Direct aspiration versus follicular flushing in poor responders undergoing intracytoplasmic sperm injection: a randomised controlled trial.

OBJECTIVE: To compare follicle flushing three times with direct follicular aspiration in poor responders. Our hypothesis was that follicle flushing three times in poor responders would result in similar oocyte yield compared with direct aspiration in poor responders. DESIGN: A randomised controlled trial performed between January 2015 and June 2015. SETTING: University hospital. POPULATION OR SAMPLE: Eighty eligible poor responders, who were defined as having five or fewer follicles ≥13 mm in average diameter with at least two follicles having maximum diameters >17 mm on the day of human chorionic gonadotrophin administration. Monofollicular cycles, including natural cycles, were excluded from the current trial. METHODS: In the double-lumen needle group, oocyte retrieval was performed by flushing three times with 2 ml in each follicle and in the single-lumen group direct follicle aspiration was performed. MAIN OUTCOME MEASURE: Number of metaphase II oocytes retrieved. RESULTS: The mean number of metaphase II oocytes was similar in both groups (1.9 ± 0.1 versus 2.1 ± 0.1, respectively). The clinical pregnancy and live birth rates were similar in both groups (32.5% versus 25% and 25% versus 22.5%, respectively). The only significant difference between the two groups was the duration of oocyte retrieval (178.4 ± 13.4 versus 236.3 ± 24.1 seconds, respectively, P = 0.01). CONCLUSION: Follicular flushing is time consuming and has similar results compared with direct follicle aspiration in poor responders. TWEETABLE ABSTRACT: Direct follicle aspiration versus flushing in poor responders yields similar metaphase II oocytes.

Left ventricular function in patients with polycystic ovary syndrome: a Doppler echocardiographic study.

PURPOSE: Polycystic ovary syndrome (PCOS) is frequently accompanied by the presence of cardiovascular risk factors. The aim of this study was to determine and compare the echocardiographic profiles of patients with PCOS with those of healthy subjects by using conventional echocardiographic methods and tissue Doppler imaging. METHODS: The study population consisted of 26 untreated patients with PCOS and 24 healthy controls who were mathced with respect to age and body mass index. In addition to standard two dimensional and M-mode measurements, color Doppler M-mode of left ventricular inflow propagation velocities (Vp), pulmonary venous flow measurements, transmitral valve flows and tissue Doppler imaging of the mitral annulus and basal wall were recorded. RESULTS: There were no significant differences between patients with PCOS and control subjects with respect to ejection fraction, mitral E/A ratio, deceleration time, isovolumic relaxation time, Vp and pulmonary venous velocities. The tissue Doppler profiles of patients with PCOS were also found to be similar to those of controls. CONCLUSION: This study suggests that there are no significant differences in certain conventional and tissue Doppler echocardiographic measures of cardiac function between patients with PCOS and healthy control subjects.

Early onset of subclinical atherosclerosis in women with gestational diabetes mellitus.

OBJECTIVE: Common carotid artery intima-media thickness (CIMT) is a non-invasively assessed marker of subclinical atherosclerosis. Our aim in this study was to investigate CIMT in women with gestational diabetes mellitus (GDM). METHODS: Thirty women with GDM and 40 unaffected women (as a control group) were included in the study. Blood samples were drawn from each woman in the morning after they had fasted for at least 8 h, and levels of fasting glucose, insulin, homocysteine, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and very low-density lipoprotein (VLDL) cholesterol were measured, along with the CIMT in the two groups. RESULTS: The mean triglyceride (P = 0.016) and VLDL cholesterol (P = 0.011) levels in the GDM group were significantly higher than those in the unaffected women. There were no significant differences between the groups with respect to plasma levels of total cholesterol, HDL cholesterol, LDL cholesterol and insulin. The mean homocysteine (P = 0.027) and fasting glucose (P = 0.019) levels in women with GDM were significantly higher than those in the control group. Patients with GDM had significantly higher CIMT than did the unaffected women (0.582 +/- 0.066 mm vs. 0.543 +/- 0.049 mm, P = 0.006). CIMT correlated positively with maternal age (r = 0.316, P = 0.008), body mass index (BMI) at the time of a 50-g oral glucose load test (r = 0.414, P = 0.001) and homocysteine levels (r = 0.332, P = 0.008), and fasting glucose (r = 0.265, P = 0.031) and 1-h glucose value (r = 0.410, P = 0.001) at the time of the oral glucose tolerance test. There was a positive correlation between the presence of GDM and CIMT (r = 0.372, P = 0.001). However, stepwise multiple regression analysis showed that GDM/no GDM (95% CI +0.012 to +0.076, P = 0.008) and BMI at the time of the 50-g test (95% CI +0.001 to +0.009, P = 0.011) were independent parameters related to CIMT. CONCLUSION: Women with GDM have increased CIMT compared with unaffected women.

Well-differentiated papillary mesothelioma complicating endometrial carcinoma: a case report.

We present a case of well-differentiated papillary mesothelioma discovered during staging surgery for endometrial carcinoma in a 50-year-old postmenopausal woman. In case of simultaneous well-differentiated papillary mesothelioma (WDPM) and endometrial carcinoma, the surgeon may be mistaken by considering peritoneal implants as tumor metastasis. This situation may result in overtreatment of the patient. Thus a thorough pathologic examination of the specimens taking care not to miss any areas of invasion, and utilizing immunohistochemical analysis when necessary are important to avoid such mistakes. To our knowledge this is the first report of the simultaneous occurrence of endometrial carcinoma in conjunction with diffuse WDPM of the peritoneum.