Change of estrogen concentration in the menstrual cycle

Background: Many research works showed that menstruation is caused by the sudden reduction of the estrogens and progesterone to low levels of secretion at the end of the menstrual cycle. However, it should be investigated to which levels the concentration of these two hormones sharply reduces to cause menstruation. Objective: To determine estradiol concentration at the beginning of menstruation, the second day of menstruation and the ending of menstruation during the menstrual cycle. Subject and methods: 30 women with the normal menstrual cycle and 30 women with the long menstrual cycle were used as subjects to determine estradiol concentration at the day at the beginning of menstruation, the second day of menstruation and the last day of menstruation during the menstrual cycle. Result and Conclusion: In the women group with the normal menstrual cycle, the estradiol concentration: at the day at the beginning of menstruation is 159.93 \xb1 51.29 pmol/L, at the second day of menstruation is 170.58 \xb1 46.54 pmol/L and at the lastday of menstruation is 177.55 \xb1 46.42 pmol/L. In women in the group with long menstrual cycle, the estradiol concentration: at the day of beginning of menstruation is 154.55 \xb1 61.60 pmol/L and at the last day of menstruation is 154.55 \xb1 61.60 pmol/L.

The efficacy of low dose GNRH agonist depot in combination with recombinant FSH for ovarian stimulation in in vitro fertilization

Background: Ovarian stimulation is an important process in IVF. Objectives:To assess the efficacy of low dose GnRH agonist depot in combination with recombinant FSH for ovarian stimulation in IVF and evaluate the clinical pregnancy rate of this protocol. Subject and method: A prospective study recruited 60 patients undergoing IVF. The patients was injected intramuscularly with a single dose of diphereline of 1.25 mg on cycle day 21-23. Then recombinant FSH was given subcutaneously on day 3. hCG was injected intramuscularly when at least one follicle reached 18 mm in diameter. Oocytes retrieval in 36 hours and embryo 2 transfer on day after oocytes retrieval. Results: Duration of stimulation was 10.8 \xb1 0.9, average number of oocytes was 3.3 \xb1 4.7, average number of embryos was 6.5 \xb1 4.1, clinical pregnancy rate was 41.7%. Ovarian hyperstimulation rate was 5%, frozen embryo rate was 40 %. Conclusions: The use of low dose GnRH agonist depot in combination with recombinant ISH is effective for ovarian stimulation in IVF.

A cesarean scar pregnancy was successfully managed by gestational reduction in combination with methotrexate injections: a case report

Cesarean scar pregnancy is one of the rarest forms of etopic pregnancy. We reported here the case of a 30 year old woman who had a previous preterm delivery with a dead newborn, one live birth with cesarean section and twice MVA after cesarean section. She was presented an with 8-week gestational pregnancy. Diagnosis of cesarean scar pregnancy was made by abdominal and intravaginal ultrasound. We used oocyte retrieval needle to aspirate the gestational sac under ultrasound guidance. The patient was given 4 shots of methotrexate with a dosage of 50mg every other day. Beta HCG level was monitored every 3 days during hospitalization and weekly afterward. It was found that the beta HCG levels normalized after 6 weeks and the woman\u2019s condition was stable. This case showed that the combination of ultrasound-guided gestational sac aspiration and methotrexate injection was successful in management of cesarean scar pregnancy.

Sex ratio at birth in Viet Nam 2006

Background: In recent years the sex ratio at birth in Viet Nam is imbalanced, with the number of male births being higher than that of female births. Objectives: To describe the trend and distribution of sex ratio at birth by time and geography, and investigate the relationship between sex ratio at birth and abortion ratio in 2006. Subjects and method: The study was conducted in 3.840 communal health stations, 723 district hospitals/polyclinics and 132 provincial and central hospitals with total of 1,095,064 births, occupied 78% of births over the nation in 2006. Result: The male/female sex ratio varies between areas, with the ratio being higher in rural than in urban and higher in the North \u2013East and North-Central regions than in the rest of country (p<0.05). Conclusion: There has been the clear imbalance of sex ratio at birth since 2002 (varying from 110 to 113), as well as the significant imbalance of sex ratio at birth by provinces. High imbalance of sex ratio at birth is related to the high abortion rate in these provinces. Viet Nam needs to implement strong measures/actions to avoid the same situation as in China and India.

