Step-down dose regimen of human menopausal gonadotropin, a prospective, randomized study

The objective was to assess potential differences in treatment duration and dose, ovarian stimulation, and response between a low dose step-up and a step-down protocol for gonadotropin induction of ovulation. This is a prospective randomized fashion in 29 normogonadotropic clomipheneresistant infertile women. The duration of treatment, ovarian stimulation [serum FSH levels], and response [serum estradiol [E2] levels and number and size of follicles] were monitored. Monitoring [blood sampling and transvaginal sonography] took place on the day of initiation of treatment, the first day of ovarian response as assessed by ultrasound [i.e. the first day a follicle 10 mm could be recognized] and the day of hCG administration to induce ovulation. The median duration of treatment in the low dose step-up group was 18 [range, 7-41] days compared to 9 [range, 4-16] days in the step-down group [P = 0.003], and the total numbers of ampules administered were 20 [range, 7-69] and 14 [range, 7-33], respectively [P = 0.12, NS]. Serum FSH levels from the first day of sonographic ovarian response until the administration of hCG were increased [median increase, 2%/day] in patients receiving the low dose step-up protocol, but showed a decrease [median, 5%/day] in step-down cycles [P < 0.001]. Monofollicular growth, defined as not more than one follicle 16 mm or larger on the day of hCG administration, was observed in 53.3% of low dose step-up and 85.7% of step-down cycles [P < 0.05]. The percentage of patients with normal range periovulatory E2 serum levels [500-1500 pmol/L] was 40% in the low dose step-up group vs. 85.7% in the step-down group [P < 0.05]. None of the step-down group had hyperstimulation or multiple pregnancy compared with 3 and 1 among the low dose step-up group respectively. That a step-down protocol for gonadotropin induction of ovulation exhibits a more physiological, late follicular phase FSH serum profile than a low dose step-up protocol. This results in a shorter duration of treatment, a greater number of monofollicular cycles, less incidence of hyperstimulation and multiple gestation, and more cycles with periovulatory E2 levels within the normal range in the step-down protocol

Plasma phospholipase A2 levels in patients with preeclampsia

The aim was to compare plasma levels of phospholipase A2 [PLA2] in normal and preeclamptic pregnancies, and to investigate the correlation between the level of PLA2 and the severity of the disease. Plasma PLA2 levels in 39 patients with preeclampsia [18 mild, and 21 severe preeclampsia] were compared with 30 normal pregnancies. Patients with preeclampsia [PE] were matched with controls for maternal age, parity, and gestational age at blood sampling. Plasma levels of PLA2 were measured by enzyme immunoassay. The levels of plasma PLA2 were correlated with clinical and biochemical markers of the severity of disease. Plasma levels of PLA2 are elevated in PE and correlated well with the severity of disease. Elevation of this enzyme may contribute to increase placental thromboxane [TXA2], and increased TXA2/prostacyclin [PGI2] ratio, which precedes clinical onset of PE

Computed tomography in hydatid disease of the liver and lung

Computed tomographic [C.T.] studies of the thorax and/or abdomen were performed on 32 patients presented with confirmed or suspected diagnosis of hydatid disease. C.T. finding of hydatid disease can be either diagnostic or highly suggestive of the disease

Hydatid disease of sigmoid colon

A 57 years old man presented with right loin pain and bouts of diarrhea. Plain x-ray of the abdomen revealed two calcified masses, one in the right hypochondrium and the other one in the pelvis, the diagnosis was that of calcified hydatid cysts [fig. 1]. Ultra sound examination revealed that the calcified mass in right hypochondrium was located in the liver, while the other pelvic mass was not related to any organ, it was located posterior and superior to the urinary bladder in relation to an air filled bowel loop [sigmoid colon]. The patient refused further investigations, he used an antidiarrheal locally grown plant named [shandagura]. Two weeks later he came back claiming that he had passed out a small hard piece with stools. Plain x-ray of abdomen showed that the pelvic calcified mass was broken and two pieces were been in the pelvic cavity [fig. 2]. One day later, the patient passed out another piece confirmed by plain way of the abdomen [fig. 3]. Another day passed and the last piece was expelled out [fig. 4]. The two calcified pieces that had passed out with stools are shown in [fig. 5]. Three months later the patient showed up for follow up, plain abdomen showed same findings of calcified mass in right hypochondrium and no pelvic calcifications. C.T. of the abdomen was done and the findings were consistent with calcified hepatic hydatid cyst [fig. 6]

Role of computed tomography in gastric neoplasms

Gastric neoplasms often form a diagnostic problem to the examining clinician.Fourty nine patients with gastric neoplasms represent the material for this study, 19 were males and 30 were females; their ages ranging between 29-66 years. CT scans and barium studies were done for all af them. Endoscopic examination was carried for 38 and surgical interferance was done for 27. CT studies have proved, from our work, to be very useful in detection and evaluation of gastric neoplasms