OBJETIVE: This study was performed to investigate the effect of metformin therapy on ovulation induction & pregnancy rate in clomiphene citrate-resistant PCOS women. METHOD: This study used a randomized, single-blinded, case-controlled methods. Total study group consisted of 21 women who showed clomiphene citrate-resistant parttern on previous ovulation induction cycles. Patients of metformin group received metformin 500 mg three times daily, for 7 weeks. Control group received none. Metformin group was consisted of 10 women and control group was consisted of 11 women. Then clomiphene was administrated at daily 50 mg for 5 days to both groups. Clomiphene dosage was increased to daily 150 mg until ovulation was occurred. Before and After metformin treatment, blood samples for measurement of insulin, glucose, steroids were obtained. RESULTS: In the metformin and control groups, 6 of 10 women (60%) and 2 of 11 women (18%) ovulated. And 4 of 10 women (40%) and 0 of 11 women (0%) conceived. Comparisons between the groups were significant. CONCLUSION: In PCOS women who are resistant to CC, metformin use increased the ovulation rate and pregnancy rate from CC treatment, significantly.
Case-Control Studies ; Clomiphene* ; Female ; Glucose ; Humans ; Insulin ; Insulin Resistance ; Metformin* ; Ovulation ; Ovulation Induction ; Polycystic Ovary Syndrome* ; Pregnancy Rate ; Steroids

BACKGROUND: The laryngeal mask airway (LMA) should be correctly placed into the hypopharynx for adequate ventilation. The purpose of this study was to evaluate a LMA position relation to the laryngeal skeleton and narrowing degree of a LMA lumen by the epiglottis. METHODS: The LMA (# 3 or # 4) was placed into the hypopharynx after induction of anesthesia and muscle paralysis. The fiberoptic laryngoscopic findings through the lumen of LMA were recorded at ten minutes after LMA placements. The position of the LMA was estimated in relation to its distal aperture to the laryngeal skeleton as central, posterior, right and left lateral position. The narrowing degree of the LMA by the epiglottis was estimated as 0%, 1~25%, 26~50%, 51~75%, or 76~100%. RESULTS: The fiberoptic laryngoscope showed central positions in 70.1%, lateral deviations to the left or right in 21.2% and posterior positions in 9%. The most frequent incidence (84/231, 36.4%) of narrowing by the epiglottis is 76~100% but ventilating problems were not developed. However, ventilation was impossible immediately after LMA placement in one patient, so the LMA was removed and the trachea was intubated. Esophageal enterance was visible in one patient without regurgitation of the stomach content. CONCLUSIONS: These findings show that LMA provides a reliable and safe airway management technique, although inadequate positioning and narrowing of LMA lumen by the epiglottis may frequently occur.
Airway Management ; Anesthesia ; Epiglottis ; Gastrointestinal Contents ; Humans ; Hypopharynx* ; Incidence ; Laryngeal Masks* ; Laryngoscopes ; Paralysis ; Skeleton ; Trachea ; Ventilation

Arterial cannulation for constant monitoring of arterial pressure and blood gase analyses has become commonplace in the care of the critically ill patients. The radial artery is often regarded as causing a negligible complication risk because of extensive collateral arterial flow in the hand. One of other alternative sites for arterial cannulation is femoral artery. Femoral artery cannulation has a high degree of success in very small, critically ill children. It should be considered an acceptable alternative to small-vessel cannulation when the latter is not technically achievable, or in the unstable patient where rapid establishment of reliable artery access is necessary. Arterial cannulation may cause many complications: arterial catheters can directly injure the vessels, resulting in thrombosis, occlusion, distal embolization or ischemia. Local insertion site complications, such as hematoma, hemorrhage, and infection may occur. Arterial catheter may also be a source of systemic sepsis. We report an unusual case of unintentional release of a catheter fragment into the external iliac artery in a 7-month (7.8 kg) male patient with tetralogy of Fallot, which was inadvertently inserted during right femoral artery cannulation. The catheter fragment was successfully retrieved with the Amplatz Goose Neck microsnare under fluoroscopy without any problems.
Arterial Pressure ; Arteries ; Catheterization* ; Catheters* ; Child ; Critical Illness ; Femoral Artery* ; Fluoroscopy ; Hand ; Hematoma ; Hemorrhage ; Humans ; Iliac Artery* ; Ischemia ; Male ; Neck ; Radial Artery ; Sepsis ; Tetralogy of Fallot ; Thrombosis

