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Uterine myomata and outcome of assisted reproduction 总被引:5,自引:8,他引:5
Ramzy AM; Sattar M; Amin Y; Mansour RT; Serour GI; Aboulghar MA 《Human reproduction (Oxford, England)》1998,13(1):198-202
The aim of this work was to study the effect of uterine myomata on the
implantation rate and outcome in in-vitro fertilization (IVF) and
intracytoplasmic sperm injection (ICSI). Among 406 patients, 51 (12.6%)
were found to have uterine corporeal myomata. Twelve patients were excluded
from the study as they had large myomata, submucous myomata or intramural
myomata encroaching on the cavity. These patients were advised to have
myomectomy before being enrolled in the IVF/ICSI programme. The remaining
patients (n = 39) were sorted according to the number, site and size of the
myomata as assessed by transvaginal sonography. Three patients had more
than one myoma. Most of the myomata were subserous (72.7%) and the mean
diameter of the myomata was 3.5 +/- 0.9 cm. A control group (n = 367) was
chosen with normal uteri and no history of uterine reconstruction surgery.
The mean age of myoma patients was 34.7 +/- 3.6 years as compared to 34.0
+/- 4.4 years in the control group. The age, period of infertility, body
mass index, duration and number of human menopausal gonadotrophin ampoules
needed for stimulation, oestradiol levels, number of oocytes retrieved and
the fertilization rate were not significantly different in the myoma
patients compared to the control group. Fifteen myoma patients (38.5%)
subsequently showed one or more pregnancy sacs on ultrasonography of which
three (20%) spontaneously aborted during the first trimester and two
(13.3%) had preterm labour, as compared to 123 (33.5%), 19 (15.5%) and nine
(7.3%) respectively, among the control group (P = 0.27, 0.33 and 0.21). In
conclusion, uterine corporeal myomata, not encroaching on the cavity and
<7 cm in mean diameter, do not affect the implantation or miscarriage
rates in IVF or ICSI.
相似文献
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四氯偶氮苯(3,3’,4,4’tetrachloroazobenzene,TCAB)和四氯氧化偶氮苯(3,3’,4,4’tetrachloroazoxybenzene,TCAOB)是在合成氯代或二氯代苯胺类除草剂时生成的污染废弃物。此类除草剂经... 相似文献
5.
G Saggese S Bertelloni GI Baroncelli G Federico 《Acta paediatrica (Oslo, Norway : 1992)》1992,81(6-7):532-535
Osteoporosis is a common finding in Turner's syndrome. To test the hypothesis that calcitonin deficiency may contribute to bone mineral loss in Turner's syndrome, we studied basal and calcium-stimulated (2 mg/kg body weight in 5 min) levels of total calcitonin, extractable calcitonin and katacalcin in 15 girls with Turner's syndrome and osteoporosis. Fifteen age-matched healthy girls were studied as controls. Both basal calcitonin (total and extractable) and katacalcin values were not significantly different in patients with Turner's syndrome in comparison with those of the controls. The calcium stimulation test showed a similar "C" cell secretory reserve in both groups. The calculation of delta CT/delta iCa of total and extractable calcitonin and delta KC/delta iCa, which accounts for individual variations in serum ionized calcium increases, did not show any significant difference between girls with Turner's syndrome and controls. We conclude that calcitonin deficiency is not a causative factor of osteoporosis in girls with Turner's syndrome and that in this syndrome long-life estrogen deficiency does not impair "C" cell secretory activity. 相似文献
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Taewoo Lee Adil Gasim Vimal K. Derebail Yunro Chung JulieAnne G. McGregor Sophia Lionaki Caroline J. Poulton Susan L. Hogan J. Charles Jennette Ronald J. Falk Patrick H. Nachman 《Clinical journal of the American Society of Nephrology》2014,9(5):905-913
Background and objectives
In ANCA-associated GN, severe renal dysfunction portends a poor prognosis for renal recovery and patient survival. This study evaluated the prognostic factors affecting renal and patient outcomes in patients presenting with severe kidney failure to guide immunosuppressive therapy.Design, setting, participants, & measurements
This study retrospectively evaluated clinical and histopathologic characteristics of 155 patients who underwent biopsy between October 1985 and February 2011 (median eGFR at presentation, 7.1 ml/min per 1.73 m2; 87% required hemodialysis), all treated with immunosuppressive medications. Three outcomes of interest were measured: patient survival, renal survival, and treatment response (defined as dialysis-free survival without active vasculitis by 4 months after biopsy). Competing risk, Cox, and logistic regression analyses were conducted for each outcome measure.Results
Within 4 months after biopsy, treatment response was attained in 51% of patients, 35% remained on dialysis, and 14% died. In a competing risk analysis, estimated cumulative incidence rates of ESRD and disease-related mortality were 26% and 17% at 1 year and 32% and 28% at 5 years, respectively. Cyclophosphamide therapy and treatment response by 4 months were independently associated with patient and renal survival, adjusting for the percentage of normal glomeruli, histopathologic chronicity index score, and baseline clinical characteristics. Only 5% of patients still dialysis dependent at 4 months subsequently recovered renal function. Low chronicity index score (odds ratio [OR], 1.16; 95% confidence interval [95% CI], 1.04 to 1.30, per unit decrease) and baseline eGFR>10 ml/min per 1.73 m2 (OR, 2.77; 95% CI, 1.09 to 7.01) were significantly associated with treatment response by 4 months. Among cyclophosphamide-treated patients, the likelihood of treatment response was >14% even with highest chronicity index score and eGFR<10 ml/min per 1.73 m2.Conclusions
Although low baseline renal function and severe renal scarring are associated with lower treatment response rate, no “futility” threshold could be identified. Conversely, continued immunosuppressive therapy beyond 4 months is unlikely to benefit patients who remain dialysis dependent. 相似文献8.
