight had skin involvement, and two had extrathoracic lymph node involvement. The most frequent biopsy specimens were from the skin (n = 10), followed by the intrathoracic lymph nodes (n = 4), lungs (n = 2), and extrathoracic lymph nodes (n = 2). Four patients had positive biopsies from two organs. Our data showed an older age distribution and a greater female predominance of the disease compared with Western countries. A higher rate of intrathoracic and skin involvement was also found, but the reason for this was not clear. CONCLUSIONS: Greater awareness of possible skin involvement may enable chest physicians and clinical practitioners to suspect this condition earlier. A histologic diagnosis from skin biopsy should then be made, rather than using more invasive procedures.     

Reducing the dose of human chorionic gonadotropin in high responders does not affect the outcomes of in vitro fertilization

OBJECTIVE: The lowest effective hCG dose in high responders during IVF-embryo transfer (ET) has not been established. This study was performed to confirm that a dose of 3,300 IU is sufficient to provide adequate oocyte maturation and fertilization. DESIGN: Retrospective review of IVF clinical data. SETTING: Infertility center at a tertiary care university. PATIENT(S): Ninety-four IVF cycles were analyzed from high responders based on peak E(2) levels. Demographics were compared including age, diagnosis, and stimulation protocol. INTERVENTION(S): On the day of hCG administration, if E(2) levels were >/=2,500 but <4,000 pg/mL, patients received 5,000 IU (group A). For levels between 4,000 pg/mL and 5,500 IU pg/mL, they received 3,300 IU (group B). MAIN OUTCOME MEASURE(S): Number of oocytes retrieved, proportion of mature oocytes, fertilization rates, chemical and clinical pregnancy rates (PR). The incidence and severity of ovarian hyperstimulation syndrome (OHSS) was also analyzed. RESULT(S): Mean ages were 35.4 +/- 0.7 and 33.2 +/- 0.7 for groups A and B, respectively. Peak E(2) levels differed significantly (2,907 +/- 76 vs. 4,260 +/- 129 pg/mL), as well as the mean number of eggs retrieved (15.9 +/- 0.9 vs. 20.3 +/- 1.2). Proportion of mature eggs (81.6% vs. 81.9%), fertilization rate (70.5% vs. 68.7%), chemical PR (58.7% vs. 58.7%), and clinical PR (50.0% vs. 43.5%) were similar. There was no difference in the incidence of mild, moderate, or severe OHSS. CONCLUSION(S): A reduced hCG dose of 3,300 IU results in a similar proportion of mature eggs, similar fertilization rates, and similar PRs compared to 5,000 IU. Reducing the dose of hCG does not eliminate the risk of OHSS in a high-risk group.     

Toxic megacolon secondary to infective colitis in children.

BACKGROUND AND PURPOSE: Toxic megacolon is a fulminating and potentially lethal complication of severe colitis. Toxic megacolon secondary to infective colitis in children is rare. We analyzed the clinical course, pathology, treatment, and outcome of toxic megacolon secondary to infective colitis in children. METHODS: The medical records of all 20 children treated for infective colitis complicated with toxic megacolon during a 12-month (October 1997-October 1998) period were retrospectively reviewed. RESULTS: There were 10 boys and 10 girls, with a mean (+/- standard deviation, SD) age of 26.2 +/- 12.9 months (range, 6-57 mo). With an initial presentation of nonspecific gastroenteritis syndrome lasting several days, the disease progressed rapidly. In the acute stage, most patients developed toxic signs such as mental change, ranging from irritability to stupor (20, 100%), fever (19, 95%), tachycardia (20, 100%), abdominal distension (20, 100%), and abnormal stool pattern (19, 95%). Initial investigations revealed anemia (11, 55%), leukocytosis (11, 55%), and elevated levels of C-reactive protein ranging from 25.0 mg/L to 483.0 mg/L with a mean +/- SD of 185.7 +/- 129.1 mg/L (normal range, < 8 mg/L) (20, 100%). Salmonella enteritidis (12 patients, 60%) and Clostridium difficile (1, 5%) were isolated from stool samples in some cases. Plain abdominal x-rays revealed severe colonic dilatation. Prolonged hospitalization (mean, 33.6 d) and intensive therapy including a combination of broad-spectrum antibiotics, physical decompression, and total parenteral nutrition were necessary. Three patients (15%) underwent surgical management; the pathologic findings in these patients demonstrated severe transmural inflammation. We believe that bacterial and/or endotoxin translocation played an important role in gut failure. Three patients (15%) in the study died. CONCLUSION: Toxic megacolon in infective colitis is a fulminating illness that has a high mortality rate. The disease course can be divided into three stages: the acute toxic stage, the gut failure stage, and the convalescence or deterioration stage. Early diagnosis and aggressive management are important.     

