Advances in oocyte cryopreservation--part II: rapid cooling using vitrification.

Purpose: The need for freezing oocytes has been established for females undergoing potential therapy that could damage their ovarian egg reserve, for ethical or religious reasons (not having excess embryos frozen) or for women nearing the age of lower fecundity but not married and not ready to use donor sperm. Applying cryopreservation techniques for oocytes used for embryos resulted in very poor pregnancy results. A rapid flash freezing technique has rekindled interest in oocyte freezing known as vitrification.

Septoplasty allows successful delivery in a primary aborter with six previous first trimester miscarriages.

Purpose: To demonstrate that septoplasty can correct a problem of recurrent miscarriage.

Methods: The patient was a primary aborter with a history of six consecutive miscarriages. Septoplasty by hysteroscopy/laparoscopy was performed.

Outcome measures utilized in clinical trials of interventions for post-cardiac arrest syndrome: a systematic review.

Background: The post-cardiac arrest syndrome (period of critical illness following return of spontaneous circulation [ROSC]) is a promising window of opportunity for clinical trials of therapeutic interventions to improve outcome from cardiac arrest. However, the methodological rigor of post-ROSC trials and the ability to compare or pool data on treatment effects across studies requires consistent and appropriate outcome measures. We aimed to determine the current degree of uniformity of outcome measures in clinical trials of post-ROSC interventions.

Cardiogenic shock: a historical perspective.

Significant progress has been made over the past 60 years in defining and recognizing cardiogenic shock (CS), and there have been tremendous advances in the care of patients who have this illness. Although there are many causes of this condition, acute myocardial infarction with loss of a large amount of functioning myocardium is the most frequent cause. It was recognized early in the study of CS that prompt diagnosis and rapid initiation of therapy could improve the prognosis, and this remains true today.

Correction of failed fertilization despite intracytoplasmic sperm injection with oligoasthenoteratozoospermia but with acrosomes present by oocyte activation with calcium ionophore--case report.

Purpose: To determine if fertilization and embryo cleavage can be achieved by artificial oocyte activation in circumstances of repeated failed fertilization with sperm that have an acrosome.

Methods: A woman with three IVF cycles with intracytoplasmic sperm injection (ICSI) failed to fertilize any eggs. The sperm had severe oligoasthenoteratozoospermia with no sperm with normal morphology.

Early arterial hypotension is common in the post-cardiac arrest syndrome and associated with increased in-hospital mortality.

Aim: After return of spontaneous circulation (ROSC) from cardiac arrest, profound myocardial stunning and systemic inflammation may cause hemodynamic alterations; however, the prevalence of post-ROSC hemodynamic instability and the strength of association with outcome have not been established. We tested the hypothesis that exposure to arterial hypotension after ROSC occurs commonly (>50%) and is an independent predictor of death.

Methods: Single-center retrospective cohort study of all post-cardiac arrest patients over 1 year.

Support for the hypothesis that successful immunotherapy of various cancers can be achieved by inhibiting a progesterone associated immunomodulatory protein.

A hypothesis was proposed that cancer cells may utilize a pre-existing mechanism that pregnant mammals use to avoid natural killer cell immune surveillance of the fetus. The hypothesis suggested that those cancer cells that are able to proliferate may have found a way to cause the expression of the immunomodulatory protein known as the progesterone induced blocking factor (PIBF). The cancer cells could find an alternate pathway to make this protein that does not require progesterone secretion, or the cancer cells may actually utilize progesterone and thus make PIBF in a similar fashion to normal pregnancy.

Improved pregnancy outcome for women with decreased ovarian oocyte reserve and advanced reproductive age by performing in vitro fertilization-embryo transfer.

Objective: To compare the pregnancy rates with IVF-ET vs non-assisted reproductive technology in women of more advanced reproductive age with decreased egg reserve as manifested by elevated day 3 serum FSH.

Methods: A retrospective evaluation was made in women aged > or = 38 with a day 3 serum FSH of degrees 15 mIU/ml with > or = 1 year of infertility. Another inclusion criterion was three cycles (unless a pregnancy occurred before that time) of either IVF-ET or non-assisted reproductive therapy which as a minimum included luteal phase support with progesterone.

Use of a standardized order set for achieving target temperature in the implementation of therapeutic hypothermia after cardiac arrest: a feasibility study.

