Background: The golden age of trauma has gone. 25 years ago the trauma surgeon was the life saver in the emergency department. He was the leader of the resuscitation team and made the important ...decisions in the process. Nowadays different factors have diminished the role of the trauma surgeon.
Discussion: Thanks to the decrease of severely injured patients in Europe and the advances in diagnostic and treatment possibilities the approach to trauma victims is less often operative. Furthermore, the uprising of emergency medicine specialists has taken many tasks out of the hands of the trauma surgeon. However, experienced trauma surgeons can do both critical care and acute care surgery and should be included in the decision-making process in the emergency room. Conclusion: Although the trauma surgeon often is no longer the captain of the ship in the emergency department, he can still play an important role in trauma care. They still are life savers.
Abbreviations: CAT-scan: computed axial tomography . CT: computed tomography; HIV: Human Immunodeficiency Virus.
Thresholds of sperm parameters associated with intrauterine insemination (IUI) success are controversial. This entails heterogeneous practices and leads to low success rate (approximately 8% per ...attempt). The aim of this study was to evaluate the influence of sperm parameters on the outcome of IUI.
This study included 248 cycles of IUI. Parameters of the raw and selected sperm, as well as the main female characteristics, have been prospectively tabulated and compared, according to the presence or not of a clinical pregnancy.
In all, 28 clinical pregnancies were obtained (11.3% per cycle). Thresholds of 10% for the forward motility "a" in the whole sperm and of 20% for the percentage of typical spermatozoa in the selected sperm were related to the success of IUI. The number of motile inseminated spermatozoa, concentration and overall motility of sperm, determined before or after selection, did not have any significant influence on the outcome of IUI.
Thresholds determined in our study should help to optimize the use of IUI.
Since the 1950s, several studies have been carried out to investigate the occurrence of schizophrenia-like psychoses in epilepsy. The psychopathological profile comprises symptoms from the affective, ...schizophrenic, and cognitive domains and the prevalence varies between 2% to 20%. Classification of such conditions is performed according to their temporal relationship with the seizure itself. Although it is well known that epilepsy may be associated with psychotic disorders, it is less widely recognized that relapsing psychotic phenomena may be the first and only symptom of epilepsy. In this research, two patients are described who were initially referred for recurrent episodes of bipolar affective disorder and schizophrenic psychosis, respectively. In both patients, a diagnosis of relapsing postictal psychotic states due to previously undiagnosed epilepsy was made and consequently, treatment with antiepileptics was started. During follow up over several months, they remained free of both epileptic and psychotic symptoms. Given the kaleidoscopic nature of the postictal psychosis and full recovery from this, such psychoses best meet the criteria for a cycloid psychosis. These observations illustrate diagnostic and therapeutic pitfalls due to the conceptual disintegration emerging from the inadequate separation between psychiatry and neurology. Therefore, the importance of a neuropsychiatric viewpoint should be promoted.
Several studies have been performed up to date, in order to assess whether the addition of hyaluronan (HA) in human embryo culture could improve the probability of pregnancy, leading, however, to ...controversies. The aim of the present study was to analyze whether the use of a HA-enriched transfer medium increases clinical pregnancy (PR) and implantation rates (IR), compared with the use of a conventional transfer medium.
All IVF/ICSI attempts from unselected women were included from January 2009 to July 2009 (study group). All embryo transfers (ET) were performed using a HA-enriched media. IVF outcomes of this series were compared to those of a retrospective series, including continuous IVF/ICSI attempts from January 2008 to July 2008 where ET were classically performed (control group). Primary endpoints were PR and IR, compared firstly in all patients of the study and control groups and then regarding woman's age and presence of previous implantation failures.
In all, 292 (study group) and 296 (control group) IVF/ICSI attempts were included. PR (32.9%) and IR (22.2%) were significantly increased in the study group compared with those of the control group (PR=25.0%; IR=15.4%; p<0.05). We observed that PR and IR were statistically increased only in subgroups of women >or=35 years or in case of at least one previous implantation failure (p<0.05).