Hot flashes are related to hormonal changes of the menopause. Hot flashes occur in women with natural or premature menopause due to surgery and chemotherapy. In addition, tamoxifen for the adjuvant treatment of breast cancer precipitates or exacerbates hot flashes. Hormonal replacement therapy has been recognized as a primary treatment for hot flashes. However, this therapy is generally not recommended in patients with breast cancer. Several evidences suggest that some antidepressants may be effective in reducing hot flashes. We report a case of 43-year-old female depressed patient receiving tamoxifen, who suffered from severe hot flashes and perspiration. The patient had undergone a modified radical mastectomy and chemotherapy for breast cancer. Her hot flashes were remarkably reduced in intensity and frequency during mirtazapine treatment. This report suggests that mirtazapine could be an effective agent for hot flashes caused by tamoxifen treatment in depressed women with breast cancer. Further studies would be needed to determine the optimal dose and duration of mirtazapine treatment in menopausal women with or without breast cancer.
Adult ; Antidepressive Agents ; Breast Neoplasms* ; Breast* ; Drug Therapy ; Female ; Hot Flashes* ; Humans ; Mastectomy, Modified Radical ; Menopause ; Menopause, Premature ; Tamoxifen*

The objectives of fusion surgery for spinal deformities include decompressing neural elements and achieving balanced spinal alignment. Particularly, in cases where spinal deformities coexist with osteoporosis, successful surgery requires careful consideration due to the susceptibility to fixation failure and non-union. Various efforts are being made to restore spinal alignment through surgery in osteoporotic patients. The administration of osteoporosis medications before and after surgery is effective for bony union. Additionally, appropriate selection of fusion range, rigid internal fixation, and utilization of bone substitutes play significant roles in successful fusion surgery. Although surgical treatment for spinal deformities accompanied by osteoporosis remains still challenging, we can anticipate successful outcomes with effective strategies and ongoing advancements in the future.

The objectives of fusion surgery for spinal deformities include decompressing neural elements and achieving balanced spinal alignment. Particularly, in cases where spinal deformities coexist with osteoporosis, successful surgery requires careful consideration due to the susceptibility to fixation failure and non-union. Various efforts are being made to restore spinal alignment through surgery in osteoporotic patients. The administration of osteoporosis medications before and after surgery is effective for bony union. Additionally, appropriate selection of fusion range, rigid internal fixation, and utilization of bone substitutes play significant roles in successful fusion surgery. Although surgical treatment for spinal deformities accompanied by osteoporosis remains still challenging, we can anticipate successful outcomes with effective strategies and ongoing advancements in the future.

The objectives of fusion surgery for spinal deformities include decompressing neural elements and achieving balanced spinal alignment. Particularly, in cases where spinal deformities coexist with osteoporosis, successful surgery requires careful consideration due to the susceptibility to fixation failure and non-union. Various efforts are being made to restore spinal alignment through surgery in osteoporotic patients. The administration of osteoporosis medications before and after surgery is effective for bony union. Additionally, appropriate selection of fusion range, rigid internal fixation, and utilization of bone substitutes play significant roles in successful fusion surgery. Although surgical treatment for spinal deformities accompanied by osteoporosis remains still challenging, we can anticipate successful outcomes with effective strategies and ongoing advancements in the future.

The objectives of fusion surgery for spinal deformities include decompressing neural elements and achieving balanced spinal alignment. Particularly, in cases where spinal deformities coexist with osteoporosis, successful surgery requires careful consideration due to the susceptibility to fixation failure and non-union. Various efforts are being made to restore spinal alignment through surgery in osteoporotic patients. The administration of osteoporosis medications before and after surgery is effective for bony union. Additionally, appropriate selection of fusion range, rigid internal fixation, and utilization of bone substitutes play significant roles in successful fusion surgery. Although surgical treatment for spinal deformities accompanied by osteoporosis remains still challenging, we can anticipate successful outcomes with effective strategies and ongoing advancements in the future.

No abstract available.
Breast Neoplasms* ; Tamoxifen*

We reported 3 cases of intestinal anisakiasis. The patients had abdominal pain, nausea or vomiting, after eating raw sea-fishes 1 to 5 days before. Intestinal resection was performed under the impression of mechanical obstruction or cancer. The resected intestines showed marked edema, congestion or hemorrhage in the mucosa. Microscopically the larvae were found in the submucosa or inner muscle layer, and surrounded by phlegmonous inflammation with intense eosinophilic infiltration. The larvae were identified as Anisakis spp. by multiple sections.