Clinical pregnancy rate and factors affecting pregnant outcome in frozen embryos transfer

Background: In vitro fertilization cycle often have redundant embryos. These redundant embryos will be frozen and used for the next embryos transfer. Objective: To evaluate clinical pregnancy rate and factors affecting pregnancy outcomes after frozen embryos transfer. Subjects and method: 1013 frozen embryos were cultured until day 2 or 3 and then frozen by the slow freezing procedure. The embryos were thawed and transferred when indicated. Data was processed by SPSS software. Results: The mean age of patients was 32.81 +/- 5.4 years. 70% of patients were infertile due to ovarian diseases. Clinical pregnancy rate after frozen embryos transfer was 28.1%, pregnancy rate on day 3 higher than on day 2, pregnancy rate on day 1 was 40%. Miscarriage rate was 22.3%, multiple pregnancies was 44.4%. Age of patient did not affect pregnancy outcome. Endometrial thickness, quality of embryos had affected pregnancy rate. Conclusions: Clinical pregnancy rate after frozen embryos transfer was 28.1%. Quality of embryo, endometrial thickness and time of transfer had affected pregnancy rate after frozen embryos.

Factors that influence abortion decisions of women at the National Hospital for Obstetric and Gynecology in 2006

Background: The rate of abortion in Vietnam is still high and is dependent on the personal factors of the women as well as the supply of contraceptive services. Objectives: To evaluate some of the factors that influenced the abortion decisions of the women admitted to the National Hospital for Obstetric and Gynecology. Subjects and method: There were 334 unwanted pregnancies in women with a gestation age of less than 12 weeks, who have aborted at the National Hospital for Obstetric and Gynecology between June 2006 and December 2006, participated in this cross-sectional study. They were interviewed according to a questionnaire. Data was analyzed by SPSS software version 10.0. Results: The mean age was 28.93+/-6.57 years. Among all participants, 61.4% were civil servants, 25.7% housewives, 8.1 % students. For 54.8% of all subjects this was the first abortion, and 45.2% had at least one abortion in the past. Age, occupation, educational level, marital status and numbers of children were associated with the history of abortion. Conclusion: The main reasons of abortion were having enough children, unmarried. Determinant factors of abortion decision were older age, low level of education, marital status and having enough children.

Non-recoverable low radial nerve palsy and the outcomes of Smith's procedure of tendon transfer

Background: In the procedure of tendon transfer to treat low radial nerve palsy, recovering movement amplitude for toes is not difficult. It is more important to select the appropriate motive muscle. Previously, pillar muscle was commonly used as motivation for stretching fingers, but many authors opposed this because it\u2019s affecting the function of the hand. Objectives: To evaluate the clinical features of low radial nerve palsy and the outcomes of the treatment of non-recoverable low radial nerve palsy by Smith's procedure of tendon transfer. Subjects and methods: 36 patients suffering from irreversible low radial nerve palsy were treated by Smith's procedure of tendon transfer from Jan 2000 to Jan 2008. Mean follow-up was 23 months. Outcomes assessment was based on Tajima's criteria. Results: All 30 patients were satisfied with the operation and were greatly improved both their functional and aesthetic aspects. In term of biomechanics, the Flexor Carpi Radialis (FCR) is more suitable for reconstruction of the Extensor Digitorum Communis (EDC) in comparison with the flexor carpi ulnaris (FeU) or the power density spectrum. The patients showed good movements of the wrist and fingers/ the thumb moved independently with satisfactory extension and abduction/ the grip strength was rapidly improving. Conclusions: The use of the FCR for reconstruction of the EDC is a suitable choice and Smith's procedure of tendon transfer is a good procedure for the treatment of irreversible radial nerve palsy.

