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Objective To evaluate the effects of three different estrogen used for endometrium preparation on pregnancy rate, as well as hormone profile on day 5 frozen embryo transfer (FET) cycles. Methods Retrospective, observational study. Setting: A tertiary teaching and research private reproductive medicine center. Patients: Ninety patients who were undergoing endometrium preparation for day five frozen embryo transfer cycle (FET). Intervention(s): The women were divided in three groups according to the administration route of estrogen (E2): oral (Primogyna), transdermal patches (Estradot), or transdermal gel (Oestrogel Pump). These administration routines of estrogen are equivalent to 6mg of estradiol daily. All women received 600mg of vaginal progesterone (P) per day (Utrogestan) for luteal phase support. We drew blood samples on starting P day, as well as on beta hCG day for E2 and P measurements. Main Outcome Measure(s): Clinical pregnancy rates (PR). Results Patient features in the three groups were comparable. There were no significant differences concerning implantation rate, clinical PR, miscarriage rate, multiple-pregnancy rate, or E2 and P levels on starting P day and on beta hCG day. Conclusions In FET cycles with oral (Primogyna) or transdermal patches (Estradot), or transdermal gel (Oestrogel Pump), there was no significant difference on pregnancy rates.

Systemic lupus erythematosus (SLE) is a multi-organic autoimmune disease with a wide variety of clinical manifestations. However, hepatic dysfunction is not included in the diagnostic criteria for the disease and has not been recognized properly. The spectrum of hepatic involvement described in these patients ranges from abnormalities in liver function tests (LFTs) to fulminant hepatic failure. Usually, abnormalities in LFTs are only mild and transient, have a hepatocellular pattern and are not related to SLE but rather are mostly drug related. The most frequent finding on liver biopsy is steatosis (non-alcoholic fatty liver disease). Patients do not frequently progress to advanced chronic liver disease, and their outcome is favourable. Those who develop cirrhosis have traditional risk factors, such as other non-SLE-related conditions. In this work, we aim to review hepatic manifestations in patients with SLE, as well as the diagnostic and therapeutic approaches used for different liver diseases in these patients.

Atrophic carcinoma and microcystic carcinoma have previously been classified as variants of conventional acinar adenocarcinoma. In this article, we studied 4 cases of atrophic carcinoma and 4 cases of limited microcystic carcinoma. We found an incidence of 0.8% in 250 needle prostatic biopsies and 1.3% of atrophic carcinoma in 150 radical prostatectomies. Microcystic carcinomas were found in 3 prostatectomies (1.2%) and in 1 needle biopsy (0.67%). The useful histological criteria for atrophic carcinoma included the irregular disposition of the glands, infiltrative pattern, “rigid” luminal borders, and intraluminal secretions. Cytological changes included scant cytoplasm, nucleomegaly, hyperchromatic nuclei, and visible nucleoli. The glands of the microcystic carcinoma differ from the benign glands because the malignant ones show a markedly greater dilatation and exhibit rigidity of glandular lumens. In some cases of microcystic carcinoma, the nuclei were flattened, small, and hyperchromatic; therefore, they can be difficult to recognize as malignant.

Objective: The aim of the present prospective study was to evaluate which ovarian reserve marker would be more reliable as the quality of the A + B embryos (day 3 and blastocyst). Methods: We ran a prospective study with 124 infertile women, aged 24-48 years, from 2017 to 2018. The patients were divided into 3 groups according to age and the subgroups were compared for AMH, AFC, number of A+B embryos. New division of the 3 groups was performed based on the AMH, and the subgroups were compared for age, AFC and number of A+B embryos. Finally, we divided the patients into 3 groups, based on the AFC, and we compared the subgroups for age, AMH and number of A+B embryos. P

Objective: This study aimed to evaluate the effects of three different luteal phase support protocols with estrogen on the pregnancy rates and luteal phase hormone profiles of patients undergoing in vitro fertilization-embryo transfer (IVF-ET) cycles. A secondary objective was to evaluate which ovarian reserve markers correlated with pregnancy rates. Methods: This retrospective observational study was carried out at a private tertiary reproductive medicine teaching and research center. The study enrolled 104 patients undergoing intracytoplasmic sperm injection (ICSI) on an antagonist protocol for controlled ovarian hyperstimulation (COH). The women were divided into three groups based on the route of administration of estrogen (E2) for luteal phase support: oral (Primogyna); transdermal patches (Estradott); or transdermal gel (Oestrogel Pump). The administration of estrogen provided the equivalent to 4 mg of estradiol daily. All women received 600mg of vaginal progesterone (P) per day (Utrogestan) for luteal phase support. Blood samples were drawn on the day of hCG administration and on the day of beta hCG testing to measure E2 and P levels. Clinical pregnancy rate (PR) was the main endpoint. Results: The patients included in the three groups were comparable. No significant differences were found in implantation rates, clinical PR, miscarriage rates, multiple-pregnancy rates, E2 or P levels on the day of beta hCG measurement. Concerning ovarian reserve markers, significant correlations between testing positive for clinical pregnancy and AMH (r = 0.66, p

