Endometrial fluid collection in women with hydrosalpinx after human chorionic gonadotrophin administration: a report of two cases and implications for management

The impact of hydrosalpinx (HSPX) on in-vitro fertilization (IVF) outcome has recently been the subject of intense debate. Most, but not all, studies have reported decreased implantation and pregnancy rates and increased early pregnancy loss in HSPX patients. This has led to prophylactic salpingectomies prior to IVF in HSPX patients despite the lack of any prospective studies to suggest that any improvement will occur. Women with HSPX constitute a heterogeneous population because some conceive easily with IVF while others do not until after surgical correction. HSPX also increases in size with ovarian stimulation, and can cause implantation failure by fluid reflux into the uterine cavity. Careful assessment of the endometrial lining is mandatory in HSPX to rule out fluid reflux from the HSPX. We present two case reports of patients whose HSPX enlarged with ovarian stimulation, causing fluid reflux into the uterine cavity which was only noted after human chorionic gonadotrophin (HCG) administration.      

Plasma insulin studies in patients with lag curves

Summary The significance of the lag curve, i.e. one in which the blood sugar rises rapidly from a normal fasting value to more than 180 mg/100 ml but returns to the fasting value within 120 min, remains controversial. In order to study this further, plasma insulin levels were measured by immunoassay during oral and intravenous glucose tolerance tests in 3 groups of age/weight matched subjects: Group 1, 14 with unexplained lag curves: Group 2, 14 with lag curves following gastric surgery and Group 3, 14 normal subjects. The mean insulin levels were higher in Group 1 than in Group 3 but the hyperglycaemic stimulus was greater. The insulin response in Group 2 did not differ significantly from the controls. The mean blood sugar curves were similar in Groups 1 and 2, but despite this the insulin response was significantly prolonged in Group 1, suggesting a degree of insulin resistance or antagonism. In the intravenous test 2 patients from each of Groups 1 and 2 had aK value in the diabetic range. The meanK value was higher in Group 1 than in Group 2. Both groups showed a similar rather low insulin response.

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Plasmainsulin-Untersuchungen bei Patienten mit spitzgipfligen Glucose-Toleranz-Kurven

Zusammenfassung Die Bedeutung von spitzgipfligen Blutzuckerkurven, die von normalen Nüchternspiegeln auf mehr als 180 mg% ansteigen, um in 120 min auf die Ausgangswerte zurückzukehren, bleibt strittig. — Um diese Frage weiter zu klären, wurden imnumologisch die Plasma-Insulinwerte bei 3 Gruppen von je 14 Probanden gemessen, die nach Alter und Gewicht übereinstimmten: Gruppe 1 bestand aus Probanden mit derartigen Kurven ohne ausreichende Erklärung, Gruppe 2 aus Patienten nach Magenoperationen und Gruppe 3 diente als Vergleichskollektiv. Im Teilkollektiv 1 fanden sich höhere Insulinwerte als in 3, doch bestand gleichzeitig eine stärkere Blutzuckererhöhung als Stimulans. Die Insulinausschüttung in der Gruppe 2 unterschied sich nicht signifikant vom Vergleichskollektiv. In den Gruppen 1 und 2 stimmen die Blutzuckerspiegel weitgehend überein, doch hielt die Erhöhung der Insulinkonzentration in Gruppe 1 signifikant länger an, was auf einen gewissen Grad von Insulin-Resistenz oder -Antagonismus schließen läßt. Bei der i.v. Belastung ergaben sich für je 2 Probanden der Gruppen 1 und 2k-Werte im diabetischen Bereich. In Gruppe 1 lagen die mittlerenk-Werte höher als in Gruppe 2. Beide Teilkollektive zeigten eine eher erniedrigte Insulin-Ausschüttung.