GI van Boxel M Hart A Kiszely S Appleton 《Annals of the Royal College of Surgeons of England》2013,95(8):561-564
Introduction
Elective laparoscopic cholecystectomy (LC) is performed routinely as day-case surgery. Most hospital trusts have a policy of no routine postoperative outpatient follow-up although there are no formal guidelines on this. The aim of this retrospective study was to identify the incidence of complications, the degree of symptom resolution and patient satisfaction with a view to formally appraising the need for outpatient follow-up.Methods
Patients who underwent LC in the period between February 2011 and June 2012 were contacted retrospectively by telephone. A standardised questionnaire was used to ascertain the incidence of surgical site infection (SSI), other complications, symptom resolution and patient satisfaction.Results
A total of 211 responses were collected. The rate of SSI was 7.6% (n=16), with the only specific risk factor being smoking (p=0.027). All other complications had a combined incidence of 7% (n=15). There was complete resolution of symptoms in 64% of patients. Of the 36% of patients with residual symptoms, 45% described abdominal discomfort or pain, 41% described reflux symptoms and 14% complained of diarrhoea. Patient satisfaction was very high (96%), yet 33% of patients visited their general practitioner postoperatively in relation to their surgery.Conclusions
Patients are highly satisfied with elective day-case LC. However, SSI is not uncommon, occurring in 1 in 13 patients. Although the majority of patients experience complete symptom resolution, a significant proportion do not. In our experience, routine outpatient follow-up is not required. Nevertheless, the lack of formal follow-up may prove a missed learning opportunity, potentially resulting in inappropriate patient selection for surgery. 相似文献9.
Louis-Philippe Laurin Adil M. Gasim Caroline J. Poulton Susan L. Hogan J. Charles Jennette Ronald J. Falk Bethany J. Foster Patrick H. Nachman 《Clinical journal of the American Society of Nephrology》2016,11(3):386-394
Background and objectives
In primary FSGS, calcineurin inhibitors have primarily been studied in patients deemed resistant to glucocorticoid therapy. Few data are available about their use early in the treatment of FSGS. We sought to estimate the association between choice of therapy and ESRD in primary FSGS.Design, setting, participants, & measurements
We used an inception cohort of patients diagnosed with primary FSGS by kidney biopsy between 1980 and 2012. Factors associated with initiation of therapy were identified using logistic regression. Time–dependent Cox models were performed to compare time to ESRD between different therapies.Results
In total, 458 patients were studied (173 treated with glucocorticoids alone, 90 treated with calcineurin inhibitors with or without glucocorticoids, 12 treated with other agents, and 183 not treated with immunosuppressives). Tip lesion variant, absence of severe renal dysfunction (eGFR≥30 ml/min per 1.73 m2), and hypoalbuminemia were associated with a higher likelihood of exposure to any immunosuppressive therapy. Only tip lesion was associated with initiation of glucocorticoids alone over calcineurin inhibitors. With adjusted Cox regression, immunosuppressive therapy with glucocorticoids and/or calcineurin inhibitors was associated with better renal survival than no immunosuppression (hazard ratio, 0.49; 95% confidence interval, 0.28 to 0.86). Calcineurin inhibitors with or without glucocorticoids were not significantly associated with a lower likelihood of ESRD compared with glucocorticoids alone (hazard ratio, 0.42; 95% confidence interval, 0.15 to 1.18).Conclusions
The use of immunosuppressive therapy with calcineurin inhibitors and/or glucocorticoids as part of the early immunosuppressive regimen in primary FSGS was associated with improved renal outcome, but the superiority of calcineurin inhibitors over glucocorticoids alone remained unproven. 相似文献10.
E. E. FRANSEN VAN DE PUTTE H. J. K. ANANIAS N. P. TJON PIAN GI H. D. de BOER 《Acta anaesthesiologica Scandinavica》2014,58(7):903-905
Priapism is a rare complication of epidural anaesthesia, and the pathophysiology is poorly understood. In general, 95% of all priapism episodes is ischemic because of decreased penile blood flow, and therefore requires immediate treatment. A case is reported of a 45‐year‐old male patient in which a clear relation is demonstrated between continuous thoracic epidural analgesia and priapism after transabdominal nephrectomy. The level of epidural anaesthesia supports the theory that the erection is a consequence of increased penile blood flow, thus a relatively harmless condition. However, confirmation by serial cavernous blood gas analysis or colour duplex ultrasonography is mandatory. Until this hypothesis is confirmed, termination of epidural infusion is advised as a primary treatment. 相似文献