Our objective was to develop and test a dynamic simulation model of human papillomavirus (HPV)-related diseases to assess rational vaccination strategies in Argentina. A dynamic stochastic transmission model for hetero- and homosexual transmission of HPV oncogenic and low-risk oncogenic types among females and males was developed. The model included HPV transmission and vaccination, the natural history of HPV-related diseases, disease outcomes, and cervical cancer screening. Considering all cervical cancers, covered or not by the current quadrivalent vaccine, the existing coverage rate would lead to 60% reduction in the global incidence of cervical cancer at 25 years, and to 79% at 50 years. Isolated current female vaccination without a screening program would need around 100 years to eliminate cervical cancer from the local population. Current coverage rate would lead to 59% reduction of vulvar cancer, 76% of vaginal cancer, 85% of anal cancer, and 87% of oropharyngeal cancer, estimated over a 25-year time prospect. Female HPV vaccination within the context of current cervical cancer screening should reach a minimum long-term mean coverage of 60% of girls, receiving at least a two-dose vaccine schedule, to significantly reduce or virtually eliminate cervical cancer at 50 years. Including vaccination to boys to improve herd immunity did not influence the incidence of cervical cancer over time, as long as female coverage did not fall below 50%. Regarding vulvar, vaginal, anal, penile, and some oropharyngeal cancers, current girls-only based vaccination could virtually eliminate these cancer types after 35-40 years, both in women and men.

International audience; Objective: Ovarian reserve evaluation has been the focus of substantial clinical research for several years. This study aimed to examine the associations between markers of ovarian reserve and ovarian response. Methods: This prospective study included 132 infertile women aged 24-48 years undergoing routine exploration during unstimulated cycles prior to the start of assisted reproductive technology (ART) treatments at our center from July 2015 to January 2017. Descriptive parameters and patient characteristics were reported as mean (SD) or median (range) values depending on the data distribution pattern. Student's t-test was performed for continuous variables; the Wilcoxon and Pearson's test were used for data not following a normal distribution; and Fisher's test was used for categorical variables. p

Today, advances in technology provide the best success rates in the reproductive medicine field. One of the biggest concerns about it, is the high risk of achieving multiple pregnancies, which may carry greater health risks for both; the mother and fetuses. Besides that, multiple pregnancies are considered a complication or an adverse effect of assisted reproduction treatments.To compare the factors associated with multiple pregnancy in patients who underwent complex assisted reproduction techniques.A retrospective and transversal case control study was rolled to compare the factors associated with multiple pregnancy rates, these results were correlated using a logistic regression model.a total of 1063 cases were reviewed, we obtained a pregnancy rate of 35.9%, and a multiple pregnancy rate of 31.5%. We found positive statistical association between patient age, total number of oocytes obtained, total embryos transferred, total vitrified embryos per cycle, total serum cuantitative B-GCH level, endometrial thickness in milimeters, and the Honest of a multiple pregnancy. In the logistic regression model, we found statistical association between the number of embryos transferred, number of embryos obtained, embryo quality, total vitrified embryos and the risk for multiple pregnancies.The total number of embryos transferred in a cycle of a complex assisted reproduction, is the most important factor for the onset of multiple pregnancies. The age of patients, the number of oocytes, total number of embryos obtained, the number of embryos transferred, the quality of embryos transferred and the number of frozen embryos per cycle, correlate significantly with more risk for multiple pregnancies.

BACKGROUND: Our aim was to compare the intercycle reproducibility of serum anti-Mullerian hormone (AMH) measurements with that of other markers of ovarian follicular status. METHODS: Forty-seven normo- ovulatory, infertile women underwent serum AMH, inhibin B, estradiol and FSH measurements and early antral follicle (2- 12 mm in diameter) counts by transvaginal ultrasound on cycle day 3 during three consecutive mens- trual cycles. Reproducibility of measurements was estimated using intra-class correlation coefficient (ICC) calcu- lation. We also assessed the number of replicate measurements theoretically needed to reach satisfactory reliability of results. RESULTS: Serum AMH showed significantly higher reproducibility (ICC, 0.89; 95% confidence inter- val, 0.83-0.94) than inhibin B (0.76; 0.66- 0.86; P< 0.03), estradiol (0.22; 0.03- 0.41; P< 0.0001) and FSH levels (0.55; 0.39- 0.71; P< 0.01), and early antral follicle counts (0.73; 0.62-0.84; P< 0.001), and reached satisfactory reliability with a single measurement. CONCLUSIONS: The improved cycle-to-cycle consistency of AMH as compared with other markers of ovarian follicular status is in keeping with its peculiar production by follicles at several developmental stages and further supports its role as a cost-effective, reliable marker of ovarian fertility potential.

