The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis

BACKGROUND: Milder ovarian stimulation protocols for in vitro fertilization(IVF) are being developed to minimize adverse effects. Mildstimulation regimens result in a decreased number of oocytesat retrieval. After conventional ovarian stimulation for IVF,a low number of oocytes are believed to represent poor ovarianreserve resulting in reduced success rates. Recent studies suggestthat a similar response following mild stimulation is associatedwith better outcomes. METHODS: This review investigates whether the retrieval of a low numberof oocytes following mild ovarian stimulation is associatedwith impaired implantation rates. Three randomized controlledtrials comparing the efficacy of the mild ovarian stimulationregimen (involving midfollicular phase initiation of FSH andGnRH co-treatment) for IVF with a conventional long GnRH agonistco-treatment stimulation protocol could be identified by meansof a systematic literature search. RESULTS: These studies comprised a total of 592 first treatment cycles.Individual patient data analysis showed that the mild stimulationprotocol results in a significant reduction of retrieved oocytescompared with conventional ovarian stimulation (median 6 versus9, respectively, P < 0.001). Optimal embryo implantationrates were observed with 5 oocytes retrieved following mildstimulation (31%) versus 10 oocytes following conventional stimulation(29%) (P = 0.045). CONCLUSIONS: The optimal number of retrieved oocytes depends on the ovarianstimulation regimen. After mild ovarian stimulation, a modestnumber of oocytes is associated with optimal implantation ratesand does not reflect a poor ovarian response. Therefore, thefear of reducing the number of oocytes retrieved following mildovarian stimulation appears to be unjustified.     

Comparison of narrow-band UV-B phototherapy and PUVA photochemotherapy in the treatment of psoriasis

The therapeutic effectiveness of a new fluorescent lamp, Philips TL-01, which emits a narrow peak around 311-312 nm, was compared with the currently used PUVA photochemotherapy consisting of oral 8-MOP followed 2 h later by UV-A from fluorescent lamps Philips TL-09. Comparisons of therapeutic efficacy were performed in 10 patients with widespread, symmetrically distributed psoriasis lesions. They received treatment with PUVA on one half of the body and with TL-01 light on the other half; both treatments were given twice a week. It is concluded that on the average phototherapy with narrow-band UV-B is an effective as PUVA; it is certainly more convenient and probably less carcinogenic.     

Phonetic recalibration does not depend on working memory

Listeners use lipread information to adjust the phonetic boundary between two speech categories (phonetic recalibration, Bertelson et al. 2003). Here, we examined phonetic recalibration while listeners were engaged in a visuospatial or verbal memory working memory task under different memory load conditions. Phonetic recalibration was—like selective speech adaptation—not affected by a concurrent verbal or visuospatial memory task. This result indicates that phonetic recalibration is a low-level process not critically depending on processes used in verbal- or visuospatial working memory.     

Congenital epulis of the jaw: a series of five cases and review of literature

This article describes five cases of congenital epulis, a rare and benign swelling in the mouth of a newborn, which is not widely known. We present five cases: four cases presented as single pedunculated nodules of the gingiva and in one case two nodules were present. Of all, 50% were located at the maxilla. Excision was performed in four of the five cases and in one case, spontaneous regression was awaited. No recurrence was reported. The characteristic features of congenital epulis are a pedunculated, flesh-pink coloured tumour with a predominant occurrence on the anterior maxillary alveolar ridge in a female newborn. Although the aetiology is unknown, most authors suggest a mesenchymal, rather than an odontogenic, origin. Endogenous hormonal factors might influence growth prenatally. Histological findings include granular cells with eosinophilic cytoplasm and small, eccentric nuclei. Despite the fact that the lesion can be a striking sight, spontaneous regression is possible and can be awaited. Indications for non-radical excision under local anaesthesia are severe upper airway obstruction and interference with feeding technique. In conclusion, we provide clinical and histological information about congenital epulis, so that this entity will be more easily recognised and relevant information given to parents.     

Deciphering of mitochondrial cardiolipin oxidative signaling in cerebral ischemia-reperfusion

It is believed that biosynthesis of lipid mediators in the central nervous system after cerebral ischemia-reperfusion starts with phospholipid hydrolysis by calcium-dependent phospholipases and is followed by oxygenation of released fatty acids (FAs). Here, we report an alternative pathway whereby cereberal ischemia-reperfusion triggered oxygenation of a mitochondria-specific phospholipid, cardiolipin (CL), is followed by its hydrolysis to yield monolyso-CLs and oxygenated derivatives of fatty (linoleic) acids. We used a model of global cerebral ischemia-reperfusion characterized by 9 minutes of asphyxia leading to asystole followed by cardiopulmonary resuscitation in postnatal day 17 rats. Global ischemia and cardiopulmonary resuscitation resulted in: (1) selective oxidation and hydrolysis of CLs, (2) accumulation of lyso-CLs and oxygenated free FAs, (3) activation of caspase 3/7 in the brain, and (4) motor and cognitive dysfunction. On the basis of these findings, we used a mitochondria targeted nitroxide electron scavenger, which prevented CL oxidation and subsequent hydrolysis, attenuated caspase activation, and improved neurocognitive outcome when administered after cardiac arrest. These data show that calcium-independent CL oxidation and subsequent hydrolysis represent a previously unidentified pathogenic mechanism of brain injury incurred by ischemia-reperfusion and a clinically relevant therapeutic target.     