To evaluate preliminarily the results of the technique of PESA (Percutaneous Epididymal Sperm Aspiration) in the National Hospital of Obstetrics and Gynecology

Background: The male infertility accounts for approximately 40%-50%, in which the cases without sperms in semen occupy nearly 5% for Obstructive Azoospermia (OA). Percutaneous Epididymal Sperm Aspiration (PESA) in combination with serum FSH (Follicle Stimulating Hormone) test was effective in the diagnosis and treatment of this disease. Objectives: To evaluate preliminarily the results of the technique of PESA in the diagnosis of OA and in combination with intracytoplasmic sperm injection (ICSI) for treating male infertility. Subjects and method: A longitudinal, interventional study was carried out on 110 cases of male infertility treated at the Assisted Reproductive Technology Center of National Hospital of Obstetrics and Gynecology from August 7th 2005 to July 30th 2006. All patients underwent PESA and then testicular fine needle aspiration (TEFNA) if necessary. Results: The mean age of patients was 34.75+/-6.68 years. Among 110 patients, 54 cases (49.1%) had post-operative diagnoses of OA, 56 cases (50.9%) were diagnosed with complete azoospermia after PESA and TEFNA procedures. There were correlations between the volume of left and right testis and the probability of sperms in testing samples (p= 0.03 and =0.05, respectively). Also, serum FSH concentration related to the positive result of sperm test (p< 0.0001). Conclusion: PESA is less-invasive and exact method to the diagnosis of azoospermia. It should be done PESA for patients with testis volume >=10ml and serum FSH concentration <20mIU/mL.

To assess the infrastructure, equipment, drug availability and the supply of reproductive care service at commune health stations

Background: At commune health stations in Vietnam, there are still limitations of human resources as well as essential drug and equipment supply. However, these problems weren\u2019t assessed comprehensively. Objectives: To describe the infrastructure, equipment, drug availability and the possibility of providing reproductive health services according to National Standard Guidelines on Reproductive Health of these health facilities. Subjects and method: A cross-sectional study was carried out in 210 commune health stations, 28 district hospitals, and 14 provincial hospitals. Results:The infrastructure, equipment and essential drugs in these facilities are inefficient and of low quality that leads to limit the provision of reproductive health, especially for basic obstetric care at commune health stations and comprehensive obstetric care at district and provincial hospitals. Only 16.7% of commune health stations can provide basic obstetric care services and 39.3% of district hospitals and 50% of provincial hospitals were providing comprehensive obstetric care services according to the National Standard Guidelines on Reproductive Health. Conclusion: In order to provide good reproductive healthcare services, the health sector should have an investment strategy on infrastructure, medical equipment and essential drugs for health facilities.

Transferring free scapular flap using microsurgical technique for large soft tissue missing in leg and foot areas

12 cases that were treated successfully by microsurgery in the Department of Plastic Surgery, Military Hospital 108 are involved in study. At time of operation, there were 7 cases with sub-acute infection and 3 cases with chronic infection. The scapular flaps used in procedure had not sense nerves. However, the flaps met requirements of treatment for large skin missing in sole of foot. This procedure is performed when there are not indications of conventional therapeutic methods or island and sub-island vascular stem flaps.

The filling of focus of osteitis in the below of 1/3 leg, foot by free gracilis muscle flap with vassel connection for feeding through microsurger

3 cases of osteomyelitis in the below of 1/3 of thin bone and Tarsal bone’s were operated to remove completely the died bone and filling fully the focus of osteitis by free gracilis muscle flap with the vessel connection for feeding through microsurgery. Results have been successful in all 3 patients. The necessary techniques include the seperation of free gracilis muscle flap, eradication of died bone and decoration of focus of defective osteitis and stitch filling muscle in the focus.

Separate finger and hand reimplantation surgery

21 hands and fingers of 13 patients (male 11, ages of 20-41) of which 11 cases of separated fingers or hands treated by microsurgery and antibiotics, anti-inflammatory drugs. The results have shown that the microsurgery successfully reimplanted the separated fingers in the segment 1 or 2. The factors played an important role for success of microsurgery was vascular anastomosis. In addition to, the preservation of separated limbs, removal of damage tissue also played an important role

Transfer of toe to replace amputed thumb by microsurgery

A study on transfer of toe to replace the finger by microsurgical technique has shown that the successful rate is 7/7(100%) with favorable results in which2 cases replaced by great toe and 5 cases replaced by second toe. The functions of thumb and hand were well recovered. Transfer of toe was indicated incase of completed lost thumb and metacarpal bone in order to ensure the functional recovering of toe and metacarpal bone. The transfer of second toe was indicated in case of lost head of metacarpal bone I. Toe lost metatarsus must not influence to walking and activities of patients