Among the key objectives of controlled ovarian hyperstimulation (COH) is the achievement of adequate coordination of multiple follicular growth to trigger ovulation when most of follicles have reached concomitant maturation. However, during the early follicular phase, early antral follicles present noticeable size heterogeneities that may be amplified during COH. To challenge the hypothesis that this phenomenon results, at least in part, from the early exposure of antral follicles to gradient follicle-stimulating hormone (FSH) levels during the preceding late luteal phase, we conducted three clinical studies. First, we artificially lowered luteal FSH levels by administering estradiol (E (2)) and measured follicular characteristics on the subsequent day 3. Second, we verified whether luteal E (2) administration could promote the coordination of follicular growth during COH and improve its results. Third, we assessed the effects of premenstrual gonadotropin-releasing hormone (GnRH) antagonist administration on follicular characteristics during the early follicular phase. Our results showed that luteal FSH suppression by either E (2) or GnRH antagonist administration reduces the size and improves the homogeneity of early antral follicles during the early follicular phase, an effect that persists during COH. Coordination of follicular development may optimize ovarian response to short GnRH agonist and antagonist protocols, and constitutes an attractive approach to improving their outcome.

During the early follicular phase in the menstrual cycle, antral follicle sizes are often markedly heterogeneous. These follicular size discrepancies may, at least in part, result from the early exposure of FSH-sensitive follicles to gradient FSH concentrations during the preceding luteal phase. In addition, they potentially affect the results of ovarian stimulation. Indeed, pre-existing follicle size discrepancies may encumber coordinated follicular growth during ovarian stimulation, thereby reducing the number of follicles that reach maturation at once. To investigate this issue, three clinical studies were conducted to test the hypothesis that luteal FSH suppression could coordinate follicular growth. First, luteal FSH concentrations were artificially lowered by administering physiological oestradiol doses and measured follicular characteristics on the subsequent day 3. Second, it was verified whether luteal oestradiol administration could promote the coordination of follicular growth during ovarian stimulation and improve its results. Third, the effects of premenstrual gonadotrophin-releasing hormone (GnRH) antagonist administration on follicular characteristics were assessed during the early follicular phase. The results showed that luteal FSH suppression by either oestradiol or GnRH antagonist administration reduces the size and improves the homogeneity of early antral follicles during the early follicular phase, an effect that persists during ovarian stimulation. Coordination of follicular development may optimize ovarian response to short GnRH agonist and antagonist protocols, and constitutes an attractive approach to improving their outcome.

The purpose of this study was to estimate the prevalence of erectile dysfunction (ED) in Colombia, Ecuador, and Venezuela. A 49-item questionnaire was completed by 1946 men aged 40 years and older. The age-adjusted combined prevalence of minimal, moderate, and complete ED for all three countries was 53.4%, with 19.8% of all men reporting moderate to complete ED. Age was the variable most strongly linked to ED; the prevalence of complete ED increased markedly in men older than 79 y of age (31.9%) and 70-79 y (17.2%) compared with men aged 40-49 y (

Acute pharyngitis is a frequent pediatric consultation, being group A beta-hemolytic Streptococcus (GABHS) the main bacterial etiology. GABHS screening is controversial in children less than 5 years, because of the low frequency historically reported. Nevertheless, 24% prevalence was recently estimated in this group. The aim of this study was to estimate the GABHS frequency in symptomatic children less than 15 years, for which we performed a retrospective, cross sectional study, to evaluate its presence in the throat of 6691 patients, during 2010. The maximum frequency was observed in children from 5 to 11 years. For children aged 3 and 4, frequency was estimated at 36%, thus seeming to be mandatory to do the screening, as it is done in older children. In younger children, the epidemiology of each patient should be considered before asking for diagnostic tests.

Alternating hemiplegia of childhood is an entity of uncertain etiology, with an incidence of about one case per million. This paroxysmal disease with progressive course is characterized by repeated episodes of hemiplegia that alternates its location and that may last from a few minutes to several days. These episodes are usually aborted during sleep. Paroxysmal eye movements, cognitive impairment and autonomic disorders, can also be seen. Due to its progressive course and bad prognosis, it turns out to be important for the generalist physician to be aware of this entity, thus facilitating an early diagnosis and avoiding empiric pharmacologic ineffective treatments. We present the case of a ten year-old girl with alternating hemiplegia of childhood, show imaging of this disease and make a brief review of the literature.

