[Early mortality among patients with supraventircular tachyarrhythmia after acute myocardail infarction]

In this study the frequency of early term mortality [1 months] was evaluated among patients with early supraventricular tachyarrhythmia [<72 hours] during the first acute myocardial infarction [AMI]. In this prospective descriptive study, we studied 315 patients with the first S-T elevation AMI. Various factors including age, gender, risk factors and types of supraventricular tachyarrhythmias [within first 72 hours of CCU admission] were assessed based on medical records. Early cardiovascular mortality [30 days sudden cardiac death or acute coronary syndrome complicated with death] was probed through out-patient clinic. Among 300 patients, 208 individuals [69.3%] had one tachyarrhythmia with 8.1% mortality, 78 patients [26%] had two tachyarrhythmia with 12.8% mortality and the rest 11[3.7%] had three tachyarrhythmia with 45% mortality. Mortality among patients with and without atrial tachycardia [AT] was 36% and 9.4%, respectively [p<0.05], but in patients with and without atrial fibrillation [AF] was 20% and 9%, respectively [p>0.05]. Mortality among patients with and without atrial premature contraction [APCs] was 8% and 14%, respectively, [p>0.05] while among patients with and without sinus tachycardia [ST] was 15% and 5%, respectively. [p<0.05]. Early mortality [within 30 days] was more frequent among patients with S-T elevation myocardial infarction complicated with sinus tachycardia, atrial tachycardia and multiple simultaneously supraventricular tachyarrhythmia

relation between third day FSH level and incidence of poor response in patients undergoing ART cycles

The number and the quality of oocyte are very important in ART cycles. The level of FSH on third day of menstrual cycle plays an important role in success ART cycles. To study the relation between third day FSH level and ovarian response in patients undergoing control ovarian hyperstimulation for IVF cycles. This was an analytical study in which 2200 files form patients referred to Royan institute between 1991 and 1999 were examined. The study group included 212patients whose serum FSH was measured for a maximum of six months before ovation stimulation with long protocol GnRHa. Exclusion criteria included endometriosis and pervious treatment with ART. The patients were divided into two groups on the basis of third day serum FSH levels. Group I included 36 patients with FSH >/= 151IU/L and group II included 176 patients with FSH<151IU/l. The data [age, number of mature follicles, infertility duration, infertility type, and the levels of FSH, LH and progesterone] were analyzed X[2], t-test and Fisher's exact test. Finding: There statistically significant differences between two groups in the number of mature follicles [3.3 +/- 3.3 vs. 5.2 +/- 2.9, respectively], number of oocytes [4.5 +/- 7.75 vs. 7.0 +/- 5.5]], number of transferred embryos [1.4 +/- 1.5 vs. 2.2 +/- 1.7], number of cancelled cycles [30.5% vs. 2.8%] and the level of serum LH [23.5 +/- 20.5 vs. 9 +/- 8.5]. The third day level of serum FSH can be relatively used as a predictor of ovarian reserve and success of ART cycles

[Sjogren-Larsson Syndrome: a case report]

Background: Congenital icthyosis associated with neurologic deficit, developmental delay and spasticity suggests Sjogren-Larson syndrome [SLS]. The most important neuro-imaging findings in this syndrome is white matter impairment

Case: We report an 14-month old infant with SLS with congenital ichthyosis, psychomotor delay and lower limb spasticity. Brain MRI shows white matter changes as previous reports, with a nectoric lesion in left temporal lobe that has not been reported yet

[Comparison of halothane and propofol effect on blood pressure and heart rate changes in maintenance of anesthesia]

Background and Objective: Propofol is an intravenous anesthetic for induction and maintenance of anesthesia, which its usage is increasing owing to produce a general state of post operative well being, antiemetic effect, rapid onset and recovery. This study was done to compare the effect of halothane and propofol on blood pressure and heart rate in maintenance of anesthesia

Methods: One hundred patients in ASA class I and II [American Society of Anesthesiologists] 16-60 years old were randomly divided into two groups. Halothane and propofol with continuous IV infusion were used for maintenance of anesthesia in group 1 and 2, respectively. Hemodynamic changes were measured after premedication, 1 minute after intubation and then every 5 minutes but it was recorded to 30 minutes after beginning and end of surgery. In the end of surgery, the patients were taken to recovery room and observed for evaluating nausea and vomiting for one hour and duration of recovery was compared on the basis of visual and verbal response

Findings: Systolic blood pressure during maintenance of anesthesia was similar in two groups, but systolic blood pressure changes [0.037] and heart rate [P=0.009] were different in both groups. Relative frequency of nausea and vomiting was one in propofol group and four in halothane group. First and second recovery time in propofol group were 9.60, 10.52 min and in halothane group were 20.20, 22.90 min, respectively that there was significant difference between them [P=0.000]

