Human chorionic gonadotropin-administered natural cycle versus spontaneous ovulatory cycle in patients undergoing two pronuclear zygote frozen-thawed embryo transfer

OBJECTIVE: To compare human chorionic gonadotropin (HCG)-administered natural cycle with spontaneous ovulatory cycle in patients undergoing frozen-thawed embryo transfer (FTET) in natural cycles. METHODS: In this retrospective cohort study, we analyzed the clinical outcome of a total of 166 consecutive FTET cycles that were performed in either natural cycle controlled by HCG for ovulation triggering (HCG group, n=110) or natural cycle with spontaneous ovulation (control group, n=56) in 166 infertile patients between January 2009 and November 2013. RESULTS: There were no differences in patients' characteristics between the 2 groups. The numbers of oocytes retrieved, mature oocytes, fertilized oocytes, grade I or II embryos and frozen embryos in the previous in vitro fertilization (IVF) cycle in which embryos were frozen were comparable between the HCG and control groups. Significant differences were not also observed between the 2 groups in clinical pregnancy rate (CPR), embryo implantation rate, miscarriage rate, live birth rate and multiple CPR. However, the number of hospital visits for follicular monitoring was significantly fewer in the HCG group than in the control group (P < 0.001). CONCLUSION: Our results demonstrated that HCG administration for ovulation triggering in natural cycle reduces the number of hospital visits for follicular monitoring without any detrimental effect on FTET outcome when compared with spontaneous ovulatory cycles in infertile patients undergoing FTET in natural ovulatory cycles.

Malignant Paraganglioma in the Common Hepatic Duct / 대한내과학회지

Paragangliomas are rare extra-adrenal neoplasms of neural crest origin. The neoplasms may develop at various sites, but most are located in the para-aortic space along the sympathetic chain. A paraganglioma in the bile duct is very rare; only four cases of such tumors in the hepatic bile duct have been reported to date. Herein, we report on the first Korean case of a malignant paraganglioma in the common hepatic duct (with hepatic metastases) in a 75-year-old male. Computed tomography of the abdomen revealed a heterogeneously enhancing lesion in the common hepatic duct with dilatation of the intrahepatic ducts. After balloon sweeping, the mass exited spontaneously through the Ampulla of Vater. The mass was about 1.5 × 1.3 × 0.5 cm in its dimensions and the surface appeared to be necrotic and edematous. Microscopically, the tumor cells were arranged in a Zellballen pattern. The tumor was diagnosed as a malignant paraganglioma.

A Case of Primary Lung Cancer Mistaken for Pulmonary Metastasis of Renal Cell Carcinoma / 대한내과학회지

Renal cell carcinoma (RCC) is rare relative to other urological cancers, but relatively common overall among males. Even when primary tumors are successfully removed by surgery, metastases are often noted within a few years. On the other hand, masses found at other sites in patients with RCC may represent different primary cancers. We present the case of a 63-year-old man with a right lung mass and a left lung nodule who underwent radical right nephrectomy for RCC. We found no local recurrence of RCC in the abdomen. Despite treatment for RCC, the right lung mass increased in size. We performed a lung needle biopsy and diagnosed primary lung cancer. Postoperatively, the remaining left lung nodule also increased in size. It was diagnosed as an RCC metastasis upon biopsy and removed by wedge resection. The patient was treated with everolimus after the second surgery.

A Novel Angiotensin Type I Receptor Antagonist, Fimasartan, Prevents Doxorubicin-induced Cardiotoxicity in Rats

Angiotensin receptor blockers (ARBs) have organ-protective effects in heart failure and may be also effective in doxorubicin-induced cardiomyopathy (DOX-CMP); however, the efficacy of ARBs on the prevention of DOX-CMP have not been investigated. We performed a preclinical experiment to evaluate the preventive effect of a novel ARB, fimasartan, in DOX-CMP. All animals underwent echocardiography and were randomly assigned into three groups: treated daily with vehicle (DOX-only group, n=22), 5 mg/kg of fimasartan (Low-fima group, n=22), and 10 mg/kg of fimasartan (High-fima group, n=19). DOX was injected once a week for six weeks. Echocardiography and hemodynamic assessment was performed at the 8th week using a miniaturized conductance catheter. Survival rate of the High-fima group was greater (100%) than that of the Low-fima (75%) and DOX-only groups (50%). Echocardiography showed preserved left ventricular (LV) ejection fraction in the High-fima group, but not in the DOX-only group (P=0.002). LV dimensions increased in the DOX-only group; however, remodeling was attenuated in the Low-fima and High-fima groups. Hemodynamic assessment showed higher dP/dt in the High-fima group compared with the DOX-only group. A novel ARB, fimasartan, may prevent DOX-CMP and improve survival rate in a dose-dependent manner in a rat model of DOX-CMP and could be a treatment option for the prevention of DOX-CMP.