Lymphatic malformations--previously called "lymphangiomas"--emerge due to an abnormal development of the lymphatic channels, with obstruction of the lymph flow and formation of lymphatic cysts. These cystic masses are frequently located in the neck and axillary region (95%). A pancreatic localization is extremely rare in children. Pancreatic lymphatic malformations should be distinguished from other cystic pancreatic masses. For those located in the head of the pancreas, a pancreaticoduodenectomy is proposed. We report the case of a 13-month-old child with a lymphatic malformation on the pancreas head, resected through a pancreaticoduodenectomy. A persistent chylous drainage followed, causing immunitary impairment and an overwhelming sepsis. A non surgical approach to this lesion is discussed, and a literature review is made.

Objective: We assessed a new estradiol (E2) immunoassay on the Architect-i2000 (Abbott Laboratories) for monitoring ovulation stimulation for IVF-ET and re-establishing clinical cut-off points. The method has been modified to improve E2 measurements especially at normal and low concentrations. Design and method: E2 was determined for 552 samples, from 83 women, presenting normal follicular status and undergoing 100 cycles of IVF treatment. We assessed the value of this assay for down-regulation of E2 concentration limit using gonadoliberin-releasing hormone agonist (GnRHa), and monitoring of the ovarian hyperstimulation, expected range of E2 per mature follicle prior to the administration of exogenous hCG and day 3 concentration limit. We compared results with our routine method (E2-6II Advia-Centaur; Siemens-Diagnostics) for which decision-making values were known. Results: Considering E2 concentrations obtained with the new Architect-i2000 assay for patients treated with GnRHa for 2 weeks, the cutoff-point for ovarian down-regulation should be set down at 110 pmol/L to maintain 100% of sensitivity. Considering day 3 concentration limit determination, results were not significantly different from those obtained with our routine method. The mean E2 values per mature follicle fell into the range generally expected. Conclusion: E2 determination with the new E2 Architect-i2000 assay could be used to monitor ovulation, in patients undergoing IVF-ET, in combination with transvaginal ultrasound.

The strong relationship between serum anti-Müllerian hormone (AMH) levels and the number of antral follicles supports the use of AMH measurements as a quantitative marker of the ovarian follicular status. Yet, it still is unclear whether the aptitude of an individual follicle to produce AMH reflects its reproductive competence.This study examined the possible relationship between serum or follicular fluid (FF) AMH concentrations and the fate of the ensuing oocytes and embryos obtained by in vitro fertilization-embryo transfer conducted in monodominant follicle cycles.We conducted a prospective study at the University of Paris XI, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale U782.Patients included 118 infertile in vitro fertilization-embryo transfer candidates.Concentrations of AMH, progesterone, and estradiol were measured in the serum on cycle d 3 and on the day of oocyte pickup (dOPU), and in FF. Cycles were sorted into three sets of three distinct groups according to whether serum d 3, serum dOPU, and FF AMH concentrations were 30th centile or below (low AMH), between the 31st and the 70th centiles (average AMH), or above the 70th centile (high AMH) of measurements.Clinical pregnancy and embryo implantation rates were assessed.Clinical pregnancy rates (5.7, 20.0, and 39.5%, respectively; P0.002) and embryo implantation rates (11.8, 30.8, and 65.4, respectively; P0.001) were markedly different among the low, moderate, and high FF AMH groups but not among the serum (d 3 or dOPU) AMH groups. Fertilization rates and embryo morphology remained similar irrespective of AMH concentrations in the serum or in FF. Incidentally, FF AMH concentrations were negatively correlated with FF progesterone (r = -0.27; P0.003) and FF estradiol (r = -0.21; P0.02) concentrations.Concentrations of AMH in the FF, but not in the serum, constitute a useful follicular marker of embryo implantation and are negatively related to FF progesterone and estradiol concentrations.

BACKGROUND: The objective of this study was to determine whether the vascular status of a single pre-ovulatory follicle is associated quantitatively and/or qualitatively with its reproductive competence. METHODS: We studied 61 monofollicular IVF-embryo transfer cycles. Just before single oocyte retrieval, follicle vascularization was detected by transvaginal power-Doppler, 3-dimensionally reconstructed, and analysed quantitatively by coloured/gray voxel ratio [vascularization index (VI)] and qualitatively by blood cell displacement [flow index (FI)] calculation. Cycles were sorted in two sets of two groups: low VI (8%, n 5 44) and high VI (>8%, n 5 17); low FI (30, n 5 22) and high FI (>30, n 5 39). RESULTS: Patients’ characteristics, fertilization rates, and embryo morphology were comparable in all groups. In contrast, clinical pregnancy rates/oocyte retrieval (4% versus 33%, P< 0.009) and implantation rates (11% versus 50%, P< 0.04) were markedly poorer in the low as compared to the high FI groups, respectively, but remained similar between the low and the high VI groups (22% versus 23% and 38% versus 44%, respectively). CONCLUSIONS: A qualitative (FI) rather than quantitative (VI) relationship exists between vascular status and functional quality of the follicle after HCG administration.

