Peripheral inflammatory and fibrinolytic markers in adolescents with growth hormone deficiency: relation to postprandial dyslipidemia

OBJECTIVE: To determine whether peripheral inflammatory and fibrinolytic markers are elevated in growth hormone-deficient (GHD) adolescents and associated with increased postprandial lipoproteins. STUDY DESIGN: Fifteen GHD children on GH treatment with a chronologic age of 12.7 +/- 2.5 years and 10 untreated GHD adolescents with a chronologic age of 13.0 +/- 2.6 years were studied. Triglycerides (TG), C-reactive protein (CRP), fibrinogen, interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-alpha) were measured in the fasting state and 4 hours after ingesting a high-fat meal; 15 healthy adolescents served as controls. RESULTS: Fasting and postprandial TG of untreated GHD children were higher than those in treated subjects and healthy controls. Fasting TNF-alpha, CRP, and fibrinogen concentrations of untreated GHD adolescents were higher than those in healthy controls, but similar to those of GH-treated GHD adolescents. Although fibrinogen levels increased after a high-fat meal in GHD adolescents, CRP, TNF-alpha, and IL-6 concentrations did not increase further. Fasting and postprandial TG of untreated GHD adolescents were positively associated with fasting and postprandial CRP, and with postprandial TNF-alpha and IL-6 concentrations. Fasting TG also correlated positively with fasting fibrinogen concentrations in untreated and treated GHD adolescents. CONCLUSIONS: The pronounced inflammatory response seen in GHD adolescents seems to be associated with the presence of elevated levels of fasting and postprandial TG, which may result in an increased susceptibility for premature atherosclerosis.     

The triad of seizures, hypertension, and neuroblastoma: the first described case

The combination of seizures, hypertensive encephalopathy, and neuroblastoma has not been described before. The authors report one case, which is not only of interest in its own right, but also emphasizes the importance of including blood pressure measurement in the clinical examination of children, especially when hypertension could be the cause of the symptoms.     

Cryopreservation of human spermatozoa: comparison of two cryopreservation methods and three cryoprotectants

OBJECTIVE: To evaluate the ability of two cryopreservation methods and three cryoprotectants to preserve sperm quality. DESIGN: A prospective clinical study. SETTING: Male infertility clinic at a tertiary healthcare center. PATIENT(S): Twenty infertile men and 10 healthy donors. INTERVENTION(S): In the first experiment, semen was cryopreserved by either the Irvine Scientific method (IS) or the Cleveland Clinic Foundation (CCF) method. In the second experiment, semen was cryopreserved by the IS method and one of three cryoprotectants: TES and Tris yolk buffer, Sperm Freezing Medium, or Enhance Sperm Freeze. MAIN OUTCOME MEASURE(S): Postthaw sperm motility, cryosurvival, and kinematics. RESULT(S): Percentages of postthaw sperm motility and cryosurvival were higher in the IS cryopreservation method compared with in the CCF method (15.94 +/- 9.19 vs. 12.07 +/- 7.31 and 47.42 +/- 17.44 vs. 35.76 +/- 17.56). However, the CCF method resulted in significantly better sperm kinematics. Postthaw motility in the donors and patients was highest in the samples frozen in TES and Tris yolk buffer medium. CONCLUSION(S): The IS method was associated with more flash freezing compared with the CCF method and resulted in better preservation of sperm motility and a higher cryosurvival rate. TES and Tris yolk buffer was most effective at protecting sperm from the negative effects of the cryopreservation process. This may be due to the presence of egg yolk along with glycerol.     

The relationship between maternal serum alpha-fetoprotein and maternal haemoglobin

