Propofol anesthesia for transvaginal ultrasound guided oocyte retrieval.

The purposes of this study were to determine the efficacy of propofol anesthesia for oocyte retrieval and its effect on IVF outcomes. The anesthetic records of 339 oocyte retrieval cycles were analysed. The mean of total amount of propofol, duration of anesthesia and oocyte pick up were 197.7 +/- 84.2 mg, 25.2 +/- 8.5 and 19.5 +/- 7.4 minutes, respectively. In all cases propofol induced anesthesia within seconds. Mean recovery time was 32.2 +/- 5.4 minutes. Significant nausea and vomiting occurred in one patient. Mild hypotension was observed in 55 out of 339 cycles (16.2%) which did not correlate to the amount and duration of propofol used. A total of 3,417 oocytes were obtained. Fertilization occurred in 2,431 oocytes (71.1%). Mean cleavage rate was 84.5 per cent of fertilized eggs. Mean number of transferred embryo was 4.4 +/- 2.0. Embryos were transferred in 321 cycles, resulted in 73 pregnancies (21.5% per oocyte pick up and 22.7% per transfer). Neither the dose of propofol or the duration of anesthesia has significant effect on pregnancy rate. Propofol anesthesia was found to be efficacious for oocyte retrieval with a rapid induction and recovery, and minimal side effects. The fertilization and pregnancy rates are comparable to other reports using different anesthetic or analgesic agents. However, to reliably determine if propofol affects the IVF outcome a prospective and randomized trial should be performed.

"Simplified IVF": program for developing countries.

The aim of this study is to assess the results of the "Simplified IVF" program at Ramathibodi Hospital. Ramathibodi IVF program has been in operation since October, 1991. Some steps of the conventional IVF procedures have been modified due to the limitation of resources. The embryo laboratory is a simple, clean room situated in a different building from the oocyte recovery room. Short protocol of GnRHa/HMG is used for ovarian stimulation. Monitoring of the follicular development is performed by ultrasound alone with limited number of scans (2-3 times/cycle). Oocyte retrieval is carried out under transvaginal ultrasound guidance and the aspirate transported to the embryo laboratory in a simple insulated box. Luteal phase is supported by giving micronized progesterone. Eighty five couples have undergone 105 ovarian stimulation cycles. OR was done in 100 cycles from 80 couples. Total oocytes collected is 1091. The fertilization rate is 75 per cent. Embryos were transferred in 97 cycles. Clinical pregnancy occurred in 25 cycles. Pregnancy rate per OR and ET is 25 and 25.8 per cent respectively. Nineteen patients have delivered (6 twins, 13 singletons). Simplification of procedures has enabled the IVF service to be available in a center with limited resources without compromising the results. Other advantages are improvement of the patient's convenience, cost savings and less time consumed as well as being less stressful.

Urinary N-acetyl-beta-D-glucosaminidase (NAG) in aminoglycoside nephrotoxicity.

Urinary N-acetyl-beta-D-glucosaminidase (UNAG) excretion was measured in 37 children before and during the treatment with aminoglycosides at the Department of Pediatrics, Ramathibodi hospital from July 1 to October 31, 1986. There were 20 males and 17 females whose ages ranged from 15 days - 15 years. Twelve were in postoperative status, 11 with respiratory tract disease, 11 with urinary tract disease and 3 in the miscellaneous group. Aminoglycosides were given alone in 11 patients, combined with cloxacillin in 14 and with other antibiotics in 12 patients. The duration of aminoglycoside given ranged from 5-27 days (mean +/- SD = 11.5 +/- 5.5 days). Clinical nephrotoxicity was detected in 12 patients (32.4%), of which 7 were males and 5 were females, 4 were less than 1 year old. It appeared 4-9 days (mean +/- SD = 5.8 +/- 1.6 days) after initiation of the treatment. Variation in age, sex, initial UNAG excretion and antibiotic combination were not associated with increased risk of nephrotoxicity. Thirty patients had elevated baseline UNAG excretion from 1-14 times higher than the normal value. UNAG excretion was increased 0.23-5.57 fold in all patients after 24 hours of treatment. In those with clinical nephrotoxicity, the enzymuria rose more than one fold in all of them (sensitivity 100%, specificity 68%, accuracy 78.4%) and this was detected 2-7 days (mean +/- SD = 3.8 +/- 1.6 days) prior to the rise of serum creatinine.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute glomerulonephritis in children: a prospective study.

Fifty-six patients with acute glomerulonephritis were studied prospectively during 1984. Their ages ranged from 10 months to 14 years old with the peak age range between 5 to 9 years. Most of them had edema, hypertension, hematuria with or without proteinuria and had low serum complement. Azotemia was found in 45 per cent of the cases. Serologic evidence for streptococcal infection was positive in 68 per cent and only 6 per cent had positive culture. Edema and hypertension were all resolved within 2 weeks. All patients that were followed up had normal serum complement by the 6th week, normal BUN, Scr by one year. The hematuria disappeared by 6 months and proteinuria by 2 months in 50 per cent of the cases. By the 4th year only one patient had microscopic hematuria and mild proteinuria with normal serum creatinine, normotension and no edema. In conclusion, in Thailand AGN is still a common kidney disease in children but with prompt and proper treatment its prognosis is still very good.

Comparison of urine specific gravity values from total-solids refractometry and reagent strip method.

The comparison of specific gravity values of 561 urine samples from TS meter and reagent strip was made. The data were divided into two groups: group 1-less than 2+ protein contained urine samples and group 2--equal or more than 2+ protein contained urine samples. The results revealed that the specific gravity values from both methods in both groups were statistically different (p less than 0.01) but they were correlated at r = 0.84 (p less than 0.001) and r = 0.73 (p less than 0.001) in group 1 and group 2, respectively. It was concluded that the reagent strip is suitable for use as a screening test but it should not be considered when precise measurement is necessary.

The changes of the hair roots in correlation to the clinical status of the nephrotic syndrome.

The examination of the hair roots were performed by a modified technique as described by Bradfield. The mean hair bulb diameter in children with overt nephrotic syndrome was statistically smaller than the controls. The distributions of hair root morphology amongst them were also statistically different from those of the control group. The hair roots of the children with remission or with questionable relapse were not different from the control group. The application of hair root examination, therefore may be useful in the differentiation of various stages of the nephrotic syndrome.