Review 46 cases use of free transplant by the microsurgery in the treatment of defect due to injury of lower extremitis

46 cases of the soft tissue, bone and bone tissue defect in the lower extremities due to the different injuries were received the reconstruction microsurgery with free transplant including 17 of back skin-muscle transplants, 17 of shoulder muscle-skin transplant, one of skin-deltoid muscle transplant... The successful rate is 95%. This is a unique solution for reservation of extremities in the most of patients

Treatment of the soft tissue defect in the pelvic limb by using free flaps with microsurgery

A study on 63 patients (male: 47; female: 16) with the soft tissue defect in the pelvic limb, ages of 11-70(average: 36,93) has shown that the free flaps with microsurgical technique repaired the complicated soft tissue defect in every position of the pelvic limb with a good result (97%). The surgery did not depend on the situation of acute or subacute infection in the transplanted area (good results: 96,3%). The latissimus dorsal muscle flaps or latissimus dorsal muscle- cutaneous flaps were suitable with the reconstruction of the large, deep soft tissue defects of the leg, thigh, especially open shin bone, shin defect ostitis (good results: 96%). The lesion combined with the soft tissue defect found the good results (97%) when treated by the free flaps. 2 complications included 1 patient with the long inflammatory with fistula in the transplanted area and 1 patients with the necrosis of the latissimus dorsal flaps

Free vascularized iliac bone transplantation in treatment of bone defects in shin bone and tarsal bone's

A retrospective study was carried out in 5 patients with bone defect in the pelvic limbs (male: 4, female: 1), ages of 22-42 in which due to injuries (2), weapon (1), osteomyelitis (1) and synovioma damaging the tarsal bone (1). These patients received the free vascularized iliac bone-cutaneous transplantation. The results showed that 4 patients healed the incision in the first phase and one patient healed the incision in 2nd phase. 3 patients had infection, 1 patient was stable and 1 patient had no infection.

Folded fibular bone transplantation with revascularization for reconstruction of the femoral and shin bone defects

The prospective clinical study was carried out on 9 patients (male: 8; female: 1), between the ages of 17 - 50, with the femoral and shinbone defects due to the osteomyelitis or after operative removal of osteoblastoma. 7 patients had a skeletal defect due to traumatic osteomyelitis, 1 patient had a skeletal defect due to osteomyelitis via blood and 1 patient had a skeletal defect after removal of giant cell tumor. The results have shown that situation of nutrition in transplantation area: good (1), bad (8), situation of infection in the transplantation area: asepsis (1), sepsis in the stable period (1) and unstable sepsis (7). Skin - bone complex defect (4), operation results: good (8), medium (1).

Latissimus dorsal free muscle transfer, soft tissue defect

9 patients (male: 7, ages of 14-73 suffered from the soft tissue defect in the leg received the plastic reconstruction by transferring latissimus dorsal free muscle flaps in the central army hospital 108 during 1991-1997. The results have shown that all latissimus dorsal free muscle flaps were living; the incisions were in the first stage. After 3-68 months of plastic surgery, the soft tissue defects were stable and there is no relapsed ostitis or infection.

Plastic reconstruction of long bone defects by free vascularized fibular and pelvic flaps

37 patients with the long bone defects in Central Army Hospital 108 received the free vascularized pelvic and fibular transplantation. Results showed that: good (89.2%), normal (5.4%). The complex pelvic and fibular osteocutaneous flaps showed the good results in 11/11 cases. The folded fibular transplantation found the good results in 8/9 cases.

Results of vascularized fibular bone transplantation in the treatment of stem defect of long-bone

31 cases received the vascularized fibular bone transplantation by microsurgery for recovering the defect of long bones. The successful rate was 29/31. The causes of bone defect were myeloostitis, postoperative traumas of osteoma and congenital fibular pseudojoint. This was a modern method with high efficacy to recovery the defect of long bone and conservation of the limbs.