Taking a history in the evaluation of infertility: obsolete or venerable tradition?

Taking a relevant history that includes pelvic inflammatory disease or exposure to sexually transmitted diseases is not obsolete.     

Over a decade of experience with preimplantation genetic diagnosis

The three respondents provide additional support for preimplantation genetic diagnosis (PGD) having the pivotal place it now has in prenatal genetic diagnosis: chromosomal abnormalities (e.g., unbalanced translocations), Mendelian disorders, and HLA typing for transfer of compatible, genetically normal, embryos. Transferring euploid embryos has decreased the clinical abortion rate and increased the implantation rate in assisted reproductive technologies (ART), but it has not necessarily improved the live-birth rate. Safer embryo biopsy, more extensive diagnostic efforts (i.e., microarray analysis), and more refined patient selection may be required before shifting from preselection of embryos based solely on morphological parameters to transfer of only aneuploidy-free embryos.     

Increased rate of aneuploid embryos in young women with previous aneuploid conceptions

OBJECTIVES: To determine whether a history of a previous aneuploid conception increases the rate of aneuploidy among women having preimplantation diagnosis (PGD). METHODS: Preimplantation embryos were tested for aneuploidy using FISH probes specific for chromosomes 13,15,16,17,18,21,22,X and Y.Using logistic regression to control for maternal age, we compared the rates of aneuploidy and other chromosome errors in 344 embryos from women having PGD because of a history of a previous aneuploid conception, 363 embryos from 42 women having PGD because of X-linked disorders and 1158 embryos from 135 women having PGD because of repeated in vitro fertilization failure. RESULTS: The frequency of aneuploidy differed significantly among patient groups for women younger than 35 (p = 0.003) but not for women older than 35. In women < 35, the rate of detected aneuploidy was 37.4% in the Aneuploid group, 20.9% in the X-linked group and 27.0% in the RIF group. (p = 0.0003 when the control groups are combined). The frequency of other chromosome abnormalities, as well as pregnancy and implantation rates, did not differ significantly among patient groups. CONCLUSIONS: This study suggests that a history of a trisomic pregnancy, whether or not it was a viable trisomy, is associated with an increased risk of another aneuploid conception at conception.     

A score for measurement of the role of social vulnerability in decisions on abortion

OBJECTIVE: To devise a score allowing a better measure of the role of social vulnerability (SV) in a woman's attitude toward abortion. STUDY DESIGN: Consecutive sampling and semi-structured personal interviewing of 2641 women requesting legal termination of pregnancy from 1994 to 2001 in the county of Roanne, France. RESULTS: SV was estimated from each woman's situation with reference to work, family composition, marital status, health insurance status and characteristics of neighbourhood of residence. It was correlated with the income and home ownership situation. With a high SV level taken as reference, the relative risks (RR) of severe, moderate, and low SVP, respectively, were equal to 3.3 (1.8-6.1), 4.6 (2.5-8.6) and 7.2 (3.9-13.1) in women under 18.5 years of age; 1.2 (1.0-1.5), 2 (1.4-2.8), and 2.1 (1.4-3.2) from 18.5 to 19 years of age; 0.7 (0.6-0.8), 0.6 (0.5-0.8) and 0.4 (0.3-0.5) in those aged 19-28; and 0.9 (0.9-1), 0.7 (0.6-0.8) and 0.71 (0.6-0.8) in those over 28. The use of different basic hypotheses (cumulative time of pregnancy in women's life, withdrawal or restarting of the clock after each event in the case of recurrence) resulted in slight modification of the age cut-off points and the amplitude of RR also differed, but their order relative to SV categories was unchanged. CONCLUSIONS: At the individual level knowledge of SV allowed a good estimate of a woman's attitude to an unwanted pregnancy, and SV must be taken into consideration when future actions are planned.     

Laparoscopic excision of deep endometriosis

Deep endometriosis is essentially characterized by the presence of a rectovaginal or retrocervical nodule, which is a circumscribed, nodular aggregate of smooth muscle, endometrial glands, and, usually, endometrial stroma. The authors suggest that the retroperitoneal space should definitely be considered as the origin of this retroperitoneal adenomyotic disease. This article reviews the classification, the diagnosis, and the surgical treatment of deep endometriosis (adenomyotic disease).     

Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers

BACKGROUND: Dexmedetomidine, a highly selective alpha2-adrenoceptor agonist used for short-term sedation of mechanically ventilated patients, has minimal effect on ventilation. METHODS: This study compared the respiratory effect of dexmedetomidine to that of remifentanil. The authors measured and compared respiratory responses of six healthy male volunteers during (1) a stepwise target-controlled infusion of remifentanil, (2) a stepwise target-controlled infusion of dexmedetomidine, and (3) a pseudonatural sleep session. RESULTS: Compared with baseline, remifentanil infusions resulted in respiratory depression as evidenced by a decrease in respiratory rate and minute ventilation, respiratory acidosis, and apnea episodes resulting in desaturations. Remifentanil disturbed the natural pattern of breathing and flattened the distribution of ventilatory timing (inspiratory time/ventilatory cycle time). The respiratory effects of dexmedetomidine markedly contrasted with those of remifentanil. When compared with baseline, during dexmedetomidine infusions, the respiratory rate significantly increased, and the overall apnea/hypopnea index significantly decreased. The distribution of inspiratory time/ventilatory cycle time showed an increased peak. In addition, dexmedetomidine seemed to mimic some aspect of natural sleep. While the subjects were breathing a 5% CO2 mixture, hypercapnic arousal phenomena (documented by the Bispectral Index, the electroencephalogram, and sudden increase in the minute ventilation) were observed during dexmedetomidine infusions. Similar phenomena during natural sleep have been reported in the literature. CONCLUSIONS: In comparison with remifentanil, dexmedetomidine infusions (1) did not result in clinically significant respiratory depression, (2) decreased rather than increased the apnea/hypopnea index, and (3) exhibited some similarity with natural sleep.     

Three-dimensional virtual cholangioscopy: a reliable tool for the diagnosis of common bile duct stones

OBJECTIVE: Our goal was to evaluate the clinical reliability of a new software system employing 3-dimensional (3D) virtual anatomic reconstruction and intraluminal virtual exploration for detection of choledocholithiasis and preoperative visualization of the biliary anatomy. SUMMARY BACKGROUND DATA: Virtual reality systems have been proposed for gastroscopy, bronchoscopy, and colonoscopy, as well as for the 3D reconstruction of liver anatomy and hepatic lesions. The impact of these systems in preoperative diagnostics has not been established due to the lack of large clinical series evaluating their reliability. METHODS: From November 2000 to July 2002, all patients presenting to our Institute with suspected choledocholithiasis were prospectively included in the study. All patients underwent conventional magnetic resonance cholangiopancreatography (MRCP) and either intraoperative cholangiogram (IOC) or endoscopic retrograde cholangiopancreatography (ERCP). The digital data from MRCP were incorporated into an original virtual reality software system to generate a 3D reconstruction. All 3D reconstructions were evaluated by a surgeon and a computer software engineer who were blind to the results of the IOC or ERCP. Sensitivity and specificity were then calculated based on the results of either the IOC or ERCP. RESULTS: Sixty-five patients were enrolled in the study. The average time required to reconstruct the images into navigable virtual reality was 7.5 minutes (range, 4-13.5). The 3D virtual cholangioscopy had sensitivity and specificity rates of 71% and 91%, respectively, compared with 61% and 86% of the standard MRCP. CONCLUSION:: The 3D virtual cholangioscopy provides detailed preoperative reconstruction of biliary anatomy and reliable identification of choledocholithiasis with acceptable sensitivity and specificity in a clinical setting. Newer software developments may further enhance its accuracy, so that virtual cholangioscopy might challenge or replace more invasive diagnostic measures in the near future.     

Are communication activities shaped by environmental constraints in reverberating and absorbing forest habitats?

In the dense vegetation of temperate or tropical forests, communication processes are constrained by propagation-induced modifications of the transmitted sounds. The presence of leaves, trunks and branches induces important sound reverberation and absorption leading to diminution of the signal energy as well as qualitative modifications. The aim of this paper is to briefly review the different strategies used by birds to manage with these constraints. At the emitter's level, an adapted emission behavior which takes into account both the physical heterogeneities of the forest environment and the temporal variations of the acoustic constraints, is especially useful to control the active space of signaling. The coding of information into acoustic parameters that have different susceptibility to propagation constraints is also of great interest. At the receiver's level, an adaptive reception behavior (listening post) and a great tolerance to sound degradation during the decoding process are the keys to an optimal communication process.