Objective To evaluate the impact of the first division morphology on embryo development and IVF–embryo transfer outcome. Design Prospective study. Setting Teaching hospital, France. Patient(s) All zygotes from 201 couples were checked for early cleavage. We defined as "even," early cleaved (EC) zygotes with 2 cells of even size; as "uneven," EC zygotes with 2 cells of uneven size; and as "fragmented," EC zygotes with more than 20% fragmentation rate. Day 2 embryo quality was assessed as "top" embryo or "non-top," with the evaluation of multinucleated blastomeres. Intervention(s) None. Main Outcome Measure(s) Day 2 embryo quality, pregnancy and implantation rates. Result(s) Among EC zygotes, 59.1% were even, 13.0% were uneven, and 27.9% were fragmented. Even EC yielded more "top" embryos and less multinucleated blastomere embryos than uneven EC (77.0% vs. 46.3%) and fragmented EC (77.0% vs. 13.9%). The 125 double embryo transfers that comprised at least one embryo derived from even EC zygote led to higher pregnancy rate (PR) (64.0% vs. 43.4%) and implantation rate (42.0% vs. 27.6%) compared to the 76 double embryo transfers with embryos derived from breakdown or 2PN zygotes. Conclusion(s) The morphology of the early cleaved zygote is involved in embryo development. Evaluation of this morphology is an effective and valuable method of assessing the embryo quality.

In contrast to most hormonal biomarkers of the follicular status, anti-Mullerian hormone (AMH) is exclusively produced by the granulosa cells of a wide range of follicles (primary to the early antral stages), presumably FSH-independently and with little susceptibility to disorders of antral follicle growth during the luteal-follicular transition. This paper summarizes the authors' clinical research on the role of AMH as a marker of ovarian functioning. It shows that the relationship between antral follicle counts and serum AMH concentrations is stronger than that observed with FSH, inhibin B and oestradiol on day 3, and that intercycle reproducibility of AMH measurements is better than the latter parameters. In addition, peripheral AMH concentrations decline during ovarian stimulation, thus confirming that maturing follicles loose progressively their ability to produce AMH. Indeed, follicular fluid (FF) AMH concentrations in small antral follicles are 3-fold as high as AMH in pre-ovulatory follicles. Further, human chorionic gonadotrophin-driven luteinization additionally curtails follicular AMH production. Finally, AMH production measured in FF from individual follicles is increased in women having normal follicular counts and responsiveness to ovarian stimulation. Together, these data reinforce the soundness of AMH measurements as a quantitative and possibly qualitative marker of granulosa cell activity and health.

To evaluate the importance of follicular flushing on semi natural cycle IVF.We have compared prospectively the reproductive potential of oocytes obtained from follicular fluid (LF, N = 79) to those obtained from follicular flushing (R, N = 47) in 146 oocyte pick ups.The group LF and R were similar with regard to fertilization rate (79.7 versus 88.1%, respectively), percentage of superior grade embryos (28.8 versus 37.8%) and implantation rate (24.1 versus 44.1%).The practice of follicular flushing on semi natural IVF cycle improves the pregnancy rate. The oocytes obtained by follicular flushing had the same reproductive potential than those obtained on follicular fluid.

BACKGROUND: To investigate the dynamics of serum anti-Mullerian hormone (AMH) levels during the luteal phase of controlled ovarian hyperstimulation (COH) and its possible association with follicle development. METHODS: We prospectively studied 34 women undergoing COH with GnRH agonist and FSH. On the day of hCG (dhCG), serum AMH, estradiol (E2), progesterone and hCG levels were measured, and ovarian follicles were sorted into three size classes

The phototoxic drug thiocolchicoside (2-dimethoxy-2-glucosidoxythiocolchicine, 1), is photolabile under irradiation with UV-A light from TL 100 W-P Philips bulbs (at lambda max 355 nm) light and also with a N2 laser (at 337 nm) in aerobic and anaerobic conditions. Irradiation of a methanol solution of 1 produces two photoproducts without a glucoside group. One of these lost the methylthio-group, while the other is oxidized (only under aerobic conditions) to sulfoxide. The formation of singlet oxygen by photolysis of 1 was evidenced by trapping with 2,5-dimethylfuran (GC-MS), furfuryl alcohol, 1,3-cyclohexadiene-1,4-diethanoate (HPLC) and by the histidine test as 1O2 scavengers. Thiocolchicoside has been shown to photosensitize the reduction of nitro blue tetrazolium by direct electron transfer mechanism, when irradiated under the same conditions as for photolysis. Oxygen may also be involved in this electron transfer reaction to form the superoxide anion radical. Thiocolchicoside was screened in vitro in different concentrations for UV-Vis-induced phototoxic effects in a photohemolysis test, in the presence and absence of different radical scavengers, singlet oxygen and superoxide radical quenchers. In addition, 1 photosensitized the peroxidation of linoleic acid, monitored by the UV-detection of dienic hydroperoxides. Studies on peripheral blood mononuclear cells (lymphocytes) demonstrated phototoxic effects on them. Protection by GSH, DABCO, sodium azide and SOD are indicative of both Type I and II photosensitization pathways mediated by free radicals and singlet molecular oxygen.