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Etude de l'insuline plasmatique chez des patients présentant un pic élevé dans leur courbe

Résumé La signification de la courbe pointue («lagcurve») c-à-d celle dans laquelle le sucre sanguin monte rapidement à partir de la valeur normale à jeun à plus de 180 mg/100 ml mais retourne à la valeur à jeun en 120 min, reste controversée. Pour étudier cela plus profondément, le taux de l'insuline plasmatique a été mesuré par dosage radio-immunologique, pendant des épreuves de tolérance au glucose orales et intraveineuses, chez trois groupes de sujets comparables en ce qui concerne l'âge et le poids. Groupe 1, 14 avec des courbes pointues inexpliquées [(lagstorage curves) caractéristique de l'absorption intestinale rapide]. Groupe 2, 14 avec des courbes pointues à la suite d'une intervention chirurgicale gastrique. Groupe 3, 14 sujets normaux. Le taux moyen d'insuline était plus élevé dans le groupe 1 que dans le groupe 3, mais le stimulus hyperglycémique était plus grand. La réponse insulinique dans le groupe 2 n'a pas différé des témoins d'une façon significative. La courbe moyenne du sucre sanguin était semblable dans les groupes 1 et 2, mais en dépit de ceci, la réponse insulinique était significativement prolongée dans le groupe 1 suggérant un degré de résistance ou d'antagonisme insulinique. Dans les épreuves intraveineuses, 2 malades de chacun des groupes 1 et 2 avaient une valeur K dans le domaine des valeurs diabétiques. La valeur moyenne de K était plus élevée dans le groupe 1 que dans le groupe 2. Les deux groupes montraient une réponse insulinique semblable mais plutôt basse.

     

Dobutamine magnetic resonance imaging as a predictor of myocardial functional recovery after revascularisation

OBJECTIVE—To assess the use of dobutamine magnetic resonance imaging (MRI) as a preoperative predictor of myocardial functional recovery after revascularisation, comparing wall motion and radial wall thickening analyses by observer and semi-automated edge detection.
PATIENTS—25 men with multivessel coronary disease and resting wall motion abnormalities were studied with preoperative rest and stress MRI.
MAIN OUTCOME MEASURES—Observer analysis for radial wall thickening was compared with a normal range, while wall motion analysis used a standard four point scale. Semi-automated analysis was performed using an edge detection algorithm. Segments displaying either improved or worsened thickening or motion with dobutamine were considered viable. Postoperative rest images were performed 3-6 months after coronary artery bypass grafting (CABG) for comparison.
RESULTS—For observer analysis the values for sensitivity and specificity were 50% and 72% for wall motion, with respective values of 50% and 68% for thickening. With semi-automated edge detection the figures for motion were 60% and 73%, with corresponding values of 79% and 58% for thickening. Combining thickening and motion for the semi-automated method to describe any change in segmental function yielded a sensitivity of 71% and specificity of 70%.
CONCLUSIONS—Dobutamine MRI is a reasonably good predictor of myocardial functional recovery after CABG. The use of semi-automated edge detection analysis improved results.


Keywords: dobutamine; magnetic resonance imaging myocardial viability; coronary artery bypass grafting     

Fat-to-glucose interconversion by hydrodynamic transfer of two glyoxylate cycle enzyme genes

The glyoxylate cycle, which is well characterized in higher plants and some microorganisms but not in vertebrates, is able to bypass the citric acid cycle to achieve fat-to-carbohydrate interconversion. In this context, the hydrodynamic transfer of two glyoxylate cycle enzymes, such as isocytrate lyase (ICL) and malate synthase (MS), could accomplish the shift of using fat for the synthesis of glucose. Therefore, 20 mice weighing 23.37 ± 0.96 g were hydrodinamically gene transferred by administering into the tail vein a bolus with ICL and MS. After 36 hours, body weight, plasma glucose, respiratory quotient and energy expenditure were measured. The respiratory quotient was increased by gene transfer, which suggests that a higher carbohydrate/lipid ratio is oxidized in such animals. This application could help, if adequate protocols are designed, to induce fat utilization for glucose synthesis, which might be eventually useful to reduce body fat depots in situations of obesity and diabetes.     