The use of a HA-enriched embryo transfer medium is beneficial since associated with increased PR and IR. This type of media should be used in infertile women >or=35 years or needing at least a second IVF/ICSI attempt.
Les seuils des paramètres spermatiques associés au succès des inséminations intra-utérines (IIU) font l’objet de controverses dans la littérature. En découlent, des pratiques hétérogènes aboutissant ...à des taux de succès relativement faibles (≈
8 % par tentative). L’objectif de cette étude a ainsi été d’évaluer dans notre centre l’influence des paramètres spermatiques sur l’issue des IIU.
L’étude a inclus 248 cycles d’IIU. Les paramètres du sperme entier et préparé, ainsi que les principales caractéristiques féminines, ont été évalués prospectivement et comparés selon la survenue ou non d’une grossesse clinique.
Au total, 28 grossesses cliniques ont été obtenues (11,3 % par cycle). Les seuils de 10 % de mobilité fléchante «
a » dans le sperme entier et de 20 % de formes typiques dans l’inséminat ont déterminé de manière significative l’issue de l’IIU. Le nombre de spermatozoïdes mobiles inséminés, la concentration et la mobilité progressive globale des spermatozoïdes, avant ou après préparation, n’avaient pas d’influence significative sur les chances de succès.
Les seuils déterminés dans notre étude, sous lesquels les chances de succès sont faibles, devraient permettre d’optimiser le recours à ce type d’assistance médicale à la procréation (AMP).
Thresholds of sperm parameters associated with intrauterine insemination (IUI) success are controversial. This entails heterogeneous practices and leads to low success rate (≈
8% per attempt). The aim of this study was to evaluate the influence of sperm parameters on the outcome of IUI.
This study included 248 cycles of IUI. Parameters of the raw and selected sperm, as well as the main female characteristics, have been prospectively tabulated and compared, according to the presence or not of a clinical pregnancy.
In all, 28 clinical pregnancies were obtained (11.3% per cycle). Thresholds of 10% for the forward motility “
a” in the whole sperm and of 20% for the percentage of typical spermatozoa in the selected sperm were related to the success of IUI. The number of motile inseminated spermatozoa, concentration and overall motility of sperm, determined before or after selection, did not have any significant influence on the outcome of IUI.
Thresholds determined in our study should help to optimize the use of IUI.
Plusieurs études ont évalué si l’addition d’acide hyaluronique (HA) dans les milieux de culture embryonnaire pouvait augmenter la probabilité de survenue d’une grossesse, avec à ce jour, des ...résultats contradictoires. Le but de ce travail est d’analyser si l’utilisation d’un milieu de transfert embryonnaire (TE) enrichi en HA modifie les taux de grossesse clinique (GC) et d’implantation, comparés à ceux obtenus après usage d’un milieu de transfert traditionnel.
Toutes les tentatives de FIV/ICSI ont été incluses de janvier 2009 à juillet 2009. Tous les TE étaient effectués en utilisant un milieu enrichi en HA. Cette série a été comparée à une série rétrospective, incluant toutes les tentatives effectuées de janvier 2008 à juillet 2008. Dans ce groupe contrôle, les TE étaient effectués à l’aide d’un milieu classique. Les critères de jugement principaux étaient les taux de GC et d’implantation, comparés globalement entre les deux groupes, puis en fonction de l’âge des femmes, et de l’existence d’au moins un échec d’implantation lors d’une tentative précédente.
Respectivement 292 et 296 tentatives ont été incluses dans les groupes d’étude et contrôle. Les taux de GC (32,9 vs 25,0 % ; p=0,035) et d’implantation (22,2 vs 15,4 % ; p=0,04) étaient globalement augmentés dans le groupe d’étude comparé à celui du groupe contrôle. L’analyse des sous-groupes montraient une augmentation des taux de GC et d’implantation seulement chez les femmes ≥35 ans (p=0,03) ou en cas d’au moins un échec d’implantation précédent (p=0,02).