The phototoxic antidiabetes drug glipizide (1) is photolabile under aerobic conditions and UV-B light. Irradiation of a phosphate-buffered solution of 1 under oxygen atmosphere produces 4 photoproducts as well as singlet oxygen, which was detected by trapping it with 2,5-dimethylfuran and by the histidine test. The photochemistry of 1 involves cleavage of the sulfonamine and the sulfonamine-R bonds. Red blood cell lysis, photosensitized by glipizide and the products of its aerobic photolysis were demonstrated. The photohemolysis rate was lower for 1 than for its photoproducts. Inhibition of this process on addition of 1, 4-diazabicyclo[2.2.2]octane (DABCO), reduced glutathione (GSH), Vitamin C, sodium azide, superoxide dismutase, and a-tocopherol confirmed the possibility of singlet oxygen, superoxide ion and free radicals participation. Furthermore, in a lipid-photoperoxidation test with linoleic acid the in vitro phototoxicity of glipizide was also verified. A low decreasing cell viability of lymphocytes and neutrophils was observed.

The photodegradation process of the phototoxic diuretic drug chlorthalidone was studied. The products of its photolysis under UV-B were isolated and identified. Chlorthalidone was found to be active when examined by photohemolysis on human erythrocytes, but not in the presence of the isolated photoproducts. Inhibition of the photohemolysis process induced by chlorthalidone on addition of reduced glutathione (GSH) or ascorbic acid suggests the involvement of radicals species. The inhibition with 1,4-diazabycyclo [2.2.2] octane (DABCO), sodium azide (NaN3) sowie 2,5-dimethylfuran proof the participation of singlet oxygen (1O2) in this process.

A female neonate, born by cesarean section at 37 weeks of gestation, presented with respiratory distress syndrome, right pneumothorax and anuria. A sonogram showed increased echogenicity, with neither hydronephrosis nor macroscopic cysts. Peritoneal dialysis was started on the 14th day because of renal insufficiency, but the newborn died on the 33rd day. Family history was unremarkable, except that the mother received piroxicam at about the 26th week of gestation. A sonogram at the 28th week showed oligohydramnios. Histopathological study of the kidneys revealed crowded glomeruli and only few differentiated proximal convoluted tubules in the inner cortex, abnormally differentiated microcystic tubules and microcystic glomeruli in the outer cortex. Periodic acid-Schiff staining showed only traces of brush border in the dilated tubules of the outer cortex. Immunoperoxidase staining for epithelial membrane antigen was positive in the luminal border of all tubules. Electron microscopy confirmed the presence of brush border remnants and other proximal tubular characteristics in some segments. The renal abnormality bears some similarities to that found in familiar renal tubular dysgenesis, but it fits better with those described after maternal use of angiotensin converting enzyme inhibitors and nonsteroidal anti-inflammatory drugs. The lesion in this case appears to have resulted from fetal exposure to piroxicam. Recently, a second pregnancy ended in a completely normal female newborn.

Twelve patients with ischemic heart disease had complete left and right catheterization before and after sublingual captopril. Hemodynamic measurements were ten (10) minutes apart and were monitored for thirty (30) minutes. The heart rate increased from 70 +/- 13 to 76 +/- 11 beats/minute (P = .04). There was no change in the arterial blood pressure, although the systemic vascular resistance decreased from 1500 +/- 400 to 1026 +/- 480 dynes-sec-cm-5 (P.0001). The pulmonary artery pressure was increased 15 +/- 6 to 25 +/- 5mmHg (P = .005) and the pulmonary vascular resistance increased from 288 + 160 to 376 + 160 dynes-sec-cm-5 (P.0001). The wedge pressure increased from 7 +/- 2 to 14 +/- 3 mmHg (P = .05). The cardiac output (CO) increased from 5.06 +/- 1.06 to 578 +/- 1.58 Lt/min. (P.05 =. The left ventricular end diastolic volume (LVEDV) increased from 128 +/- 40 to 145 +/- 37cc)P = .002), without change in the end systolic volume (ESV). The ejection fraction (EF) increased from 56 +/- 3 to 61 +/- 4% (P = .02). These pressure changes appeared at two (2) minutes and disappeared after thirty (30) minutes. The study shows that, sublingual captopril produces a transient elevation of the pulmonary artery pressure and resistance.

