Recombinant LH supplementation to recombinant FSH during the final days of controlled ovarian stimulation for in vitro fertilization. A multicentre, prospective, randomized, controlled trial.

BACKGROUND: The purpose of this multicentre, multinational trial was to study whether rLH supplementation to recombinant FSH (rFSH) during the late follicular phase increased pregnancy rates. METHODS: After down-regulation with nafarelin, 526 women were randomized on Day 1 of stimulation to use either rFSH (Gonal-F) alone (n = 261) or to continue after Day 6 of stimulation with both rFSH (Gonal-F) and rLH (Luveris) (n = 265) from Day 6. The starting dose of rFSH was 150-225 IU/day according to age below or above 35 years. RESULTS: Ongoing pregnancy rate at week 10-12 was 28.7% after rFSH alone and 27.2% after rFSH + rLH. This showed no evidence of a difference. Administration of rLH significantly (P< 0.001) increased serum LH. Ongoing pregnancy rates in patients with low LH levels (<33 percentile) on Days 1 and 6 of stimulation showed no difference between the group treated with rFSH only (23.9% low Day 1 LH; 22.1% low Day 6 LH) versus rFSH + rLH (25.0% low Day 1 LH; 28.9% low Day 6 LH). CONCLUSIONS: Supplementing rFSH with daily doses of 75-150 IU of rLH during the second half of the follicular phase showed no evidence of increasing the ongoing pregnancy rates in the general population. (ClinicalTrials.gov, trial number: KF02-035/03).

Prognostic significance of symptoms and findings in renal adenocarcinoma.

The occurrence of different symptoms and signs and their relation to prognosis were studied in a series of 324 cases of renal adenocarcinoma. The most common symptoms were gross haematuria and loss of weight, but 17% of the patients were asymptomatic at presentation. The incidence of asymptomatic patients had doubled in ten years. Of the symptoms and signs studied in a multivariate survival analysis, only erythrocyte sedimentation rate had prognostic significance independently of other factors.

Transabdominal and lumbar nephrectomy for renal adenocarcinoma.

The results of 178 transabdominal and 79 lumbal nephrectomies were compared, based on a consecutive series of patients with renal adenocarcinoma. The corrected 5-year survival rate for patients without distant metastases was 64% for transabdominal and 57% for lumbar nephrectomy. This difference is not statistically significant. The transabdominal approach made possible a more extensive operation in patients with tumours extending to neighbouring organs, but none has survived as long as three years. Duration of surgery, need for blood transfusion and duration of postoperative hospital care were similar. Splenic injury occurred in 9.6% of the patients with transabdominal nephrectomy, but this did not result in additional morbidity or mortality. There were a few other sporadic complications.

Reliability of aspiration biopsy cytology in the grading of renal adenocarcinoma.

Needle aspiration biopsy and histologic samples were taken from three corresponding regions of the surgical specimens immediately after nephrectomy from 150 renal parenchymal tumours. At review 144 of these were diagnosed as adenocarcinomas and 6 as oncocytomas. The adenocarcinomas were classified into three grades according to the degree of differentiation: High, moderate, poor. The grade, as evaluated on cytologic grounds, was in agreement with the histologic grade in 75.9% of the cases and in disagreement by one grade in 24.1%. The cytologic assessment was undergraded in 19.1% and overgraded in 5.0%. The 5-year survival rate for patients with histologically highly differentiated carcinomas was 82.7%, for moderately differentiated 48.7% and for poorly differentiated 28.1%. For corresponding cytologic groups the survival rates were 72.7%, 49.9% and 22.2%. The grade was variable in the same tumour in 24.2% of the cases. The assessment demands several samples, from which the least differentiated is significant. The prognostic significance of needle aspiration biopsy is reliable when cytologic differentiation is poor, but declines as the differentiation improves.

Intra-arterial embolic occlusion of a bleeding intrarenal arteriovenous malformation: a case report.

A 41-year-old female patient with a profusely bleeding intrarenal arteriovenous malformation is described. The bleeding site was localized to the left kidney by cystoscopy and excretory urography. The diagnosis was confirmed by angiography and the malformation was treated by intra-arterial embolization without complications.

Abdominal gynaecological emergencies in the surgical unit.

We have studied two types of emergency cases that occurred in the surgical unit who were found to have gynaecological aetiology: 1) patients with the so-called "morbus acutum dexter", i.e. appendicitis, or a gynaecological disease and 2) late complications in patients who had earlier benign gynaecological disease, usually such as tumour and surgery for it. The material with seven years follow-up consisted of 97 patients, who were treated during the periods 1959--60 and 1969--70. The relative numbers in both groups increased during the latter period. Of the patients in the reproductive age with suspected appendicitis, gynaecological diseases--mostly ovarian tumours with complications--constituted 7.6% of patients who had undergone appendicectomy in the surgical unit during the former period and 9.6% during the latter. The late complications consisted mainly of small bowel obstruction, resulting from adhesions caused by previous gynaecological surgery. The time interval between initial surgery and the obstruction was rather long, 3.5 years on the average. In the surgical unit the surgery was carried out in about two thirds of these patients. Our analysis demonstrates the necessity of recognizing cases with gynaecological aetiology as a significant factor in surgical practice; it has to be taken into consideration both in surgical and gynaecological education.