Luteal phase support for documented failure of placental steroidogenesis: A case report.

OBJECTIVE: To report a case of a habitual aborter that had a pregnancy reach near term and successfully delivered a viable female infant. DESIGN: Report of a unique case of a G10P1 that was successfully able to maintain a pregnancy by maintaining serum levels of estradiol and progesterone at or above 200 pg/dL and 25 ng/dL respectively. This case provides a benchmark for exogenous support of estradiol and progesterone throughout pregnancy. SETTING: A private advanced reproductive center. PATIENT: 39-year-old G10P1091 diagnosed to have antiphospholipid syndrome but continued to have continuous miscarriages despite accepted treatment. In addition, 8 products of conception were sent for cytogenetic testing and all were found to be normal. INTERVENTIONS: Examination, laboratory studies, imaging, clinical judgment, and knowledge of previous treatment failures were used to guide the treatment of this patient. Fertility was achieved with continuous supplementation of progesterone, estrogen, LMW-heparin, and prednisone. MAIN OUTCOME MEASURE: Delivery of viable infant. RESULTS: This advanced reproductive age woman had three subsequent pregnancies. While compliant with our prescribed protocol, the patient successfully carried two pregnancies to viability. CONCLUSION: Clinicians should be alert to the possibility of a luteal phase defect when a patient presents with recurrent fertility problems and multiple spontaneous abortions.

A proposed test to support the clinical movement analysis laboratory accreditation process.

This paper describes a testing methodology and resultant set of four variables that can be used to quickly and easily document the correct installation, configuration, and combined working status of force platform (FP) and three-dimensional (3D) motion capture components of a clinical movement analysis (CMA) laboratory. Using a rigid, rod-shaped testing device, CMA laboratory data are collected simultaneously from the FP and motion capture components (typically, video-based kinematic measurements) as the device is manually loaded while being pivoted broadly about a point on the FP. Using a computational method based on static equilibrium, it is possible to independently measure the rod's orientation and tip position during the moving trial, using FP derived data exclusively, and to compare these estimates to rod orientation and tip position estimates derived exclusively from the motion capture component. The motion laboratory accreditation test (MLAT) variables include: the difference (angle) between the orientation of the long axis of the testing device as independently determined from kinematic measures (motion capture component) and the FP derived data; and the difference (x, y, z) between the center of pressure position (FP derived) and the position of the testing device tip (motion capture derived) that loads the FP. A numerical dynamics model was explored to evaluate the appropriateness of the static equilibrium-based FP data model and to determine guidelines for testing device movement frequency and FP loading. The MLAT technique provides a simple means of detecting the combined presence of errors from many sources, several of which are explored in this paper. The MLAT has been developed to help meet one criteria of the CMA laboratory accreditation process, and to serve as a routine quality assessment tool.

Changes in knee joint function over a wide range of walking speeds.

OBJECTIVE: Changes in patterns of knee joint flexion-extension rotations, moments and powers were investigated during the stance phase across a wide range of walking speeds that includes the very slow speeds used by many patients referred for gait analysis. DESIGN: Each subject walked at 25, 50, 75, 100, and 125% of a scaled natural speed of 0.785 statures.s(-1). BACKGROUND: The results of earlier studies suggest that control subjects, as they walk at progressively slower speeds, increasingly use a large internal knee flexor moment in the early stance phase. METHODS: Eighteen healthy adult subjects (nine male and nine female) were tested. RESULTS: The shapes of the mean patterns were similar for the three fastest, most natural walking speeds. At the two slowest speeds, however, subjects used little knee flexion and small knee moments through mid-stance, resulting in negligible joint power through the first 80% of the stance phase. At these speeds, most subjects had moment patterns that could not be classified with confidence as 'normal' or as predominantly flexor or extensor. Only four subjects had knee flexor moment patterns at the slowest speeds, and these included much smaller flexor moments in the early stance phase than in some previous reports. RELEVANCE: Many patients walk at very slow speeds for which 'normal' joint kinetic patterns have not been described. The knee joint kinetic data provided here from healthy subjects is useful in helping to distinguish 'abnormal' patterns caused by neuromuscular pathologies or adaptations from patterns reflecting the effects of slow walking speed alone.