Endocrinology: Intravenous albumin does not prevent the development of severe ovarian hyperstimulation syndrome in an in-vitro fertilization programme

A cohort study was undertaken to compare the effect at the timeof oocyte retrieval of the i.v. administration of either 1000ml of lactated Ringer' solution or 1000 ml of a 5% solutionof human albumin on in-vitro fertilization patients at riskfor severe ovarian hyperstimulation syndrome (OHSS). A totalof 207 patients with an oestradiol concentration > 10 000pmol/l and/or > 15 follicles (>10 mm diameter) on theday of human chorionic gonadotrophin (HCG) injection were reviewed.Of these, 158 women received 500 ml of lactated Ringer’ssolution both before and after egg retrieval, and 49 women receivedtwo infusions of 500 ml of 5% human albumin in normal salineat the time of egg retrieval. Severe OHSS developed in two patientswho received human albumin and in 10 women who did not receivethe albumin. This difference was not statistically significant.There were no differences between the two groups in terms ofage, number of follicles punctured at transvaginal oocyte retrievalor oestradiol concentration at the time of HCG injection. Theadministration of a 5% human albumin solution does not preventthe development of severe OHSS in at risk patients. It doesappear to blunt the severity of the condition.     

Department of law and ethics

The January 7, 1988 issue of The New England Journal of Medicine has two interesting articles concerning what might generally be termed euthanasia. The article titled Initiating and Withdrawing Life Support represents a consensus among members of the Stanford University Medical Center Committee on Ethics. Its main authors have written a fine example of applied ethics (1).     

Controversies in the management of cerebrovascular disease in older patients.

Several ongoing studies are evaluating the optimal management of patients with cerebrovascular disease. The Carotid Artery Stenosis with Asymptomatic Narrowing: Operation Versus Aspirin (CASANOVA) study has shown that carotid endarterectomy is not recommended for asymptomatic patients with less than 90% carotid stenosis. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgical Trial (ECST) have demonstrated that endarterectomy should be considered for patients who had recent carotid artery territory ischemic symptoms associated with angiographically defined stenosis of greater than 70%. These and other trials are expected to provide further data regarding management of cerebrovascular disease, including treatment of those patients with moderate (30 to 69%) carotid stenosis. Until that time, treatment decisions must be made on a case-to-case basis.     

Relationship between refractive error and monochromatic aberrations of the eye.

PURPOSE: To examine the relationship between ametropia and optical aberrations in a population of 200 normal human eyes with refractive errors spanning the range from +5.00 to -10.00 D. METHODS: Using a reduced-eye model of ametropia, we tested the hypothesis that the optical system of the eye is uncorrelated with the degree of ametropia. These predictions were evaluated experimentally with a Shack-Hartmann aberrometer that measured the monochromatic aberrations across the central 6 mm of the dilated pupil in well-corrected, cyclopleged eyes. RESULTS: Optical theory predicted, and control experiments on a model eye verified, that Shack-Hartmann measurements of spherical aberration will vary with axial elongation of the eye even if the dioptric components of the eye are fixed. Contrary to these predictions, spherical aberration was not significantly different from emmetropic eyes. Root mean square of third-order aberrations, fourth-order aberrations, and total higher aberrations (third to 10th) in myopic and hyperopic eyes were also uncorrelated with refractive error. Astigmatic eyes tended to have larger total higher-order aberrations than nonastigmatic eyes. CONCLUSIONS: We conclude that a reduced-eye model of myopia assuming fixed optical parameters and variable axial length is not tenable.     

Measurement of hemoglobin in long-term fixed erythroid cells: application development for cell science experiments in microgravity

Studying the effects of microgravity on cell differentiation will enhance our understanding of fundamental biology and is indispensable for a sustained space program. Rauscher murine erythroleukemic cells were chosen as a model system to study erythroid cell differentiation aboard the International Space Station because these cells undergo differentiation in response to the natural inducer, erythropoietin, as well as various chemical inducers. We have now developed a method to quantify hemoglobin in Rauscher cells after weeks of fixation and storage required for such space biology experiments. By exploiting the pseudoperoxidase activity of hemoglobin and by using reagents that yield a soluble chromophore that freely passes out of fixed cells, we developed a highly specific and sensitive assay applicable to cells fixed as long as 4 months.     

Comparison of monochromatic ocular aberrations measured with an objective cross-cylinder aberroscope and a Shack-Hartmann aberrometer.

Repeated measures of wavefront aberrations were taken along the line-of-sight of seven eyes using two instruments: an objective, cross-cylinder aberroscope (OA) and a Shack-Hartmann (SH) aberrometer. Both instruments were implemented on the same optical table to facilitate interleaved measurements on the same eyes under similar experimental conditions. Variability of repeated measures of individual coefficients tended to be much greater for OA data than for SH data. Although Zernike coefficients obtained from a single measurement were generally larger when measured with the OA than with the SH, the averages across five trials were often smaller for the OA. The Zernike coefficients obtained from the two instruments were not significantly correlated. Radial modulation-transfer functions and point-spread functions derived from the two sets of measurements were similar for some subjects, but not all. When average Zernike coefficients were used to determine optical quality, the OA indicated superior optics in some eyes, but the reverse trend was true if Zernike coefficients from individual trials were used. Possible reasons for discrepancies between the OA and SH measurements include difference in sampling density, quality of data images, alignment errors, and temporal fluctuations. Multivariate statistical analysis indicated that the SH aberrometer discriminated between subjects much better than did the objective aberroscope.