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111.
112.
A prospective trial was undertaken to evaluate the efficacy of stimulated
in-vitro fertilization (SIVF) and stimulated intrauterine insemination
(SIUI) in couples with unexplained and mild male factor infertility. In
all, 80 couples were allocated to treatment with SIVF or SIUI, both
treatments following the same protocol [clomiphene citrate and follicle
stimulating hormone (FSH) injection], except that higher doses of FSH were
used in the SIVF treatment cycles. Initially, 41 couples were allocated to
and started treatment with SIVF but eight cases were eventually converted
to SIUI because of under-response. Similarly, although 39 couples were
initially allocated to SIUI treatment, five of these converted to SIVF
because of over-response. The treatment cycles that were converted either
to SIUI or to SIVF were not considered as treatment failures but as
treatment changes and so were included in the analyses. Of the final 38
SIVF cycles, four were cancelled (dysfunctional response), failed
fertilization occurred in five cycles and 29 subjects reached embryo
transfer. There were two biochemical pregnancies [positive human chorionic
gonadotrophin (HCG) only], two clinical abortions and seven live births. Of
the final 42 SIUI cycles, only two were cancelled, insemination being
performed in the remaining 40 cases. The result was one clinical abortion,
three ectopics and eight live births. The proportion of cycles with
positive HCG was identical (28.9% per cycle treated for SIVF and 28.6% for
SIUI) and the livebirth rates were also not different (18.4% per cycle
treated for SIVF and 19.0% for SIUI). The cost per maternity of SIUI was
approximately half that of SIVF (Pounds Sterling 1923 versus Pounds
Sterling 4611) and so we conclude that, as SIUI had an efficacy that was
not significantly different from SIVF (using similar protocols) but was
more cost-effective, it must be considered the more appropriate form of
management for the treatment of unexplained and mild male factor
infertility. Indeed, it is hard to justify the routine use of IVF, as a
first approach, in unexplained infertility.
相似文献
113.
114.
We present a case in which a covert bronchogenic cyst resulted in two hospital admissions within three years, the second of which was characterised by life-threatening cardiopulmonary compromise requiring sustained support on the intensive therapy unit. 相似文献
115.
116.
Increased emphasis on strict glycaemic control of insulin dependent diabetes mellitus (IDDM) in young patients may be expected to cause increases in rates of significant hypoglycaemia. To evaluate whether this is the case for a large population based sample of IDDM children and adolescents rates of severe (coma, convulsion) and moderate (requiring assistance for treatment) hypoglycaemia were studied prospectively over a four year period. A total of 709 patients were studied yielding 2027 patient years of data (mean (SD) age: 12.3 (4.4); range 0-18 years, duration IDDM: 4.9 (3.8) years). Details of hypoglycaemia were recorded at clinic visits every three months when glycated haemoglobin (HbA1c) was also measured. Overall the incidence of severe hypoglycaemia was 7.8 and moderate was 15.4 episodes/100 patient years. Over the four years mean (SD) clinic HbA1c steadily fell from 10.2 (1.6)% in 1992 to 8.8 (1.5)% in 1995. In parallel with this there was a dramatic increase in the rate of hypoglycaemia, especially in the fourth year of the study, when severe hypoglycaemia increased from 4.8 to 15.6 episodes/100 patient years. This increase was particularly marked in younger children (< 6 years) in whom severe hypoglycaemia increased from 14.9 to 42.1 episodes/100 patient years in 1995. It is concluded that attempts to achieve improved metabolic control must be accompanied by efforts to minimise the effects of significant hypoglycaemia, particularly in the younger age group. 相似文献
117.
EA Mitchell BJ Taylor RP Ford AW Stewart DM Becroft JM Thompson R Scragg IB Hassall DM Barry EM Allen 《Archives of disease in childhood》1993,68(4):501-504
The association between dummy use and sudden infant death syndrome (SIDS) was investigated in 485 deaths due to SIDS in the postneonatal age group and compared with 1800 control infants. Parental interviews were completed in 87% of subjects. The prevalence of dummy use in New Zealand is low and varies within New Zealand. Dummy use in the two week period before death was less in cases of SIDS than in the last two weeks for controls (odds ratio (OR) 0.76, 95% confidence interval (CI) 0.57 to 1.02). Use of a dummy in the last sleep for cases of SIDS or in the nominated sleep for controls was significantly less in cases than controls (OR 0.44, 95% CI 0.26 to 0.73). The OR changed very little after controlling for a wide range of potential confounders. It is concluded that dummy use may protect against SIDS, but this observation needs to be repeated before dummies can be recommended for this purpose. If dummy sucking is protective then it is one of several factors that may explain the higher mortality from SIDS in New Zealand than in other countries, and may also explain in part the regional variation within New Zealand. 相似文献
118.
119.
由于妊娠期母体生理功能的改变,药物更易于通过胎盘进入胎儿体内。妊娠期用药不当可导致胎儿畸形或死亡。本文就耳鼻咽喉科常用的几类药物在妊娠期的应用指征做一编译,以供同道们参考。 相似文献