The Rate of Nasal Colonization of Methicillin-resistant Staphylococcus aureus at Admission to Intensive Care Units in a Secondary Hospital: The Importance of Nasogastric Tube / 병원감염관리

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization has been known as a predictor of intensive care unit (ICU)-acquired MRSA infections. We performed this study to survey the nasal colonization of MRSA among the patients admitted to an ICU and analyze risk factors associated with the colonization. METHODS: A retrospective 1:1 matched case-control study was conducted with patients admitted to the ICU from March to December 2010 at Samsung Changwon Hospital. RESULTS: A total of 602 patients among 846 patients admitted to the ICU during the study period were evaluated. The prevalence of nasal MRSA colonization was 67 (11.1%) of 602. Other factors, including underlying renal disease (odds ratio [OR]=12.37, 95% confidence interval [CI] 3.60-42.54; P<0.001), MRSA infection within the previous 3 months (OR=7.43, 95% CI 1.31-42.05; P=0.023), nursing home resident within the previous 1 month (OR=6.25, 95% CI 1.82-21.53; P=0.004), surgical procedure within the previous 1 month (OR=5.93, 95% CI 1.86-18.85; P=0.003), and current use of nasogastric tube (OR=4.98, 95% CI 1.84-13.45; P=0.002) were independently associated with nasal MRSA colonization in patients admitted to ICU. CONCLUSION: A significant number of patients admitted to the ICU in a secondary hospital were colonized with MRSA. The present study showed the possible impact of the presence of a nasogastric tube on the nasal colonization by MRSA. More effective infection control procedures must be developed for patients with nasogastric tube use.

Arterial Blood Gas Changes During Penumonctomy and Lobectomy According to the Inspired O2 Concentration / 대한마취과학회지

At the Department of Anesthesiology, Ewha Womans University Hospital from June, 1984 to August, 1986, pneumonectomies and lobectomies in 12 patients were performed in the lateral position during two-lung ventilation. 5 patients (group l) were ventilated using a portex endotracheal tube with 50% N2O and 50% O2; 7 patients (greup ll),100% 02. Analysis of artierial blood gases, mean arterial pressure and heart rates were stdudied. Arterial samples were obtained during the following times: (1) preoperative period, (2) the closed-chest in the lateral position, (3) before the ligation of the bronchus in the open-chest, (4) after the ligation of the bronchus in the open.chest and (5) the postoperative period. The results were as follows : (1) In both groups PaO2, gradually decreased during all periods and was not significant. (2) After the ligation of the bronchus in the open-chest, PaO2 values were 199.1+/-64.5 mmHg (group I) and 322.7+/-112.4 mmHg (group ll), There was a significant difference between two groups but without clinical improtance (P < 0.05). We concluded that when pneumonectomy and lobectomy were performed in the lateral position by the use of two-lung ventilation with FiOa, 0.5 or more, PaO2 was maintained satisfactorily during the closed and open christ periods.

Arterial Blood Gas Changes During Penumonctomy and Lobectomy According to the Inspired O2 Concentration / 대한마취과학회지

At the Department of Anesthesiology, Ewha Womans University Hospital from June, 1984 to August, 1986, pneumonectomies and lobectomies in 12 patients were performed in the lateral position during two-lung ventilation. 5 patients (group l) were ventilated using a portex endotracheal tube with 50% N2O and 50% O2; 7 patients (greup ll),100% 02. Analysis of artierial blood gases, mean arterial pressure and heart rates were stdudied. Arterial samples were obtained during the following times: (1) preoperative period, (2) the closed-chest in the lateral position, (3) before the ligation of the bronchus in the open-chest, (4) after the ligation of the bronchus in the open.chest and (5) the postoperative period. The results were as follows : (1) In both groups PaO2, gradually decreased during all periods and was not significant. (2) After the ligation of the bronchus in the open-chest, PaO2 values were 199.1+/-64.5 mmHg (group I) and 322.7+/-112.4 mmHg (group ll), There was a significant difference between two groups but without clinical improtance (P < 0.05). We concluded that when pneumonectomy and lobectomy were performed in the lateral position by the use of two-lung ventilation with FiOa, 0.5 or more, PaO2 was maintained satisfactorily during the closed and open christ periods.