Natural cycle in-vitro fertilization in couples with unexplained infertility: impact of various factors on outcome

This study evaluated outcome in 117 couples with unexplained infertility who underwent 162 attempts at natural cycle in-vitro fertilization (NIVF) between 1991 and 1993. An egg was obtained in 138 cycles and a single embryo was transferred in 89 cycles. There were 16 implantations (four biochemical pregnancies, three clinical abortions and nine live births). The implantation rate per embryo was 16/89 (18.0%), which translated into a live birth rate per egg collection of 9/138 (6.5%). The impact factors that were assessed included oocyte quality, sperm quality, embryo quality and woman's age. The outcome measures used were fertilization/inseminated egg and implantation/replaced embryo. All embryo transfers were of single embryos. We conclude that, in couples with unexplained infertility, outcome following NIVF is affected by both egg and sperm quality and by the age of the woman. Embryo quality was independent of the above factors but was also critical for successful implantation.      

CT of the pulmonary nodule: a cooperative study

To evaluate the role of computed tomography (CT) in the investigation of pulmonary nodules, a special reference phantom that enabled CT densitometric measurements independent of variations between scanners and patients was used in ten institutions. A total of 384 nodules not considered calcified by conventional methods were examined; 118 (31%) proved to be benign, and in 65 of these (55%), unsuspected calcification was demonstrated. In 28 of the 65, definite calcification could be identified on thin-section CT scans by simple inspection of the scans at narrow windows. In the remaining 37, presence of calcification could not be clearly established without comparison with the reference CT number from the calibration phantom. CT was most effective in establishing the benignancy of nodules 3 cm or less in diameter and those with discrete or smooth margins. CT rarely yields a confident diagnosis of benign disease in larger nodules and in those with irregular or spiculated borders. After review of prior spot radiographs, low kilovolt peak spot radiographs, and conventional tomograms, the authors conclude that thin-section CT aided by a reference phantom in equivocal cases should be an integral part of the diagnostic approach to the pulmonary nodule.     

Treatment choices and patterns in migraine patients with and without a cardiovascular risk profile

Treatment patterns in migraine patients with cardiovascular risk factors are largely unknown. A retrospective observational study was conducted to characterize the baseline cardiovascular risk profile of new users of specific abortive migraine drugs, and to investigate treatment choices and patterns in patients with and without a known cardiovascular risk profile. New users of a triptan, ergotamine or Migrafin^® ( n  = 36 839) from 1 January 1990 to 31 December 2006 were included. Approximately 90% of all new users did not have a clinically recognized cardiovascular risk profile. The percentage of new users with a cardiovascular risk profile did not differ between new users of a triptan, ergotamine or Migrafin^® and also did not change during the study period of 17 years. Differences in treatment choices and patterns between migraine patients with and without a known cardiovascular risk profile reveal a certain reticence in prescribing vasoconstrictive antimigraine drugs to patients at cardiovascular risk.     

A comparative study of the iron-clearing properties of desferrithiocin analogues with desferrioxamine B in a Cebus monkey model

A comparative study of the iron-clearing properties of subcutaneously administered desferrioxamine B (DFO) with those of orally administered desferrithiocin sodium salt (1), desmethyl desferrithiocin (2), desazadesmethyl desferrithiocin sodium salt (3), desazadesmethyl desferrithiocin pivaloyloxymethyl ester (4), and desazadesmethyl-5,5- dimethyl desferrithiocin (5) in an iron-loaded Cebus monkey model and a non-iron overloaded bile duct-cannulated rat model is presented. All six drugs, which performed well in rodent studies, demonstrated increased efficiency in the Cebus monkey model. When administered to rodents at a daily dosage of 384 mumol/kg over a period of 10 days, drug 1 demonstrated severe renal toxicity. whereas drugs 3, 4, and 5 exhibited severe gastrointestinal (GI) toxicity. Under the same experimental protocol, drug 2 did not show significant toxic side effects. In addition, to further evaluate the iron-clearing properties of analogue 2, a dose-response study was performed in the primates that showed that iron excretion increased in a dose-dependent fashion.