Initiation of the gonadotropin-releasing hormone antagonist ganirelix for in vitro fertilization cycles in which the lead follicle is >14 mm

The initiation of GnRH antagonists when the lead follicle is >14 mm does not adversely affect IVF success rates and leads to a shortened duration of GnRH antagonist administration.     

Hypercalcemia associated with a uterine leiomyoma: a case report and review of the literature

BACKGROUND: Humoral hypercalcemia is known to be an important cause of hypercalcemia associated with malignancy. Humoral hypercalcemia due to benign conditions has been rarely reported. CASE: We report on a 45-year-old woman with humoral hypercalcemia secondary to uterine leiomyoma. Following the surgical removal of leiomyoma by hysterectomy, serum calcium, suppressed parathyroid hormone (PTH) and elevated parathyroid hormone-related protein (PTH-rP) levels were normalized. CONCLUSIONS: To our knowledge, this is the second reported case of humoral hypercalcemia associated with uterine leiomyoma. We suggest that for women with hypercalcemia who had suppressed PTH and elevated PTH-rP levels, uterine leiomyoma should be included in the differential diagnosis.     

Idiopathic isolated clitoromegaly: A report of two cases

Background  

Clitoromegaly is a frequent congenital malformation, but acquired clitoral enlargement is relatively rare.     

Cervico-mediastinal tuberculous lymphadenitis presenting as prolonged fever of unknown origin

Prolonged fever of unknown origin (FUO) is a challenging and important medical problem. Tuberculosis is the most frequent cause of FUO, especially in endemic regions, such as developing countries. We present a case of cervico-mediastinal tuberculous lymphadenitis that had been searched and followed up as a prolonged FUO. Especially in endemic areas, tuberculosis should be borne in mind in the differential diagnosis of FUO cases with granulomatous lymphadenitis presenting as prolonged or recurrent fever, even if the cultures and polymerase chain reaction for Mycobacterium tuberculosis are negative.     

Investigation of the mechanism of nicotine induced relaxation in rabbit corpus cavernosum in vitro

In order to determine whether nicotine acts on corporal smooth muscle, the mechanism of its effect on strips of rabbit corpus cavernosum was studied in vitro. Rabbit corpus cavernosum muscle strips were mounted in an organ bath with modified Krebs-Henseleit solution and aerated with 95% O₂ and 5% CO₂. Tension was measured with isometric force transducers, and muscle relaxation was expressed as the percent decrease of precontraction induced by phenylephrine. Nicotine produced concentration dependent relaxation when preparations were precontracted by phenylephrine (10^–5 M). The maximum nicotine-induced relaxation was 60.4±4.2% of the phenylephrine contraction and was not affected by indomethacin (10^–5 M), N^w-nitro L-arginine methyl ester (3×10^–5 M), methylene blue (10^–5 M), glibenclamide (10^–5 M), clotrimazole (10^-6 M), tetraethylammonium (3×10^–4 M), or 4-aminopyridine (10^–3 M). Nicotine did not exhibit a calcium antagonizing effect. From these results, we conclude that nicotine-induced relaxation of the rabbit corpus cavernosum is not mediated by the release of nitric oxide, prostaglandins or a related substance, by the activation of potassium channels, or by the stimulation of nicotinic cholinoceptors. Further work is needed to determine the cellular mechanism(s) of the action by which nicotine acts on corporal smooth muscle.     

Cardiac cyclic variation of integrated backscatter in hypertension and dialysis patients

BACKGROUND: Cyclic variation of myocardial-integrated backscatter (CV-IB) offers a non-invasive myocardial contractile performance assessment. There is limited data concerning CV-IB in end-stage renal disease (ESRD) patients. METHODS: Forty essential hypertensive (EH) patients (mean age 51+/-8 yrs) and 24 ESRD patients (mean age 49+/-14 yrs) were compared to 10 healthy controls (mean age 45+/-10 yrs). A 2D-Doppler echocardiography with digitized imaging was performed to characterize myocardial ultrasonic tissue by CV-IB between systole and diastole at the interventricular septum (IVS) and left ventricular (LV) posterior wall (PW). RESULTS: There was no significant difference between age and sex among groups. Systolic and diastolic blood pressures (BP) were both higher in EH patients (157/96 mmHg in EH, 129/81 mmHg in ESRD and 115/77 mmHg in controls, p<0.001). Left ventricular mass index (LVMI) was higher in EH and ESRD patients than in controls (respectively, 119+/-37, 130+/-46, 87+/-12 g/m2, p<0.05), while there was no significant difference found between EH and ESRD patients. EH patient CV-IB values were significantly lower than in ESRD patients and controls (respectively, 6.9+/-1.6, 8.6+/-0.7, 10.6+/-1.1 dB, p<0.001 for IVS, 7.7+/-1.3, 8.7+/-0.8, 10.4+/-1.1 dB, p<0.001 for PW). CV-IB for PW and IVS were significantly lower in ESRD patients than in controls (p<0.001). CONCLUSIONS: CV-IB can offer useful parameters for myocardial structure in EH and ESRD patients. Further studies are needed to clarify CV-IB in ESRD patients.     

Endoscopic management of the intranasal glioma

The authors report the endoscopic management of a boy with nasal glioma who was only 35 days old. The nasal glioma is a rare congenital nasal abnormality, which manifests as a mass of extracranial cerebral tissue unconnected with the brain. For surgical excision, some surgeons suggest initial craniotomy for excluding intracranial extension. The authors successfully removed the intranasal glioma by endoscopic surgery without craniotomy on a 35-day-old boy. Intranasal endoscopic surgery is a less-invasive and safe procedure and does not result in postoperative facial scarring and deformity. Therefore, the use of endoscopic surgery in place of lateral rhinotomy procedure is recommended.