Epidemiologic and experimental studies have pointed to an association between fat intake and colorectal carcinogenesis. In the present work we have studied the correlation between fat intake and mortality caused by colorectal cancer in the venezuelan population. For this purpose, we have calculated the correlation coefficients between the ingestion of total fat, visible fat (vegetable oil, margarine, butter, mayonnaise) as well as non-visible fat (that contained in other foods) and the mortality rate by colorectal cancer with data from nine venezuelan states and geographical regions. The highest lipid consumption and mortality rates were observed in the more developed states. There was a positive and significant correlation between total as well as visible fat consumption and colorectal cancer mortality (r = 0.756 p0.02, and r = 0.958, p0.001; respectively). In contrast, there was no significant correlation between the consumption of non visible fats and colorectal mortality (r = 0.543, p0.05). More than 80% of the visible fats ingested in Venezuela are constituted by vegetable oil and margarine, which contain a high proportion of polyunsaturated fatty acids. Based on the above, is possible to infer that colorectal carcinogenesis in Venezuela is associated to the uptake of unsaturated fat, and that measures leading to the prevention of this disease should be based on the reduction in the consumption of total and unsaturated lipids.

The histopathological study is very useful to establish a correct diagnosis in hepatic diseases, nevertheless conventional percutaneous liver biopsy is contraindicated in patients with abnormal coagulation. For this reason, some other alternatives have been looked for. The purpose of this study was to evaluate the safety and effectivity of gelfoam plugged liver biopsy, like alternative of the conventional biopsy in patients with impaired coagulation. The procedure was done in fourteen patients with prothrombin time longer than twelve seconds over the control and platelet count until 20,000/mm3. Besides that, we used real time ultrasound to guide the biopsy, in order to improve the safety and effectivity of this technique. All were successful, and there were no serious complications. This technique is a good alternative in patients with liver disease and impaired coagulation, in whom the histological diagnosis is essential.

Objective To investigate the possible influence of follicular maturation and luteinization on anti-mullerian hormone (AMH) secretion and the relationship between per-follicle AMH levels, ovarian follicular status, and responsiveness to controlled ovarian hyperstimulation (COH). Design Prospective study. Setting University hospital in France. Patient(s) Thirty seven in vitro fertilization/embryo transfer candidates undergoing COH. Intervention(s) On the day of oocyte retrieval, serum samples and follicular fluids from two small (8–12 mm in diameter) and two large (16–20 mm in diameter) follicles were collected for AMH, E 2 , and progesterone (P 4 ) measurements. Main Outcome Measure(s) Per-follicle AMH levels. Result(s) Small follicles secreted AMH levels that were approximately three times as high as large follicles. Follicular fluid AMH and P 4 levels were negatively correlated to each other both in small and large follicles. Per-follicle AMH levels in both follicular classes were positively correlated with antral follicle count on cycle day 3 before COH and with growing follicle (≥12 mm) count and oocytes retrieved, but negatively correlated with FSH requirement. Conclusion(s) Both final follicular maturation and luteinization interfere with granulosa cell AMH production. The relationship between intrafollicular AMH content, the surrounding follicular status, and ovarian response to COH indicates that peripheral AMH levels reflect not only follicle count but also per-follicle AMH production.

Median daily iron absorption was determined in iron-replete males and females between 2 and 19 years of age from the upper and lower socioeconomic strata of the Venezuelan population. A comparison was made with iron absorption of well-nourished children, on the basis of hematological and anthropometric reference values from the U.S. The median absorption level, which was calculated from the increase in total body iron due to growth and the daily losses through exfoliation and menstruation, was also used to estimate the requirements of 95% of the population. When the requirements were expressed in terms of body weight, no significant difference in iron absorption was observed between the three Venezuelan and one U.S. groups, ranging from about 30 to 38 µg/kg/day in both sexes between 4 and 16 years of age. However, when the requirements were expressed without division by the weight factor, the requirements of the better nourished groups were somewhat higher than those of the Venezuelan lower socioeconomic population with, in addition, a threefold variation over the 5 to 16 year age range. These findings suggest that the total iron requirements of children at a certain age may be most adequately expressed in terms of the optimal body weight for that age. J Am Diet Assoc 88:454, 1988.