Objectives: Induced hypothermia (HT) after cardiac arrest improved outcomes in randomized trials. Current post-cardiac arrest treatment guidelines advocate HT; however, utilization in practice remains low. One reported barrier to adoption is clinician concern over potential technical difficulty of HT.

Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis.

Objective: Sepsis mortality is closely linked to multi-organ failure, and impaired microcirculatory blood flow is thought to be pivotal in the pathogenesis of sepsis-induced organ failure. We hypothesized that changes in microcirculatory flow during resuscitation are associated with changes in organ failure over the first 24 h of sepsis therapy.

Design: Prospective observational study.

Secondary amenorrhea with normal ovulatory cycles in a young virgin with normal follicle stimulating hormone levels--a case report.

Purpose: To determine if normal ovulation is possible despite amenorrhea in the absence of any obvious uterine abnormalities or adhesions.

Methods: The study was conducted on a 17-year-old virgin with normal sexual development and normal secondary sexual characteristics whose menarche was at age 12 but whose menses ceased after two menstruations. She was first treated with medroxyprogesterone acetate 10 mg x ten days and then a cycle of oral contraceptives.

Resuscitating the microcirculation in sepsis: the central role of nitric oxide, emerging concepts for novel therapies, and challenges for clinical trials.

Microcirculatory dysfunction is a critical element of the pathogenesis of severe sepsis and septic shock. In this Bench-to-Bedside review, we present: 1) the central role of the microcirculation in the pathophysiology of sepsis; 2) new translational research techniques of in vivo video microscopy for assessment of microcirculatory flow in human subjects; 3) clinical investigations that reported associations between microcirculatory dysfunction and outcome in septic patients; 4) the potential role of novel agents to "rescue" the microcirculation in sepsis; 5) current challenges facing this emerging field of clinical investigation; and 6) a framework for the design of future clinical trials aimed to determine the impact of novel agents on microcirculatory flow and organ failure in patients with sepsis. We specifically focus this review on the central role and vital importance of the nitric oxide (NO) molecule in maintaining microcirculatory homeostasis and patency, especially when the microcirculation sustains an insult (as with sepsis).

Ovulation induction and pregnancy in a woman with premature menopause following gonadotropin suppression with the gonadotropin releasing hormone antagonist, cetrorelix--a case report.

Objective: To determine if ovulation and pregnancy could be achieved in a case of amenorrhea, estrogen deficiency, and markedly elevated serum follicle stimulating hormone (FSH) through reduction of the serum FSH by a gonadotropin releasing hormone antagonist.

Methods: A 37-year-old woman with hypergonadotropic secondary amenorrhea related to two courses of chemotherapy with alkylating agents and abdominal radiation therapy (Hodgkin's disease and breast cancer) was treated with cetrorelix in an attempt to induce ovulation by lowering elevated serum FSH and hopefully restore sensitivity of the few remaining follicles by restoring down-regulated FSH receptors. She was monitored with serum estradiol (E2), FSH, luteinizing hormone (LH), progesterone (P) levels and sonography.

Transfusion of packed red blood cells in patients with ischemic heart disease.

Objective: To review the current literature concerning the utility of and complications associated with transfusion of packed red blood cells (PRBC) in medical and surgical patients with ischemic heart disease.

Data Sources, Study Selection, And Data Extraction: The PubMed database of the National Library of Medicine was searched for all studies investigating the use of PRBC in medical and surgical patients with cardiac disease published since 1999. Relevant background literature from before that date was reviewed for inclusion as well.

Results of vasovasostomy or vasoepididymostomy after failed percutaneous epididymal sperm aspirations.

Purpose: After undergoing vasectomy approximately 4% to 6% of men change their minds and desire more children. In the past they had 2 options: 1) vasectomy reversal and 2) sperm retrieval and intracytoplasmic sperm injection. However, in our practices we began to receive requests for another option: reconstructive microsurgery after failed percutaneous epididymal sperm aspiration.

The safety of pelvic surgery in the morbidly obese with and without combined panniculectomy: a comparison of results.

Purpose: The purpose of our study was to evaluate the benefit of panniculectomy combined with pelvic surgery in the morbidly obese patient. Previous literature has found this combined procedure in this particular patient population to have increased morbidity and that it was not beneficial.

Methods: A chart review was performed an all patients who underwent pelvic surgery with or without a panniculectomy between June 2004 and June 2005.

