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.

BACKGROUND: Recent blood gas analyzers offer electrolytes, Hb-derivatives (O2 Hb, HHb, COHb, MetHb and SulfHb), content of total hemoglobin (ctHb), and metabolites (glucose and lactate) as well as conventional blood gas parameters. Evaluation and efficient control of these instruments affect greatly monitoring and therapy of patients. The authors evaluated a recently introduced blood gas analyzer, the Roche OMNI 9 (Roche Diagnostics) for precision, analytic speed, function, features and comparability with other instruments according to NCCLS guidelines to see if it was suitable for the stat analyzer. METHODS: Commercial control materials, AUTO-trol PLUS Level 1, 2, 3 (Roche Diagnostics) were analyzed to evaluate the within-day precision, the between-day precision, and patient samples were used to evaluate comparability with other instruments. RESULTS: The within-day and the between-day precisions of the Roche OMNI 9 showed a very low CV of 0- 3.93% and 0- 3.99%, respectively, in all parameters except the lactate, which had moderate CV values of 7.74% and 5.93% in Level 3 QC material (low concentration). In compari-son with the Bayer instrument, correlation was high in all parameters with the r(2) value ranging from 0.9441 to 0.9901 except for COHb (r(2)=0.4239) and MetHb (r(2)=0.0034) whose concentrations were in the lower level. Glucose (r(2)=0.991), lactate (r(2)=0.9824), and hemoglobin (r(2)=0.9961) showed a rather high correlation. The Roche OMNI 9 could analyze 40 samples of blood gas and 27 samples of full parameter per hour, which was comparable to the Bayer M855. CONCLUSIONS: The Roche OMNI 9 showed high precision and rapid turnaround time for blood gas and in a selection of glucose, lactate and hemoglobin.
Blood Gas Analysis ; Electrolytes ; Glucose ; Humans ; Lactic Acid

BACKGROUND: Maintenance of adequate concentration of carbon dioxide during hypothermic cardiopulmonary bypass is important in order to improve tissue perfusion by maintaining vasodilatation. This study evaluated the usefulness of the analysis of gas sampled from the exhaust port of a membrane oxygenator in the estimation of carbon dioxide tension in arterial blood (PaCO2). METHODS: One hundred sixty four arterial blood gases were drawn from 45 adult and 30 pediatric cardiac surgical patients undergoing hypothermic cardiopulmonary bypass. Carbon dioxide tensions were measured in the membrane oxygenator exhaust gas (swept gas; PswCO2) using a capnography and in arterial blood using intermittent gas analysis. We compared the PswCO2 with temperature-uncorrected (alpha-stat) and -corrected (pH-stat) PaCO2 during cardiopulmoary bypass. RESULTS: The mean PaCO2 measured with alpha-stat and pH-stat, and PswCO2 obtained in adult patients during hypothermic cardiopulmonary bypass were 29.8 +/- 4.9, 19.5 +/- 4.1 and 22.3 +/- 4.2 mmHg, respectively. In pediatric patients, alpha-stat PaCO2, pH-stat PaCO2 and PswCO2 were 39.7 +/- 7.7, 24.7 +/- 6.2 and 20.3 +/- 6.0 mmHg, respectively. There was a significant positive correlation between PswCO2 and alpha-stat PaCO2 (adult patients: slope = 0.49, r = 0.64, P < 0.001; pediatric patients: slope = 0.53, r = 0.68, P < 0.001) and pH-stat PaCO2 (adult patients: slope = 0.85, r = 0.81, P < 0.001; pediatric patients: slope = 0.73, r = 0.73, P < 0.001). On comparison of subsequent measurements, 3.8% (adult patients) and 11.4% (pediatric patients) of changes in PaCO2 and PswCO2 were in opposite direction. CONCLUSIONS: Our results indicate that in adult and pediatric patients undergoing hypothermic cardiopulmonary bypass PswCO2 can be an indicator of changes in trend of PaCO2.
Adult ; Capnography ; Carbon Dioxide* ; Carbon* ; Cardiopulmonary Bypass* ; Gases ; Humans ; Oxygen* ; Oxygenators* ; Oxygenators, Membrane ; Perfusion ; Vasodilation