Hematologic studies carried out in inhabitants of the State of Carabobo revealed that 19% of the subjects studied presented iron deficiency, this being more prominent in women and in children. Iron deficiency anemia was absent in men, while in the other groups its frequency, as registered, was from 5 to 13%. Tests for iron absorption from foods which form the average diet of the population in the Carabobo State, and the diet consumed by adults from the low socioeconomic strata in the States of Carabobo and Yaracuy, demonstrated that in normal subjects, bioavailability is lower than physiological requirements of men, women and children. In the iron-deficient subjects, its bioavailability can cover physiological needs. It is estimated that an important proportion of the population strata consuming such diets, suffer from iron nutritional deficiency, especially women during the reproductive age, and children.

A 51-year-old man with epilepsy received carbamazepine during three weeks. He developed fever, jaundice, dark urine and pale stools. Laboratory data showed hepatocellular injury and cholestasis; six weeks after withdrawal of the drug these abnormalities returned to normal limits. The liver biopsy showed acute cholangitis, bile duct injury, granulomas and eosinophils in the portal areas.

Proteins, some minerals and vitamins, play important roles in erythropoiesis and the survival of the red blood cell. This article deals specifically with the physiological requirements and recommended intakes of iron, folate and vitamin B12. A comparison of the physiologic iron requirements according to age and sex, and the amount of iron which is actually absorbed from the diets consumed by the lower socioeconomic strata of the Venezuelan population; indicates that these diets do not satisfy the requirements at all ages. Such disparity is most marked in children below three years of age, in adolescents and in women during their reproductive age. Failure to do so leads to varying degrees of iron deficiency. This low bioavailability of the Venezuelan diet is also observed in other Latin American diets consumed by the same low socioeconomic strata, which explains the high prevalence of iron-deficiency anemia in the vulnerable groups. The low intake of fruits and vegetables by the lower socioeconomic strata of the Latin American population prevents these sectors from consuming an adequate intake of folate, failing to fulfill the daily recommended intake (3.3 - 3.6 micrograms/kg body weight). This situation is aggravated in pregnant and lactating women who require an additional intake of 300 micrograms and 100 micrograms, respectively. Prevalence of folate deficiency in the first stage may be in the order of 30% in some regions. In the second stage of deficiency, characterized by megaloblastic changes in the bone marrow and an erythrocyte folate concentration of less than 50 micrograms/lt, it could be as high as 40% in pregnant women. Nutritional vitamin B12 deficiency does not constitute a health problem in Latin America. Various surveys in the lower socioeconomic strata have reported normal or higher than normal serum B12 concentrations, compared to well-nourished populations.

This is a retrospective study based on growth and development data published in Venezuela by various authors in the period 1936-1978. The data on height for males of the middle and high socioeconomic strata show growth curves which are very similar to the standards for British children. Likewise, the girls of the same socioeconomic condition follow the British standards, but only up to about 10-12 years of age. After that age, the girls studied by the Venezuelan authors, show a pattern of early maturation with a corresponding lower adult height compared with their British counterparts. There were differences in the growth curves according to the socioeconomic strata. These differences were more marked in the girls data. A secular increase for height was discerned, from the published data, in all socioeconomic strata and in both sexes. The data on sexual maturation showed a tendency for progressively early menarche in Venezuelan girls. These changes in growth in height and age of menarche were more notorious and came about at an earlier age in the upper socioeconomic strata. They were less marked, not constant, and came about later in the lower socioeconomic groups. The secular changes in height and sexual maturation apparent from these data, could be explained by an improvement in the environmental conditions, especially nutrition and hygiene of the population, and also be genetic heterosis from European immigration and with improvement in communications.A review of trends in height and weight at menarche in Venezuela is presented using data from studies published during the period 1936 to 1978. Variations by socioeconomic status are identified and discussed. (summary in ENG)

The objective of this study was to assess the reproductive competence of oocytes obtained by follicular flushing in poor responder patients. This prospective comparative study, at the University of Paris XI, Assistance Publique des Hopitaux de Paris, INSERM Unit 782, was performed on 165 infertile IVF embryo transfer candidates. A total of 271 consecutive minimal stimulation IVF cycles were studied. Oocyte retrieval was performed 34 h after human chorionic gonadotrophin administration and oocytes were allocated into two groups according to their retrieval method: oocytes obtained in the first follicular aspiration (FA, n = 127); and oocytes retrieved in the subsequent follicular flushing (FF, n = 102). The principal outcome was to evaluate clinical pregnancy and embryo implantation rates. Thus, patient characteristics, fertilization rate and clinical pregnancy rate per oocyte were comparable in both of groups. In contrast, embryo morphology (41 versus 59%, P < 0.01) and implantation rates (20.4 versus 34.8%, P < 0.04) were better in the FF group. In conclusion, an optimal reproductive competence was observed in oocytes retrieved by follicular flushing in minimal stimulation IVF in poor responder patients.