Conclusion: With regard to cardiovascular changes in maintenance of anesthesia with propofol, halothane and recovery time, propofol is a better choice in cases that rapid recovery time is need or inhalational drug usage is contraindicated

Role of serum betaHCG measurement in prediction of empty follicle syndrome

One of important matter in treatment of patients who need in vitro fertilization and embryo transfer to uterus is retrieval of good quality and enough number of oocytes. Unfortunately, in some cases though ovary had good appearance in ultrasound and hormonal aspect, no oocyte was retrieved after HCG injection, which this condition is known as empty follicle syndrome. The aim of this study is to determine the relationship between serum betaHCG and empty follicle syndrome [EFS] in infertile women undergoing ovulation induction. This research was a prospective and case control study over 1009 patients, which 135 patients were omitted due to different reasons and amongst 874 remaining patients, 23.3% had undergone IVF and 76.7% of them had undergone intracytoplasmic sperm injection. All patients with HMG and GnRHa treatment had undergone long protocol. Then the numbers of mature oocytes were assessed during treatment and level of serum betaHCG was measured on time of HCG injection and oocytes retrieval and it was compared with retrieved oocytes. In evaluation of results of this study, no oocytes were found in 34 [3.9%] patients [group I] and less than 50% matured follicles were found in 92 [10.5%] patients [group II] and finally more than 50% matured follicles were found in 748 [85.5%] patient [group III]. Mean level of serum betaHCG was [154.6 +/- 107] in group I, [141.7 +/- 90.4] in group II and [156 +/- 56.6] in group III, 36 hours after HCG injection. The results showed no significant difference between betaHCG and EFS [P=0.194]

Relationship between ovarian volume, BMI and follicular number and clomiphene response in polycystic ovary syndrome

Polycystic ovary syndrome [PCOS] is one of the most common causes of anovulation in women during reproduction years. In this syndrome the first choice for ovulation induction is clomiphene citrate. Approximately 15-25% of patients have been shown to be resistant to even high levels clomiphene and fail to ovulate. To assess the relationship between ovarian unresponsiveness to clomiphene and some clinical and paraclinical factors in PCOS, a prospective, randomized clinical trial was performed on patients referring to the Royan Institute between May 1998 to May 2000. Fifty three PCOS patients with at least 5 successive years of infertility and an age range of 25-35 years were randomly selected. All patients suffered from oligomenorrhea, hirsutism and in all patients baseline concentrations of FSH, LH, testosterone, FBS, fasting insulin, androstandione, 17-alpha-hydroxy progesterone and DHEAs were determined. In all patients the body mass index [BMI], ovarian volume and the number of follicles in each ovary were measured. After transvaginal sonography on 3rd day of menstrual cycle, the patients were treated with clomiphene citrate in 2 cycles. In the first cycle 100 mg/day clomiphene citrate was administered from day 5 to day 9 of the cyle and if no response, the second cycle included 150 mg/day clomiphene citrate and the rate of ovulation was studied. With respect to ovulation the patients were divided in 2 groups, group 1 with ovulation and group 2 without ovulation Usingt student test, the two groups were statistically compared. The ovarian volumes were 8.6 +/- 4.3ml [Mean +/- SD] and 8.74?3.7ml in groups 1 and 2, respectively. The BMI in the 2 groups were 28.0 +/- 3.8 and 29.72 +/- 4.36 [mean +/- SD], respectively. No siginficant difference were observed between the 2 groups in these cases. However, 72.4% of patients in group 1 and 45.8% in group 2 had <10 follicles in each ovary [p < 0.05]. There results suggest no correlation between ovarian volume or BMI and response to clomiphene. However, our findings are highly suggestive of a correlation between number of primary follicles in each ovary and responsiveness to clomiphene, and thus measurement of primary follicle number in ovaries may be a predictive factor for clomiphene responsiveness

Evaluation of essential time to reach mature follicle following ovulation stimulation with clomiphene citrate

Ovulation disorders and unexplained infertility are most common infertility causes among women. The first line treatment in these cases is clomiphene citrate. This study has been designed to evaluate the essential time for growth follicle to reach 18 mm of diameter among patients who were stimulated to ovulate with clomiphene citrate. Study was experimental type and 78 women with polycystic ovary syndrome and 92 women with unexplained infertility referring to Royan Institute had taken to this study. These persons were under treatment with clomiphene citrate 100mg from day of 5-9 of menstrual cycle and follicular growth monitoring was performed by vaginal ultrasonograghy. The necessary time for follicular growth was determined separately in patients with polycystic ovary disease and unexplained infertility and its correlation with age, duration of infertility, BMI and hirsutism was studied in both groups. There was no significant association between the essential time for follicular growth groups and in both groups it was day of 14 of cycle and length of this time had no significant correlation with age, duration of infertility, hirsutism and BMI. There were more common cases of no response to follicle as absence of follicular growth or progesterone serum level less than 5ng/ml in patients with polycystic ovary syndrome. Since the average time of follicle growth in patients with PCO and unexplained infertility who were stimulated to ovulate with clomiphene citrate was the day 14 of the cycle in this study, it has been suggested in cases that follicular growth monitoring with ultrasonography or evaluation of LH peak in urine is not possible, the continuation of treatment can be scheduled on the basis that patients with have a mature follicle on day 14 of their cycle