L’utilisation d’un milieu de TE enrichi en HA augmente les taux de GC et d’implantation. Ce type de milieu devrait être utilisé lors des FIV/ICSI effectuées chez les femmes ≥35 ans ou dès la deuxième tentative.
Several studies have been performed up to date, in order to assess whether the addition of hyaluronan (HA) in human embryo culture could improve the probability of pregnancy, leading, however, to controversies. The aim of the present study was to analyze whether the use of a HA-enriched transfer medium increases clinical pregnancy (PR) and implantation rates (IR), compared with the use of a conventional transfer medium.
All IVF/ICSI attempts from unselected women were included from January 2009 to July 2009 (study group). All embryo transfers (ET) were performed using a HA-enriched media. IVF outcomes of this series were compared to those of a retrospective series, including continuous IVF/ICSI attempts from January 2008 to July 2008 where ET were classically performed (control group). Primary endpoints were PR and IR, compared firstly in all patients of the study and control groups and then regarding woman's age and presence of previous implantation failures.
In all, 292 (study group) and 296 (control group) IVF/ICSI attempts were included. PR (32.9%) and IR (22.2%) were significantly increased in the study group compared with those of the control group (PR=25.0%; IR=15.4%; p<0.05). We observed that PR and IR were statistically increased only in subgroups of women ≥35 years or in case of at least one previous implantation failure (p<0.05).
The use of a HA-enriched embryo transfer medium is beneficial since associated with increased PR and IR. This type of media should be used in infertile women ≥35 years or needing at least a second IVF/ICSI attempt.
The recent use of gonadotrophin-releasing hormone agonist in a short-term regimen has allowed the effectiveness of human menopausal gonadotrophin (HMG) stimulation to be markedly improved. It seems ...to be related to the flare-up effect of the agonist in the early follicular phase of the cycle. However, individual hormonal responses to the agonist are quite variable and four patterns of oestradiol secretion have been described. The present study indicates that in women pre-treated with progestogen, only two patterns of serum oestradiol are observed in the flare-up period, with a significant increase in 57% of patients. Significant correlations are observed between oestradiol values and the endogenous gonadotrophin surge (positively with luteinizing hormone, r = 0.38; P less than 0.05 and negatively with follicle stimulating hormone, r = 0.48; P less than 0.005). Furthermore, there was a significant relationship between the hormonal flare-up and the ovarian parameters following HMG stimulation. In conclusion, in progestogen-pre-treated women, the serum oestradiol level during the flare-up period is a reliable index to predict subsequent effectiveness of ovarian stimulation with HMG.
We report the case of a 40-year-old patient referred to our centre after 3 years of infertility. Karyotyping with the aid of fluorescence in situ hybridization (FISH) analysis showed a unique ...pericentric inversion of chromosome 21:46,XY,inv(21)(p12q22.3). This type of intrachromosomal structural rearrangement can lead to chromosome imbalance in offspring by producing unbalanced gametes if an odd number of crossover events occur within the inverted segment. Therefore, partial trisomy/monosomy with clinical consequences can be observed in the progeny of carriers. Semen samples from the inversion carrier were analysed by FISH using a combination of probes a subtelomeric 21q probe and a locus-specific Down's syndrome critical region (DSCR) probe to evaluate the proportion of recombinant chromosomes. Sperm-FISH analysis of 3400 spermatozoa revealed a 67.4% rate of balanced chromosomes (normal or inverted). The frequencies of recombinant chromosomes with duplication of the long arm and deletion of the short arm, and vice versa, were 11.2 and 21.4%, respectively. The risk for the couple of conceiving a child with an unbalanced chromosome 21 is estimated to be around 32%. This case study shows the utility of sperm-FISH analysis in the genetic counselling of a pericentric inversion in a male carrier to assess the frequency of recombinant chromosomes and therefore evaluate the probability of having a normal conception.
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