Three Cases of Translunate Perilunate Injury Treated with Wrist Arthroscopy.

Background An acute fracture of the lunate is an uncommon injury with the reported incidence ranging from 0.5 to 1% of all carpal bone fractures. The combination of lunate fracture and perilunate injury is even rarer and Bain et al first introduced the "translunate arc concept" in 2008. We reported three cases of translunate perilunate injury treated with wrist arthroscopy. Materials and Methods All the three cases had been treated successfully with the use of wrist arthroscopy. A novel technique of arthroscopic reduction and fixation of a volar pole of lunate fracture was illustrated. The lunate fracture healed in all cases with normal carpal alignment. Results All patients achieved a painless and functional joint with good range of motion at an average follow-up of 15 months. There was no radiological evidence of avascular necrosis of the lunate in all three cases. Conclusion Translunate perilunate injury is rare and a high index of suspicion is necessary for diagnosis. There was no consensus on the surgical approach to this kind of injury. Wrist arthroscopy had proven to be successful in treating the greater and lesser arc perilunate injury. For translunate perilunate injury, wrist arthroscopy is also a feasible option with the advantages of lower risk of arthrofibrosis and avascular necrosis.

Toward developing a once-a-month pill: a double-blind, randomized, controlled trial of the effect of three single doses of mifepristone given at midcycle on the pattern of menstrual bleeding.

OBJECTIVE: To test the feasibility of timing the administration of mifepristone as a once-a-month contraceptive pill on the 12th day before the next menses, as calculated from the length of the previous menstrual cycles. DESIGN: Double-blind, randomized, controlled trial. SETTING: Five family planning centers across the world. PATIENT(S): Three hundred ninety-nine women attending family planning clinics. INTERVENTION(S): Randomized to receive 10, 25, or 200 mg of mifepristone or a placebo. MAIN OUTCOME MEASURE(S): Lengthening or shortening of the normal menstrual cycle length following administration of the drug by at least 5 days. RESULT(S): The menstrual period came within 5 days of the predicted date in 88% of women receiving the placebo, 84% of women receiving 10 mg, 72% of women receiving 25 mg of mifepristone, and only 48% of women treated with 200 mg of mifepristone. Increasing the dose of mifepristone was associated with an increased chance of having a delayed period (P<.001). Only 45% of women were in the peri-ovulatory phase of the cycle according to LH and P measurements on the day of drug administration. Women treated before ovulation were more likely to have delayed menses with all three doses of mifepristone. CONCLUSION(S): Because of the disruption in cycle length, it appears unlikely that mifepristone administered once a month, at a calendar-based time, would provide a reliable method of contraception.

Patients with three or less dominant follicles may not be associated with reduced pregnancy rate of in vitro fertilization treatment.

OBJECTIVES: The management of poor ovarian responders remains a great challenge in in vitro fertilization (IVF) treatment. This study compared implantation and pregnancy rates among women who developed or=16 mm in diameter and those who had >3 dominant follicles after ovarian stimulation. STUDY DESIGN: Retrospective study. RESULTS: Out of 911 consecutive patients receiving ovarian stimulation between January 2000 and December 2002, 894 (98.1%) patients underwent oocyte retrieval. Women with 3 dominant follicles. Despite a significantly higher percentage of non-elective single embryo transfer in women with 3 dominant follicles. CONCLUSION: Implantation and pregnancy rates appeared to be comparable for women who developed 3 dominant follicles during IVF treatment.

Relationship between uterine blood flow and endometrial and subendometrial blood flows during stimulated and natural cycles.

OBJECTIVE: To evaluate the relationship between uterine Doppler flow and endometrial and subendometrial blood flows during stimulated and natural cycles. DESIGN: A prospective observational study. SETTING: A tertiary-assisted reproduction unit. PATIENT(S): Infertile patients undergoing IVF treatment. INTERVENTIONS: A three-dimensional ultrasound examination with power Doppler was performed on the day of egg retrieval in stimulated cycles and the day after the LH surge in natural cycles. MAIN OUTCOME MEASURE(S): Pulsatility and resistance indices of uterine vessels, and the vascularization, flow, and vascularization flow indices of endometrial and subendometrial regions. RESULT(S): Uterine pulsatility and resistance indices were negatively correlated with subendometrial vascularization, flow, and vascularization flow indices in both stimulated and natural cycles, whereas uterine resistance index was negatively correlated with endometrial vascularization and flow indices in natural cycles only. Subendometrial vascularization and vascularization flow indices were significantly lower in patients with an uterine resistance index > or =0.95 than those with an uterine resistance index <0.95. CONCLUSION(S): Uterine blood flow is a poor reflection of subendometrial blood flow during stimulated and natural cycles, and its measurement cannot reflect endometrial blood flow during stimulated cycles.

Are there differences in ultrasound parameters between Chinese women with polycystic ovaries only and with polycystic ovary syndrome?

OBJECTIVE: We aimed to compare antral follicle count (AFC), ovarian volume, ovarian stromal blood flow between Chinese women with polycystic ovary (PCO) only and polycystic ovary syndrome (PCOS) and to evaluate the effect of age on these ultrasound parameters in these women. STUDY DESIGN: In the second to fourth day of the period, they underwent a transvaginal three-dimensional scanning with power Doppler to determine total AFC, total ovarian volume, total ovarian vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Hormonal profile was also measured. RESULTS: A total of 71 Chinese women were recruited in the study: 39 women with PCO only and 32 women with PCOS. Women with PCO only had significantly lower AFC, ovarian volume, ovarian VI, serum LH, testosterone and DHEAS concentrations but higher serum SHBG concentration when compared with PCOS women. When women with PCO only and PCOS were considered together, the rate of decline of AFC over age was 0.905 follicle per year (95% CI=0.008-1.803, p=0.048) and there was no significant decline of ovarian volume and total ovarian VI, FI and VFI over age. CONCLUSION: PCO only represents a milder end of the PCOS spectrum.