Gonadotropin-releasing hormone antagonist protocol: a novel method of ovarian stimulation in poor responders.

OBJECTIVE: To estimate the efficacy of gonadotropin-releasing hormone (GnRH) antagonist 'Cetrorelix' in poor responders comparing with the standard long protocol. DESIGN: The study population consisted of 21 poor responders who underwent ICSI and treated with Cetrorelix according to the multiple-dose protocol and who were compared with 21 poor responders treated according to the long protocol and who also underwent ICSI. Patients in both groups were matched for chronological age, the number of follicles found by ultrasound at the retrieval day and cause of infertility. Fifteen patients of GnRH antagonist group were treated with the combination of GnRH antagonist with clomiphene citrate (CC) plus gonadotropins, while six patients were treated with the combination of GnRH antagonist plus gonadotropins, but without CC. RESULTS: The use of GnRH antagonist in a multiple dose protocol gave a pregnancy rate of 14.28% which was in the range expected for patient with poor response, but with shorter treatment duration and with fewer ampoules of gonadotropins as compared with the use of a GnRH agonist protocol in a depot formulation. Within Cetrorelix group patients who received CC had a significant shorter duration of stimulation and needed fewer ampoules as compared with patients in the same group who did not receive CC. CONCLUSIONS: A GnRH antagonist multiple dose protocol may be the protocol of choice for the treatment of poor responders. The use of GnRH antagonist Cetrorelix ended with significantly less ampoules of gonadotropins and a shorter duration of stimulation.

[Toxic shock syndrome with multi-organ involvement]. / Toxisches Schocksyndrom mit Multiorganbeteiligung.

HISTORY AND ADMISSION FINDINGS: An 18-year-old school girl was referred for admission by another hospital because of headache, joint pains, fever, vomiting, diarrhoea and orthostatic syncope associated with renal failure. On admission he was somnolent with a blood pressure of 90/60 mmHg, heart rate of 104 beats/min and a slight fever of 39.1 degrees C. A sunburn-like skin rash was noted. INVESTIGATIONS: Laboratory tests indicated low levels of platelets and calcium, increased levels of white cells, C-reactive protein, creatinine, bilirubin, transaminases, creatinekinase and lactate. Chest X-ray demonstrated diffuse shadows, while other imaging revealed a space-occupying lesion, ca. 3 cm in diameter, in the right lowere quadrant of the abdomen. The patient was hypoxic. Microbiology revealed vaginal colonies of Staph. aureus (producing toxic shock syndrome toxin 1 [TSST-1]). Serum antibody titre against TSST-1 was less than 1:25. DIAGNOSIS, TREATMENT AND COURSE: A toxic shock syndrome (TSS) with multi-organ involvement was suspected because of the association of menstruation with the use of tampons. An inserted tampon was removed. At laparoscopy the space-occupying lesion proved to be a haematoma. As bacterial septicaemia could not ne excluded broad-spectrum antibiotics were administered together with symptomatic measures. The patient fully recovered within a week. The characteristic skin desquamation confirmed the diagnosis of TSS. CONCLUSION: In its acute phase the diagnosis of TSS is often uncertain. The initial symptoms are nonspecific and numerous conditions need to be considered in the differential diagnosis. The diagnosis can be confirmed, if at all, only in the convalescent phase by the skin desquamation or a rise in anti-TSST-1 antibody titre. A search for a focus of infection is essential for differentiation from a non-menstrual TSS, even if there is as association with menstruation.

[Auxiliary MR spectroscopy of blood plasma in the diagnosis of malignant head and neck tumors]. / NMR-Spektroskopie von Blutplasma als Hilfsmittel in der Diagnostik von malignen Tumoren im Kopf-Halsbereich.

Magnetic resonance (MR) spectroscopy of an EDTA or citrate plasma sample (also referred to as "Fossel test" after Fossel, who first described it) started out as a promising method for fast and simple diagnosis of malignancies. Although the results of our own studies of the head and neck area confirm this tendency, we believe--and so do meanwhile also other investigators--that the clinical use of this test in its present form is not feasible because of lacking specificity.