Low-temperature atmospheric pressure plasma enhanced tooth whitening: the next-generation technology.

OBJECTIVES: To evaluate the safety and effectiveness of the plasma pencil (PP) device in conjunction with H2 O2 gel. The purpose of this study was to determine whether LTAPP delivered using the PP would enhance the tooth-whitening process while causing no thermal threat. METHODS: The study consisted of thirty extracted human teeth that were randomized into two groups: Group I received LTAPP plus 36% H2 O2 gel at 10, 15 and 20 min and Group II received 36% H2 O2 gel only at the same time intervals. Tooth surface temperature was measured periodically throughout the experiment using a non-contact thermometer. Digital photographs were taken pre- and post-treatment and transferred to Adobe Photoshop for comparison, using the CIELAB Color Value System. Only L* (lightness) values were evaluated in this study. Data were analysed using descriptive statistics and t-test at the 0.05 level. RESULTS: The results revealed a statistically significant difference in mean CIE L* values after exposure to LTAPP plus 36% H2 O2 gel, compared with 36% H2 O2 only, in the 10- and 20-min groups (P = 0.0003 and 0.0103, respectively). The temperature in both treatment groups remained under 80°F throughout the study, which is below the thermal threat for vital tooth bleaching. CONCLUSION: Utilizing PP device in conjunction with 36% H2 O2 safely accelerates and enhances the tooth-whitening process.

Comparison of agonistic flare-up-protocol and antagonistic multiple dose protocol in ovarian stimulation of poor responders: results of a prospective randomized trial.

The management of poor responders in IVF has always been a big problem. The ideal approach has yet to be formulated. In this study we aim to compare two alternative stimulation protocols. A total of 48 poor responder patients described from previous cycles were included and grouped into two: group I consisted of 24 patients in 24 cycles in which leuprolide acetate (40 microg s.c. per day) was initiated on cycle day 2 followed by exogenous gonadotrophins on cycle day 3; group II consisted of 24 patients in 24 cycles in which ovarian stimulation included gonadotrophin-releasing hormone (GnRH) antagonist (cetrorelix, 0.25 mg daily during late follicular phase) administration. While only the oestradiol concentrations on the day of HCG were lower in group II compared with group I, the clinical pregnancy and implantation rates among groups did not show any significance. The impact of these two regimens in ovarian stimulation of poor responders seem to be same and to establish these results further randomized studies with larger sample sizes are required.

Addition of GnRH antagonist in cycles of poor responders undergoing IVF.

Concern about the use of gonadotrophin-releasing hormone (GnRH) agonists in ovarian stimulation of poor responder IVF patients has arisen from the claim that GnRH agonists might have a direct deleterious effect through their receptors on the ovary. In this study, we compared two ovarian stimulation protocols in which no GnRH agonists were used. In all, 40 patients with a poor response in previous treatment cycles were included. They were divided into two groups: group I (n = 20) received ovarian stimulation for 20 cycles, without the addition of either GnRH agonist or antagonist; while group II (n = 20) patients received ovarian stimulation for 20 cycles, including the administration of a GnRH antagonist (Cetrorelix, 0.25 mg daily) during the late follicular phase. There was no statistically significant difference between the groups for mean age, duration of infertility, baseline FSH concentration, cancellation rate, number of ampoules of gonadotrophin used, number of mature oocytes retrieved, oestradiol concentrations on the day of injection of human chorionic gonadotrophin (HCG), fertilization rate and number of embryos transferred. The clinical pregnancy and implantation rates in group II appeared higher than in group I, but were not significantly different (20 and 13.33% compared with 6.25 and 3.44% respectively). The addition of GnRH antagonists to ovarian stimulation protocols might be a new hope for poor responder IVF patients, but this report is preliminary and further controlled randomized prospective studies with larger sample sizes are required.

A unique case of massive ascites before ovulation associated with gonadotropin therapy.

OBJECTIVE: To describe a unique case of massive ascites associated with gonadotropin therapy. DESIGN: Case report. SETTING: Patient in a hospital-based private IVF center. INTERVENTION(S): Ovulation induction with gonadotropins for subsequent IVF. RESULT(S): Ovulation induction with gonadotropins resulted in the accumulation, before ovulation, of 1,200 and 2,000 mL of peritoneal fluid in two consecutive cycles. The stimulation yielded four and six oocytes, respectively. CONCLUSION(S): Gonadotropin therapy can result in ascites before ovulation without an exaggerated ovarian response and without interfering with follicular development.

Deleterious effect of the presence of hydrosalpinx on implantation and pregnancy rates with in vitro fertilization.

OBJECTIVE: To determine the effect of the presence of a unilateral or bilateral hydrosalpinx on the outcome with IVF-ET. DESIGN: Retrospective analysis of clinical and laboratory data. SETTING: Hospital-based private IVF center. PATIENTS: Eight hundred forty-six patients with tubal disease younger than age 40 years undergoing 1,766 stimulation cycles. In 118 cycles, a hydrosalpinx was noted sonographically (group I) whereas, in 1,648 cycles, no such image was documented. MAIN OUTCOME MEASURES: Pregnancy and implantation rates. RESULTS: Group I displayed a significantly lower pregnancy rate per transfer than group II (16.84% versus 36.83%) and a lower implantation rate (3.92% versus 11.53%). CONCLUSION: The presence of hydrosalpinx adversely affects the outcome of IVF.

Hydrosalpinx affects the implantation of previously cryopreserved embryos.

The presence of hydrosalpinx has been reported to negatively affect the pregnancy and implantation rate after in-vitro fertilization (IVF) with embryo transfer. Hydrosalpinges are able to enlarge during ovarian stimulation with a possible increased passage of tubal fluid into the endometrial cavity. We report the effect of hydrosalpinges during the transfer of previously cryopreserved/thawed embryos during a natural cycle. In all, 14 transfers in 0 patients with a sonographically-documented hydrosalpinx during the studied cycle (group I) were compared to 98 cycles in 74 patients with tubal disease but no such sonographic finding (group II). Both pregnancy and implantation rates were significantly lower in group I (7.14 versus 24.49% and 5.0 versus 10. 8% respectively). The presence of hydrosalpinx negatively affects pregnancy and implantation rates during natural cycles.

Perforated appendicitis and ectopic pregnancy following in-vitro fertilization.

This report describes a case of perforated appendicitis and ectopic pregnancy following in-vitro fertilization (IVF) and embryo transfer. Perforated appendicitis was a coincidental event following IVF and embryo transfer. Immediate diagnosis and treatment of the perforated appendicitis saved the life of the patient. The ectopic pregnancy was completely resolved with two doses of methotrexate administration.