Complications of local anaesthesia. An observational study

Abstract: Objectives: Local anaesthesia is increasingly used by dental hygienists. As little is known about the incidence of adverse effects during and after the administration of local anaesthetics, we evaluated side‐effects associated with local anaesthesia. Methods: A prospective observational study was conducted using standard criteria among a group of 103 patients receiving mandibular block anaesthesia. Results: Physical reactions like clenching fists (14.5%), moaning (12.6%) and turning pale (7.8%) were frequently observed. Patients (3.8%) showed a painful reaction because of needle contact with a nerve or the periosteum. Systemic complications were not observed. After the injection, 41.7% said they felt tense during the administration; 4.9% of the patients reported swallowing problems and 3.9% a tachycardia. Conclusions: These results suggest that administration of local anaesthesia has a small risk of adverse events. Complications, if they occur, seem minor and transient in nature.     

PET/CT of skull base meningiomas using 2-18F-fluoro-L-tyrosine: initial report.

Precise delineation of the shape of skull base meningiomas is critical for their treatment and follow-up but is often difficult using conventional imaging such as CT and MRI. We report our results with PET/CT and 2-(18)F-fluoro-L-tyrosine ((18)F-TYR), a marker of amino acid transport, as part of the yearly follow-up of irradiated patients. METHODS: Eleven patients (mean age, 56.5 y) with skull base meningiomas (n=13 lesions) previously irradiated were included. All patients received 300 MBq of (18)F-TYR and were imaged after 30 min of uptake, using a dedicated PET/CT system. The images were first visually examined, and regions of interest (ROI) were then placed over the transaxial PET slice showing the highest uptake. Another ROI was placed over the normal parietal cortex. Tumor-to-cortex activity ratios were obtained by dividing the maximum pixel value in the tumor ROI by the maximum pixel value in the cortex ROI. The PET/CT images were compared with the MR images obtained as part of routine follow-up. RESULTS: Accumulation of the tracer was higher in all meningiomas than in the surrounding tissue. The tumor-to-cortex activity ratio was 2.53 +/- 0.35 (range, 1.3-6). Nonneoplastic tissue such as hyperemic cavernous sinus did not take up the radionuclide and was therefore easily distinguished from the meningioma. The (18)F-TYR anomalies completely overlapped with the MR image in 54% of the tumors, extended beyond the MRI lesion in 38% of the tumors, and were smaller in 8% of the tumors. CONCLUSION: Meningiomas of the skull base are clearly visualized using (18)F-TYR PET/CT, even after irradiation. In addition to MRI, (18)F-TYR PET/CT images may contribute to the evaluation, delineation, and follow-up of these tumors.     

The bitter pay back--perverse financial incentives in healthcare

This article analyses the stimuli that arise from the current design of the healthcare system. Hospital care is fragmented into an endless series of interventions and subsidiary interventions that are parts of chains, lines of care, care trajectories and care protocols. Each intervention has its own logic and quality standards. And each of these interventions not only bears an estimate of the intensity of care but increasingly a price tag as well. These interventions are vitally important because they form the basis for the declarations of costs. Consequently this set-up provides a perverse incentive that elicits greed and meanness. Three factors underlying this are discussed in this article: a meritocratic culture, Taylorism in the care process and misplaced market thinking.     

Antithrombotic therapy and dental surgery with bleeding

The advantages of stopping or reducing antithrombotic therapy should always be weigh out against the disadvantage of the enlarged risk of thrombo-embolic complications. A review of the available literature showed that, in general, it is not necessary to stop the use of aspirin or clopidogrel in case of normal dental surgery. If in doubt and in all cases of other antithrombotic therapy the medical specialist should be consulted. The treatment of postoperative hemorrhage is described and the medical legal aspects are discussed.     

Syndromes 18. Von Recklinghausen's disease

Von Recklinghausen's disease (neurofibromatosis 1; NF1) is one of the neurofibromatoses and accounts for about 90% of all cases. Inheritance is autosomal dominant with about 30-50% of cases representing new mutations. Characteristic features for NF1 are six or more café-au-lait-spots, neurofibromas, Lisch nodules and axillary freckling. Oral manifestation consists of neurofibromas and intrabony lesions. Due to growth of the oral and facial neurofibromas maldevelopment of the facial skeleton and malocclusion are seen. Surgical correction in young individuals easily leads to recurrence. Contour corrected surgery in grown up individuals is possible.