[Basal fsh level is only predictive of the quantitative aspect of the ovarian response]

Determination FSH and LH at day 3 of the menstrual cycle predicts the response to stimulation. To evaluate the value of FSH and LH measurements compared with women's age in predicting qualitative and quantitative ovarian response to gonadotrophin stimulation. 305 patients underwent at least one intra cytoplasmic sperm injection [ICSI] cycle. The levels of FSH and LH at day 3 were determined in an earlier cycle. A good quantitative ovarian response was defined as [3]3 oocytes retrieved and 3 embryos obtained. A good qualitative ovarian response was defined as a percentage of mature oocytes [3] 75% and immature ones²15% of the total number of oocytes retrieved with at least one top quality embryo obtained. Receiver operating characteristic [ROC] curves were generated for FSH, LH and female age. FSH is better than female age in predicting the number of oocytes retrieved [respectively ROCAUC=0.77, p=10-3 versus ROCAUC=0.73, p=10-3] and the number of embryos obtained [ROCAUC=0.69, p=10-3 versus ROCAUC=0.66, p=10-3]. LH is non predictive. None of the three tested parameters was predictive of the fertilization and pregnancy rates. An FSH cutoff was calculated and a value of 7.8mUI/ml is associated with a sensitivity of 73% and a specificity of 70% for the prediction of ovarian response to controlled stimulation. Basal FSH level predicts good quantitative rather than qualitative response. LH is non predictive. FSH and LH do not predict pregnancy rate. Patients having high FSH levels should not be excluded from IVF/ICSI treatment

Management of the hepatocellular carcinoma

The hepatocellular carcinoma, is detected sooner due to the progress of the hepatic ultrasound scan allowing an accessibitity to curative treatment. This cancer treatment still remains difficult in Tunisia. To show the difficulties in the management of the hepatocellular carcinoma in Tunisia Patients hospitalized in the gastrocnterology department of Habib Thameur Hospital, from 2002 until 2007, for a cirrhosis follow-up or for a hepatocellular carcinoma treatment were studied retrospectively. The data was summarized by descriptive statistics and analysed with SPSS version 10. Fifty-seven patients were registered in this study. There were 40 males with an average age of 66 years. The cirrhosis was post-viral C in 28 cases. The discovery of the carcinoma was systematic in 16 cases. Treatment was prescribed in only fifteen patients, in the other patients, treatment was not made because of the multifocal character of the hepatocellular carcinoma. Complications were cirrhosis decompensation [n=3]. Fever [n=3], portal thrombosis [n=1] and pleurisy [n=1]. Regardless of the improvement of diagnostic and therapeutic means, 17.5%of our patients having a hepatocellular carcinoma were subjected to a curative treatment. Au additional effort must be unfolded