[Vaginal progestrone versus intramuscular in assisted reproduction [a comparative study]]

Progestrone is one of the important hormones in preparation of uterine endometrium for implantation of the fertilized ovum, and hyposecretion of this hormone can cause infertility and abnormalities in menstruation cycle of the women. With rising Assisted Reproduction comparative Treatment [ART], the number of patients with his abnormality and consequently their need to use external progesterone has increased. Since progesterone exists in different forms, the research is focused upon comparing the natural oil soluble progesterone with other types which are used as vaginal or rectal suppository. A prospective study with randomized clinical trial was done on the patients who were being treated in ART cycles in which superovulation using GnRH-a+hMG was done during 1996 in Royan Institute. Over this period of time, 185 cases of embryo transfusion was performed from which 88 patients [the first group] were randomly treated with progestrone suppository, and 97 [the second group] were treated with progestrone injection. Incidence of pregnancy in the first group was 22 [25%] and in the second group was 25 [25.8%], which statistically indicates no significant difference [p=0.90]. In these patients progesterone level of the blood serum was measured five and seven days after hCG injection. The average progesterone level in blood serum of the first group was 52.72 ng/ml and of the second group was 49.29 ng/ml, which statistically indicated no significant difference [p=0.764]. These findings suggest that the effect of different forms of this progestine drug on promoting secretory phase of endomertium and thus preparing uterus for implantation of the embryo is the same. Therefore, the choice of type drug should be based on the patients condition and their own preference

[Intracytoplasmic sperm injection [ICSI] of one and two day[s]-old oocytes after complete in vitro fertilization [IVF] failure]

The objective of this study was to evaluate the outcome of late [one and two days] Intracytoplasmic sperm injection [ICSI] after total fertilization failure in IVF. 35 IVF cycles that were part of our regular IVF program and showed no evidence of fertilization 16-46 hours after insemination [oocytes were observed at 16-18 hours and again 42-44 hours after the IVF procedures], were assigned to two treatment groups. Assisted fertilization with ICSI was carried out at 24 and 48 hours after oocyte retrieval. Group I [injected-day 1], consisted of 21 patients with 72 failed-fertilized metaphase II oocytes injected 1 day after ovum pick-up; and group II [injected-day 2], included 14 patients with 45 failed-fertilized metaphase II oocytes injected 2 days after ovum pickup. A single spermatozoon from the patient's husband [same as that used for insemination in IVF program] was injected into the cytoplasm of each of these oocytes. Resultant embryos were transferred 72 and 96 hours after oocyte retrieval in group I and II, respectively. Fertilization was achieved with ICSI in most patients with fertilization failure. In group I, [80.5%] oocytes fertilized, whereas in group II, 46.6% of oocytes fertilized. Cleavage rate was 79.3% of injected oocytes in group I, and 42.8% in group II. Finally, in group one 19 of 21 [94%] embryos well transferred. The transfer rate for group two was 11 of 14 [78%]. These results indicate significant differences between fertilization and cleavage rates in both groups. One of the singleton pregnancies resulted from transfer of the embryos in group II, and none in group I. This is the first known pregnancy achieved from late [two days] ICSI and late transferred embryos, after failed IVF. In conclusion, late [24 and 48 hours] ICSI after complete failed fertilization in IVF, can give good fertilization and good cleavage rates. This method can be used as an ideal protocol in IVF programs, to increase chance of pregnancy in infertile couples using the advantages of two main assisted reproductive treatments including IVF and ICSI

[Incidence and growth of uterine myoma after ovulation induction on 1100 infertile women in shahid Akbarabadi Hospital and Royan Institute]

The aim of this study was to determine the incidence and growth rate of uterine myomas in users of ovulation induction drugs. Eleven hundred in fertile women who had undagone at least 5 cycles of ovulation induction, refering to Royan Institute and Akbarabadi Hospital were selected on the basis of easy access selection method. To study presence or absence of uterine myoma, all the patients were subjected to sonograply before ovulation induction the sonography was repeated after at least 5 cycles of ovulation induction and was compared with the initial sonography. Of the 1100 patients, 54 had myoma and of the 1046 myoma-free patients, 71 [6.8%] developed myoma later and of the 54 with initial myoma, 40 [%74] showed increased growth of their myoma. This study is a beginning for studies on the effect of ovulation induction on the growth rate of uterine myomas and may be a comparison basis for the incidenee and growth rate of myomas in an age matched control group of women