OBJECTIVES: To test the hypothesis that both second-trimester maternal serum alpha-fetoprotein (MSAFP) levels and Down syndrome-screening test are related to maternal haemoglobin concentration. METHODS: Three hundred and seventeen women in three groups according to their haemoglobin levels: normal haemoglobin concentration (between 10.5 and 13.2 g/dL) (n = 262; 82.6%), anaemia (less than 10.5 g/dL) (n = 11; 3.5%), or high haemoglobin levels (greater than 13.2 g/dL) (n = 44; 13.9%) were studied. MSAFP and Down syndrome risk (on the bases of maternal age, MSAFP and maternal serum beta-hCG concentrations) were recorded. RESULTS: MSAFP (MoM) was lower in women with high haemoglobin levels (0.79 MoM (0.66-1.14)) (p = 0.001) than in women with normal haemoglobin concentrations (1.00 MoM (0.81-1.26)). It was also decreased in women with anaemia (0.90 MoM (0.65-0.94)), even though the difference with women with normal haemoglobin levels was of borderline statistical significance (p = 0.06). The Down syndrome risk was higher in both anaemic women (1:850 (1:380-1:1400)) (p = 0.009) and women with high haemoglobin levels (1:1425 (1:460-1:3100)) (p = 0.036) than in women with normal haemoglobin concentration (1:1950 (1:800-1:5000)). A quadratic model was the best predictive model for both MSAFP (p = 0.02) and Down syndrome risk (p = 0.001) when considering maternal haemoglobin as the independent variable. CONCLUSIONS: MSAFP is decreased and Down syndrome risk is increased in both anaemic and pregnant women with high haemoglobin concentration. Further studies are needed to establish whether adjustments for maternal haemoglobin are needed when giving Down syndrome risks based on biochemical markers. Copyright 2004 John Wiley & Sons, Ltd.     

Cultural sensitivity in providing reproductive care to adolescents

PURPOSE OF REVIEW: To provide an exploration of the global attitudes towards reproductive healthcare by adolescent patients, and to review key points in promoting healthy sexual development among adolescents and appropriate guidelines for communicating within the adolescent population. RECENT FINDINGS: The adolescent's perception of healthcare providers and communication with adolescents are inextricably intertwined, hence the need to address both topics. In addition, we will briefly examine the topic of female circumcision and its impact on women's sexuality. It is necessary to approach this subject because of the increase in the number of individuals that emigrate each year to the United States and Canada from countries that still practise female circumcision. Providing reproductive care for these women has considerable implications for gynecologists and other healthcare providers dealing with reproductive care issues. SUMMARY: Healthcare providers who are aware of adolescent patients' developmental stage and cultural diversity are more able to gain the trust of their patients, and consequently are more effective at addressing their needs.     

Urological injuries during hysterectomies: a 6-year review

AIM: Urological injuries that occur during hysterectomy are a rare but important cause of morbidity. An understanding of the risk factors can help us to reduce their incidence and studying their management and outcome could help us to evolve optimal management strategies. The aim of the present study was to examine the incidence of urological injuries that occur during hysterectomy and to determine the risk factors, management and outcome of such injuries. METHODS: A retrospective analysis of cases of urological injuries sustained during hysterectomies carried out from June 1996 until May 2002, at our institution. The chi-squared test was applied for statistical analysis. RESULTS: The overall incidence of urological injuries was 0.40% (0.28% bladder and 0.12% ureteral). No ureteral injuries occurred during vaginal surgery. The incidence of bladder injury was significantly higher in non-descent vaginal hysterectomies compared with abdominal hysterectomies or vaginal hysterectomies for genital prolapse (P<0.05). Hysterectomy for ovarian malignancies had a significantly higher risk for bladder injuries compared with other indications. Bladder injuries detected during vaginal hysterectomies could be managed through the vaginal route. All the repairs healed successfully. CONCLUSIONS: Non-descent vaginal hysterectomy and hysterectomy for ovarian malignancies have a higher risk of bladder injury. Urological injuries during hysterectomy are uncommon. Early detection and appropriate management ensure successful healing and minimal long-term sequelae.     

Single-stage repair of tetralogy of Fallot with pseudoaneurysm: a unique approach

Pseudoaneurysm is a potentially lethal complication after modified Blalock-Taussig shunt. This report describes a frequently misdiagnosed clinical presentation along with noninvasive diagnosis of pseudoaneurysm after a modified Blalock-Taussig shunt. We report a novel single-stage surgical management of the pseudoaneurysm with concomitant complete repair of tetralogy of Fallot.     

Posterior capsular repair following total hip arthroplasty: a modified technique

Various techniques of posterior capsular repair following THA have been reported and studies have demonstrated the merits of posterior capsular repair with respect to decreasing the incidence of dislocation. Our modified technique using three sutures offers excellent fixation of the hip capsule on the greater trochanter. The small drill holes needed for the #2 Fiberwire minimize the risk of a greater trochanteric fracture through the drill holes and osteoporotic bone. To date, we have not experienced any complications or reaction to this material. The importance of a posterior capsule repair has been well documented in the literature. A rigid capsular repair can prevent excess internal rotation and therefore minimize the incidence of postoperative dislocation following THA.