Chirurgische Behandlung infizierter Knochendefekte

Zusammenfassung Die unhappy triad der Knochenchirurgie, Infekt, Defekt und Instabilität stellt uns auch heute noch vor schwer zu lösende Probleme. Das Vorgehen der Wahl scheint uns die Stabilisierung der Fragmente mittels einer internen (Osteosynthese) oder externen (äußere Spanner) Fixation, die radikale Ausräumung des Herdes, die vorübergehende Spüldrainage nach Willenegger [26, 27, 28] und schließlich das Auffüllen des Defektes mit autologer Spongiosa zu sein. Bei allen unseren in dieser Studie erfaßten 25 Patienten kam es zum knöcherner Einbau des Transplantates und Abheilung des Haut- und Weichteildefektes, bei vier Patienten be schleunigte eine Spalthautverpflanzung die Heilung. 23 Fälle sind 1 bis 6 Jahre nach der Behandlung vom Infekt her rezidivfrei geblieben, bei sämtlichen Patienten konnte die Belastungsstabilität erreicht werden.Durch das beschriebene Vorgehen konnte in allen Fällen die Gelenkfunktion erhalten oder verbessert werden. Das aktive Eingreifen gestattet zudem Achsen- und Längenkorrekturen.Klinische, szintigraphische und histologische Untersuchungen zeigen, daß der Einbau des spongiösen Transplantates unmittelbar nach der Verpflanzung einsetzt und nach 3 Monaten soweit fortgeschritten ist, daß die Belastungsstabilität erreicht wird.

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Autogenous cancellous bone in osteomyelitis with defects of bone, soft tissue and skin

Summary Surgeons are still confronted with the grave problem of the unhappy triad of bone surgery, i.e. infection, osseous defect and instability. To us the stabilisation of fragments by means of internal or external fixation, the radical saucerization and packing of the cavity with autogenous cancellous bone with preceding irrigation drainage seems to be the procedure best suitable. 25 patients with infected defects of bone, soft tissue and skin were treated accordingly and followed up 1 to 6 years later: In all cases the graft had been integrated and the skin- and soft tissue defects had healed. In 23 cases osteomyelitis had not re-occured, weight bearing stability had been achieved in all 25 cases.The described procedure had either maintained or even improved articular function. Additionally the active intervention allowes correction of axis and length.It is demonstrated by radiological, scintigraphical and histological examinations, that the integration of the cancellous bone transplant begins immediately after transplantation and is advanced within three months to such a point that weight bearing becomes possible.

     

Plasma insulin response to oral carbohydrate in patients with glucose and lactose malabsorption

Plasma insulin levels were determined following oral glucose in 12 patients with adult coeliac disease, after oral lactose in four patients with alactasia, and in age-matched control subjects.

In coeliac patients the insulin response was greater than expected from the small rise in blood sugar, and no correlation was found between plasma insulin and sugar levels at any period during the test. The separation of the plasma insulin curve from the blood sugar curve after glucose is in keeping with the concept that a factor responsible for stimulating insulin secretion is released from the gut during or after absorption of glucose.

In patients with selective lactose malabsorption (alactasia) administration of lactose by mouth failed to elicit any insulin response, indicating that the insulin-releasing effect of the bowel is not activated merely by the presence of intraluminal carbohydrate.

     

Postinflammatory ossicular fixation: CT analysis with surgical correlation

Postinflammatory ossicular fixation is a common problem encountered by the otologic surgeon upon exploration because of conductive hearing loss in patients with chronic otitis media. These nonotosclerotic noncongenital lesions take three pathologic forms: fibrous tissue fixation (chronic adhesive otitis media), hyalinization of collagen (tympanosclerosis), and new bone formation (fibro-osseous sclerosis). Fibrous tissue fixation appears on CT as nonbony, noncalcific soft-tissue debris encasing some or all of the ossicular chain. Tympanosclerosis appears as unifocal or multifocal punctate or weblike calcifications in the middle ear cavity or on the tympanic membrane. This debris may be in direct apposition to the ossicular chain or may replace the suspensory ligaments in symptomatic patients. New bone formation has been identified only in the attic and is the least common manifestation. Thick bony webs or generalized bony encasement may be present at CT. More than 300 patients with the clinical diagnosis of chronic otitis media have been examined. This study encompasses 23 proved cases.