Adjunctive choledochoduodenostomy to choledocholithotomy in the treatment of calculous biliary tract disease.

Between 1986 and 1991, 16 selected patients with calculous biliary tract disease (CBTD) underwent side-to-side choledochoduodenostomy (CDS) as an adjunct to either primary (10 patients) or secondary (six patients) choledocholithotomy. Patients selected for adjunctive CDS were those with common bile duct dilatation > or = 1.5 cm in size. All operations were elective procedures. The stoma of the CDS was about 3.0 cm in size, measured directly. There were no operative deaths. There were no early complications related to the CDS procedure itself, except for two (12.5%) wound infections. CDS significantly eliminates bile stasis which is indicated by a fall in both the serum levels of alkaline phosphatase (from 228 +/- 118 to 72 +/- 22 IU/L, p < 0.01) and total bilirubin (from 4.7 +/- 4.7 to 0.9 +/- 0.2 mg/dL, p < 0.01) postoperatively. Late complications (ascending cholangitis or sump syndrome) of CDS or recurrent symptoms of CBTD were not encountered during the average follow-up period of 21 +/- 18 months. From our clinical results, we suggest that adjunctive CDS to choledocholithotomy is a safe and effective procedure in the treatment of selected patients with CBTD.     

Studies on the effects of initial injection doses of follicle stimulating hormone on the pregnancy and the ovarian hyperstimulation syndrome incidence in polycystic ovarian syndrome patients

Background:  Patients with polycystic ovarian syndrome (PCOS) are often resistant to clomiphene citrate, which causes the need for subsequent gonadotropin treatment. However, careful administration is required because of the potential side-effects, that is, ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy.
Methods:  Forty-three cycles in 22 patients with PCOS were enrolled in this study. Ovarian stimulation was initiated on day 7 of the menstrual cycle with 150 IU/day of follicle stimulating hormone (FSH; 150 IU course), 100 IU/day (100 IU course), and 75 IU/day (75 IU course), successively. If follicles over 12 mm in diameter did not develop after 1 week, the dose was increased. In each treatment course, the number of developed follicles, the serum estradiol level before ovulation, total FSH dosage and duration of administration, the incidence of OHSS, and pregnancy rate were examined.
Results and Conclusion:  The largest number of developed follicles and the highest serum estradiol level were found in the 150 IU course. In contrast, the total FSH dosage and duration of administration were highest and longest in the 75 IU course. The incidence of OHSS and pregnancy rate were highest in the 150 IU course and in the 75 IU course, respectively. The present study indicates that 100 IU or 75 IU of FSH is recommended as an initial injection dose for PCOS patients. (Reprod Med Biol 2003; 2 : 63–67)     

The clinical efficacy and efficiency of a 100-IU starting dose of recombinant follicle stimulating hormone (Puregon) in Korean women undergoing in vitro fertilization and embryo transfer

