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.

Propofol infusion regimen and standarad general anesthesia with thiopental and enflurane were compared in 40 women undergoing Cesarean section. Patients were randomly assigned to either propofol(n=20) or thiopental group(n=20). In propofol group anesthesia was induced with propofol, 2 mg/kg intravenously and maintained by continuous infusion of propofol 6 mg/ kg/hr and inhalation of nitrous oxide 50% in oxygen. In thiopental group anesthesia was induced with thiopental 4 mg/kg intravenously and maintained by inhalation of enlurane l% and nitrous oxide 50% in oxygen. Hemodynamic changes were similar in the course of anesthesia and delivery between two groups except diastolic and mean arterial pressure in which propofol group showed less changes than thiopental group. Maternal recovery time as assessed by eye opening to verbal command and memory of birthday was faster in propofol group than in thiopental group. Neonates were assessed by Apgar score and neurologic adaptive capacity score. Neonatal condition was similar between two groups except that propofol group was higher than thiopental group in 1 minute Apgar score. A propofol infusion coupled with nitrous oxide appears to be satisfactory for technique for Cesarean section.
Anesthesia* ; Anesthesia, General ; Apgar Score ; Arterial Pressure ; Cesarean Section* ; Enflurane* ; Female ; Hemodynamics ; Humans ; Infant, Newborn ; Inhalation ; Memory ; Nitrous Oxide* ; Oxygen ; Pregnancy ; Propofol* ; Thiopental*

No abstract available.
Breast Neoplasms* ; Tamoxifen*

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

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

Among the many reported applications of the detection of antibodies to phenolic glycolipid-I (PGL-I) of Mycobacterium leprae, the use of seroprevalence as an indicator of the magnitude of the leprosy problem may turn out to be very useful in leprosy control programs. In order to facilitate the use of PGL-I based serology in leprosy control programs, however, a simple test system for the detection of antibodies to PGL-I has been required. For being searched the meaning of qualitative analysis for PGL-I antibodies, we examined enzyme-linked immunosorbent assay and immunochromatographic assay kit using PGL-I neoglycoconjugate antigens. The sensitivity was 91.7%, and the specificity was 78.1%.
Antibodies* ; Enzyme-Linked Immunosorbent Assay ; Immunochromatography* ; Leprosy ; Mycobacterium leprae ; Mycobacterium* ; Phenol* ; Sensitivity and Specificity ; Seroepidemiologic Studies ; Serologic Tests