Induction of the endogenous gonadotrophin surge for oocyte maturation with intra-nasal gonadotrophin-releasing hormone analogue (buserelin): effective minimal dose

From 1985-1987, a total of 34 couples undergoing superovulation for a single in-vitro fertilization (IVF) cycle with clomiphene citrate and purified follicle stimulating hormone (FSH) or human menopausal gonadotrophin (HMG) were randomly allocated doses of intra-nasal buserelin to induce an endogenous gonadotrophin surge, prior to oocyte collection. The doses ranged from a single 25 microg dose to 100 microg every 4 h for 20 h. In three cycles the treatment was abandoned because of a poor ovarian response. In the remaining 31 cycles buserelin was given to induce the endogenous gonadotrophin surge, but there was evidence of premature luteinization in eight cycles and a premature gonadotrophin surge in four cycles. Although a single dose as low as 40 microg induced a surge and resulted in a pregnancy, a single dose of 50 microg proved the most effective minimal dose consistently to induce a gonadotrophin surge and oocyte maturation. Recent reports using gonadotrophin-releasing hormone (GnRH) analogues to induce a gonadotrophin surge has prompted publication of this previously unpublished data.      

Risk factors for goiter in a previously iodine-deficient region.

OBJECTIVE: Little information exists from formerly iodine-deficient areas regarding gender-specific risk factors for goiter and their synergisms. The aim of the present study was to investigate such gender-specific risk factors and their interactions in a large population-based sample. METHODS AND RESULTS: The Study of Health in Pomerania (SHIP) comprised 4310 randomly selected participants, aged 20 - 79 years. SHIP was performed in a previously iodine-deficient region. Data from 3915 participants with no known thyroid disorders were analyzed. Goiter was determined by thyroid ultrasound. Sociodemographic characteristics, smoking and alcohol drinking habits, marital status, education level, urine thiocyanate concentrations, and specifically in women, parity and previous or current use of oral contraceptives and hormone replacement therapy, were considered as candidate risk factors for multivariable statistical tests. Only two variables, an advanced age and current smoking, were independently associated with an increased risk for goiter in both genders. Analyses further revealed specific risk factor profiles for goiter which were different among men, pre- and postmenopausal women. CONCLUSION: We conclude that besides previous iodine deficiency, other risk factors for goiter exist which differ between gender. Among the avoidable risk factors, current smoking was strongly associated with the risk of goiter in men and women. These findings should influence activities which are intended to prevent thyroid disease.     

Bedeutung der postoperativen Übungsbehandlung für das Outcome der distalen Radiusfraktur

The value of consequent and structured tutorial treatment on the outcome of distal radius fractures was examined within a prospective randomized study. Due to assessment criteria, 198 out of 380 consecutive distal fracture patients could be included in the study and randomly assigned to either an intervention group (focused management) or a control group (transition physician process). Recommendations about character, extent and degree of the exercise treatment conducted were given to therapists, in the intervention group post-treatment recommendations were carried out according to standard practice. In the interventions group there was a low degree of prescribed therapy, however, these therapies were carried out in a more structured way and within a shorter time frame. The outcome revealed that only 12.3% of cases treated within the intervention group, as measured by the reduction of earning capacity, showed a reduction despite apparently shorter periods of work incapacity. In contrast, a reduction of earning capacity was found in 27.4% of the cases treated within the control group despite apparently longer post-treatment periods. Working incapacity time periods and the outcome (reduction of earning capacity) were significantly shorter and better within the intervention group and higher therapy costs were not observed The relevance of structured post-treatment in terms of a combined therapy has therefore been underestimated and supportive control appears to be necessary. Combining both therapies assures higher treatment success in cooperation with all parties involved.     

Indications for the interlocking nailing in open fractures

The history of intramedullary nailing leads us to assume that septic complications arising from the treatment of open fractures through marrow nailing are largely due to reaming and need no longer to a full extent be put down to treatment by locking nailing. Locking nailing of an open fracture (all three degrees) of the femur can be recommended as long as the periosteum is not exposed over large segments, and coverage with soft tissue is possible. Locking nailing of the lower leg can only be recommended with open fractures of the first degree. With fractures of the second and third degrees the fixateur externe is the treatment of choice.     

Cystic intracranial lesions: magnetic resonance imaging

Thirty-three patients with cystic intracranial lesions were examined with both magnetic resonance (MR) imaging and CT scanning. The abnormalities imaged included 11 arachnoid cysts, 10 cystic tumors, six postoperative cysts, and three colloid cysts. The intensity patterns of the cyst contents as encoded with routine spin-echo imaging sequences enabled subdivision of the cysts into three categories. Arachnoid and postoperative cysts had an intensity pattern identical to cerebrospinal fluid. More proteinaceous cysts, including inflammatory cysts and nonhemorrhagic tumoral cysts, had an intermediate intensity pattern with characteristically low intensity on the short TR sequence (0.5 sec), but had clearly higher intensity than cerebrospinal fluid on the long TR sequences (2 sec). Finally, three cystic tumors with hemorrhagic fluid and three colloid cysts had a distinctly different pattern of high intensity on all four MR sequences through the same section. MR was superior to CT in characterizing intracranial cystic lesions because of its ability to categorize cysts into these three groups on the basis of the intensity pattern of cyst contents, thereby improving diagnostic specificity and patient management.