AIM: A prospective, non-comparative study was conducted to evaluate the efficacy and efficiency of a starting dose of 100 IU recombinant follicle stimulating hormone (rhFSH, Puregon) in women undergoing ovarian stimulation prior to in vitro fertilization (IVF). METHODS: A total of 40 women were down-regulated with gonadotropin releasing hormone agonist (long protocol), then treated with a fixed dose of 100 IU rhFSH for the first 4 days, and the dose of gonadotropin administration was adjusted according to patient's response thereafter. A maximum number of 3 embryos were transferred in 32 patients. RESULTS: Nine patients were treated with intracytoplasmic sperm injection, and 24 with conventional IVF. The duration of stimulation was 10.8 +/- 1.8 days, serum estradiol concentration on human chorionic gonadotropin day was 1693.0 +/- 1651.2 pg/mL, and 1480 +/- 450 IU rhFSH was used. A mean number of 8.4 +/- 5.7 oocytes were retrieved, 4.9 +/- 4.3 embryos obtained, 2.4 +/- 0.9 embryos transferred, and 3.5 +/- 3.2 embryos cryopreserved. The proportion of mature oocytes was 71.6%, and the fertilization rate was 86.4%. Clinical pregnancy was achieved in 8 patients (25.0%), and all of these pregnancies are ongoing or delivered. There were 3 cases of twin gestations (37.5%). The implantation rate was 13.1% (11/84). There was one case of moderate ovarian hyperstimulation syndrome, however, the patient recovered within 7 days without any complications. CONCLUSION: The starting dose of 100 IU rhFSH has a good safety profile, and is adequate in controlled ovarian hyperstimulation for IVF with a small amount of gonadotropin administered.     

Semen profile, testicular volume, and hormonal levels in infertile patients with varicoceles compared with fertile men with and without varicoceles

OBJECTIVE: To assess semen analysis, testicular volume, and hormone levels in fertile and infertile patients with varicoceles and fertile men without varicoceles. DESIGN: Retrospective study. SETTING: Academic medical center. PATIENT(S): Patients were divided into three groups: fertile men with varicoceles (n = 79), infertile men with varicoceles (n = 71), and fertile men without varicoceles (n = 217). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Levels of LH, FSH, and total T and testicular volume in fertile and infertile men with varicoceles and fertile controls without varicoceles. RESULT(S): LH (IU/L) and T (ng/dl) levels were not statistically different across the three groups. FSH levels were significantly higher in infertile men with varicoceles (7.8 +/- 7.6 IU/L) than in the fertile men with varicoceles (3.5 +/- 2.1 IU/L) or in fertile men without varicoceles (3.5 +/- 1.9 IU/L). The right testicle was smaller in infertile patients with varicoceles (18.7 +/- 8.3 cm(3)) than in fertile men with varicoceles (25.2 +/- 13 cm(3)) or in fertile men without varicoceles (24.9 +/- 10.7 cm(3)). In addition, the left testicle was smaller in infertile men with varioceles (17.6 +/- 8.9 cm(3)) than in fertile men with varicoceles (21.6 +/- 7.8 cm(3)) or in fertile men without varicoceles (23.4 +/- 8.3 cm(3)). Sperm concentration was lower in infertile men with varicoceles (33.7 +/- 23.3 x 10(6)/mL) than in fertile men with varicoceles (101.8 +/- 76.6 x 10(6)/mL) or in fertile men without varicoceles (111.8 +/- 74.2 x 10(6)/mL). In addition, sperm motility was lower in infertile men with varicoceles (37.2% +/- 23.9%) than in fertile men with varicoceles (53.9% +/- 17.4%) or fertile men without varicoceles (58.9% +/- 15.8%). CONCLUSION(S): Infertile patients with varicoceles have higher levels of FSH, smaller testes, and lower sperm concentration and motility compared with controls with or without varicoceles. No statistical differences were seen in the variables evaluated among the fertile men with incidental varicoceles detected at physical examination and those without varicoceles.     