Cervical length measurement by translabial sonography in women with preterm premature rupture of membranes: can it be used to predict the latency period or peripartum maternal infection?

Objectives: To determine the relationship between the translabial cervical length and the latency period or peripartum maternal infection in women with preterm premature rupture of membranes (PPROM).

Methods: Fifty-five women with a singleton gestation and PPROM between 24 and 34 weeks who had a translabial ultrasound performed within 24 hours of membrane rupture were included in the study. Translabial sonography was performed to assess cervical length and funneling.

Episcleritis as a possible complication of lymphocyte immunotherapy--case report.

Introduction: Recurrent episceleritis is uncommon. Lymphocyte immunotherapy (LIT) is frequently useful in establishing successful pregnancies in women with previously failed in vitro fertilization (IVF) cycles.

Methods: A woman with recurrent episcleritis and previous splenectomy was carefully questioned to see if there was any association with having had the LIT procedure.

Volumetric bladder ultrasound performed by trained nurses increases catheterization success in pediatric patients.

Objective: The objective of the study was to determine whether the use of volumetric ultrasound by trained pediatric emergency department (ED) nurses improves first-attempt urine collection success rates.

Methods: This randomized controlled trial was conducted in children aged < or = 36 months requiring diagnostic urine samples. Children were randomized to either the conventional (nonimaged) or the ultrasound arm.

A matched controlled study to evaluate the efficacy of acupuncture for improving pregnancy rates following in vitro fertilization-embryo transfer.

Purpose: To determine if acupuncture performed during the follicular phase and luteal phase but not on the day of embryo transfer could improve the outcome following IVF-ET compared to controls.

Methods: Acupuncture was started biweekly from day 5 of the follicular phase through the luteal phase but not on the day of the transfer. Controls were matched according to age, same number of previous failed IVF cycles and same type of embryo transfer (fresh or frozen).

Caregiver and health care provider satisfaction with volumetric bladder ultrasound.

Objectives: Conventional (nonimaged) bladder catheterization has lower first-attempt success rates (67%-72%) when compared with catheterization aided by volumetric bladder ultrasonography (US) (92%-100%), yet the total time to urine sample collection with US can be quite lengthy. Given the advantage and disadvantages, the authors assessed caregiver and health care provider satisfaction with these two methods.

Methods: Caregivers and health care providers of children enrolled in a prospective, randomized, controlled trial examining the first-attempt urine collection success rates with these two methods completed standardized questionnaires.

A disorder of sympathomimetic amines leading to increased vascular permeability may be the etiologic factor in various treatment refractory health problems in women.

There is an evidence that increased capillary permeability in the standing position is related to a deficit in the sympathetic nervous system. The leakage of this fluid leads to various clinical conditions which frequently puzzle the consulting physician because despite the frequency of this condition intelligent physicians and patients are unaware of the cause of their condition. One of the most common manifestations is the inability to lose weight despite proper dieting.

Characteristics and referral of emergency department patients with elevated blood pressure.

Objectives: To assess the prevalence, characteristics, and referral to health care of emergency department (ED) patients with elevated blood pressure (BP) and to compare those without a history of hypertension (HTN) with suboptimally controlled, known-hypertensive patients.

Methods: A prospective, observational study was conducted in non-critically ill adults with a triage systolic blood pressure (sBP) of > or =140 or with a diastolic blood pressure (dBP) of > or =90 mmHg. Two additional measurements were obtained, and a standardized questionnaire recorded demographics, medical history, and ED staff referrals.

A comparison of the efficacy of intracytoplasmic sperm injection (ICSI) using ejaculated sperm selected by high magnification versus ICSI with testicular sperm both followed by oocyte activation with calcium ionophore.

Purpose: To determine in a couple where the male had globozoospermia with failed fertilization despite intracytoplasmic sperm injection (ICSI) if fertilization could be achieved by using high magnification ICSI or by oocyte activation by calcium ionophore.

Methods: Twenty eggs were retrieved and divided according to source of sperm, i.e.

Subsequent therapeutic options and outcome in couples who fail to fertilize despite in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

Purpose: Failed fertilization with ICSI in women having at least five mature oocytes retrieved is uncommon. The present study evaluated 19 such patients to determine--based on this outcome--what option they would choose next and what the outcome would be.

Methods: The study requirements included females age < or = 43 and use of ejaculated sperm.