盆腔炎性疾病对不孕患者体外受精-胚胎移植结局的影响

目的 探讨不同程度盆腔炎性疾病（PID）及手术中是否切除输卵管对体外受精-胚胎移植（IVF-ET）治疗结局的影响。方法 选取223个IVF-ET周期,根据IVF治疗周期前手术所见,按PID盆腔病变程度分为轻度组72个周期、中度组79个周期、重度组72个周期,分别统计并分析各组间及组内手术是否切除输卵管与IVF周期中所用促性腺激素（Gn）总量、获卵数、卵巢低反应发生率、受精率、优质胚胎数及新鲜胚胎移植周期临床妊娠率的关系。结果 所需Gn总量、获卵数、优质胚胎数轻度组分别为（2057±503）IU／L、（16±6）个和（6．0±4．3）个;中度组分别为（2204±603）IU／L、（12±6）个和（4．5±3．5）个;重度组分别为（2372±1018）IU／L、（9±6）个和（3．1±2．9）个;重度组与轻度组IVF周期所需Gn总量比较,明显增加,差异有统计学意义（P〈0．05）;重度组较轻度组获卵数及优质胚胎数均下降,差异也有统计学意义（P〈0．01）。卵巢低反应发生率,轻度组为4．2％,中度组为13．9％,重度组为33．8％,3组两两比较,差异均有统计学意义（P〈0．05）。临床妊娠率轻度组为63．9％,中度组为46．8％,重度组为41．2％,3组两两比较,差异均也有统计学意义（P〈0．05）。3组受精率比较,差异无统计学意义（P〉0．05）。轻度组与重度组比较,PID手术中是否切除输卵管对术后IVF-ET结局无显著影响;而中度组切除输卵管者的获卵数、优质胚胎数、临床妊娠率均高于保留输卵管者,两者比较,差异有统计学意义（P〈0．05）。结论 PID病变降低卵巢的反应性及临床妊娠率,影响IVF-ET结局;PID患者行手术治疗时,手术中是否切除病变输卵管应视病变程度而定,但应尽可能地游离卵巢组织。     

A prospective randomized clinical trial comparing 150 IU and 225 IU of recombinant follicle-stimulating hormone (Gonal-F*) in a fixed-dose regimen for controlled ovarian stimulation in in vitro fertilization treatment

OBJECTIVE: To compare fixed daily doses of the recombinant FSH (rFSH) Gonal-F (150 IU vs. 225 IU) for ovarian stimulation in IVF-ET. DESIGN: Single-center prospective, randomized study. Assisted conception unit of a university hospital.One hundred twenty-four women aged 23-41 years participated in the study. Exclusion criteria were as follows: FSH of >10 IU/L, polycystic ovarian syndrome, one ovary or previous ovarian surgery, previous poor response to ovarian stimulation, or ovarian hyperstimulation syndrome (OHSS). INTERVENTION(S): Randomized to commence 150 IU or 225 IU of Gonal-F per day without dose alterations during treatment. MAIN OUTCOME MEASURE(S): Number of oocytes retrieved and total rFSH dose. RESULT(S): More oocytes were retrieved in women aged or=33 years), the number of oocytes retrieved in the two groups were similar. No significant differences were found for fertilization rate, number of embryos formed and cryopreserved, and pregnancy rates between the two groups. The total rFSH dose used was higher in the 225-IU group (2,595.0 +/- 510.0 vs. 1,897.5 +/- 457.5 IU). The cancellation rate due to insufficient ovarian response was higher in the 150-IU group (15.0% vs. 3.3%). All cases of ovarian hyperstimulation syndrome (n = 4) occurred in the 225-IU group. CONCLUSION(S): Two hundred twenty-five IU is more effective than 150 IU in younger women but requires a higher total dose of Gonal-F. The use of 225 IU in older women did not result in a higher oocyte yield, suggesting that 225 IU of rFSH does not compensate for the age-related decline in the number of follicles available for stimulation.     

Human chorionic gonadotropin and free beta subunit secretion in three events of pregnancy.

Serum hCG and free beta hCG subunit were measured in intrauterine pregnancies (n = 21), ectopic pregnancies (n = 20) and spontaneous abortions (n = 19) matched for gestational age. Significantly higher concentrations of both dimer and free beta subunit hCG were detected in normal pregnancies (86,336 IU/L) and 21.02 IU/L respectively) compared to abortions (10,460 IU/L and 3.73 IU/L) and ectopic pregnancies (3,900 IU/L and 3.73 IU/L) (p less than .05). When the ratio of free beta hCG/intact hCG (%) was studied, however, EP had significantly higher ratios (0.09 +/- 0.09) than IUP (p less than .05). Assessment of the relative distributions of these ratios revealed that 100% of IUP and AB and 65% of EP had ratios less than 0.10. Most notably, 35% of EP were uniquely characterized by ratios greater than 0.10. This ratio was sufficiently higher in 35% of EP to define a profile completely unique to EP. These data suggest that an increased free beta to dimer hCG ratio of greater than 0.10 may assist in the differentiation of ectopic from intrauterine pregnancies of spontaneous abortions and provide insight into a possible trophoblastic mechanics in these clinical events.     

Prevalence of nonalcoholic fatty liver disease in patients with polycystic ovary syndrome: a case-control study

OBJECTIVE: To explore the prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with polycystic ovary syndrome (PCOS). METHODS: A case-control study employing 60 nonpregnant patients with PCOS and 60 non-pregnant patients without PCOS as control was conducted to compare the prevalence of NAFLD. RESULTS: The aminotransferase (ALT), fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) levels were (29 +/- 15) U/L, (19 +/- 12) mU/L and 0.47 +/- 0.29 in PCOS group, which were significantly higher (P < 0.05) than corresponding parameters in control group [(15 +/- 13) U/L, (11 +/- 8) mU/L and 0.31 +/- 0.21)]. The occurrence of insulin resistance and NAFLD was63% (38/60) and 42% (25/60), higher than those in control group [35% (21/60) and 20% (12/60), P < 0.05]. The increment of ALT was 40% (24/60) in PCOS group, higher than that of 3% (2/60) in control group (P < 0.01). Compared with patients without NAFLD, patients with NAFLD had significantly increased body mass index (P < 0.01), waist-hip ratio, ALT, C-reaction protein, fasting insulin, insulin and HOMA-IR levels 2 hours after oral glucose tolerance test (P < 0. 05). CONCLUSION: The increased prevalence of NAFLD in PCOS patients suggests an association between these two conditions and the necessity of hepatic screening among PCOS patients for potential NAFLD.     

Tuberculous pleurisy with effusion.

To assess the clinical features of Taiwanese patients with tuberculous pleurisy and their response to treatment, we analyzed the records of patients treated for this condition from December 1990 through November 1995, at a regional 100-bed referral center for tuberculosis care. Diagnosis of tuberculous pleurisy was based on histologic evidence of caseating granulomatous inflammation in the pleural biopsy specimen, or evidence of mycobacteria in pleural fluid. Patients were also stratified on the basis of parenchymal involvement. Ninety-seven patients (79 men, 18 women) with a mean age of 47.5 (range, 15-90) years were included in the analysis. The two major symptoms were cough (69%) and shortness of breath (57%). Chest roentgenographs showed that the pleural effusion was unilateral in 88 (91%) patients, and small to moderate in amount in 74 (76%). Laboratory analysis of the pleural fluid showed moderate levels of glucose (4.6 mmol/L), with no significant difference between patients with and without parenchymal involvement. The levels of lactate dehydrogenase and triglycerides were significantly higher in patients with parenchymal involvement (172 vs 240.5 IU and 0.36 vs 0.45 mmol/L, respectively). In 85 of 93 patients (91%) with available data, lymphocytes were predominant in the differential count. All patients had received short-course chemotherapy for at least 6 months. After excluding the defaulters and patients receiving subsequent management in other hospitals, the overall rate of successful treatment was 97% (72/74). There was no significant difference in the treatment outcome between patients with parenchymal involvement and those without. None of the successfully treated patients had a relapse within a mean follow-up period of 31.7 +/- 18.4 months. We conclude that current patients with tuberculous pleurisy in Taiwan are not young, and short-course chemotherapy with isoniazid, ethambutol, rifampicin, and pyrazinamide is an effective treatment. The presence of parenchymal tuberculous lesions does not appear to influence the treatment outcome.