Endovascular Treatment versus Best Medical Treatment in Patients with Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND AND PURPOSE

Endovascular treatment has emerged as a minimally invasive technique for patients with acute ischemic stroke to achieve recanalization. Our aim was to determine the effects of endovascular treatment on clinical and safety outcomes compared with best medical treatment.

MATERIALS AND METHODS

Fifteen randomized trials that compared endovascular treatment with best medical treatment in patients with acute ischemic stroke met the inclusion criteria. We calculated pooled odds ratios and 95% CIs by using random-effects models. The primary end point was a favorable outcome defined by a modified Rankin Scale score of 0 (no symptoms), 1 (no significant disability), or 2 (slight disability) at 90 days postrandomization.

RESULTS

Of the 2980 subjects randomized, the proportion of subjects who achieved a favorable outcome was significantly greater among those randomized to endovascular treatment compared with best medical treatment (2949 subjects analyzed; odds ratio, 1.82; 95% CI, 1.38-2.40; P < .001). Excellent outcome (modified Rankin Scale score of 0 or 1) was also significantly greater among those randomized to endovascular treatment (2791 subjects analyzed; odds ratio, 1.77; 95% CI, 1.29-2.43, P < .001). Risk of symptomatic intracranial hemorrhage was similar between endovascular treatment and best medical treatment (2906 subjects analyzed; odds ratio, 1.19; 95% CI, 0.84-1.68; P = .34).

CONCLUSIONS

Compared with best medical treatment, the odds of achieving a favorable outcome or excellent outcome at 3 months postrandomization are approximately 80% higher with endovascular treatment among patients with acute ischemic stroke.

Critique of “Sew it Up! A Western Trauma Association Multi-Institutional Study of Enteric Injury Management in the Postinjury Open Abdomen”☆

Background: Use of damage control surgery techniques has reduced mortality in critically injured patients but at the cost of the open abdomen. With the option of delayed definitive management of enteric injuries, the question of intestinal repair/anastomosis or definitive stoma creation has been posed with no clear consensus. The purpose of this study was to determine outcomes on the basis of management of enteric injuries in patients relegated to the postinjury open abdomen. Methods: Patients requiring an open abdomen after trauma from January 1, 2002 to December 31, 2007 were reviewed. Type of bowel repair was categorized as immediate repair, immediate anastomosis, delayed anastomosis, stoma and a combination. Logistic regression was used to determine independent effect of risk factors on leak development. Results: During the 6-year study period, 204 patients suffered enteric injuries and were managed with an open abdomen. The majority was men (77%) sustaining blunt trauma (66%) with a mean age of 37.1 years ± 1.2 years and median Injury Severity Score of 27 (interquartile range = 20–41). Injury patterns included 81 (40%) small bowel, 37 (18%) colonic, and 86 (42%) combined injuries. Enteric injuries were managed with immediate repair (58), immediate anastomosis (15), delayed anastomosis (96), stoma (10), and a combination (22); three patients died before definitive repair. Sixty-one patients suffered intra-abdominal complications: 35 (17%) abscesses, 15 (7%) leaks, and 11 (5%) enterocutaneous fistulas. The majority of patients with leaks had a delayed anastomosis; one patient had a right colon repair. Leak rate increased as one progresses toward the left colon (small bowel anastomoses, 3% leak rate; right colon, 3%; transverse colon, 20%; left colon, 45%). There were no differences in emergency department physiology, injury severity, transfusions, crystalloids, or demographic characteristics between patients with and without leak. Leak cases had higher 12-hour heart rate (148 vs. 125, p = 0.02) and higher 12-hour base deficit (13.7 vs. 9.7, p = 0.04), suggesting persistent shock and consequent hypoperfusion were related to leak development. There was a significant trend toward higher incidence of leak with closure day (χ for trend, p = 0.01), with closure after day 5 having a four times higher likelihood of developing leak (3% vs. 12%, p = 0.02). Conclusions: Repair or anastomosis of intestinal injuries should be considered in all patients. However, leak rate increases with fascial closure beyond day 5 and with left-sided colonic anastomoses. Investigating the physiologic basis for intestinal vulnerability of the left colon and in the open abdomen is warranted.

A rare complication of laparoscopic surgery

Gallstone disease is one of the most common problems affecting the digestive tract. Symptomatic patients are advised to undergo laparoscopic cholecystectomy (LC), which is considered the gold standard of care in these patients. LC has clear advantages over traditional surgery such as a shorter hospital stay, an earlier return to work and better patient satisfaction. Despite LC being a common surgical procedure, it is not totally free from complications. These include cardiorespiratory problems, biliary leakage, peritonitis, hemorrhage and superior mesenteric artery (SMA) occlusion. We report an unusual and fatal complication of LC, being SMA thrombosis complicated by multiple intra-abdominal collections, abdominal compartment syndrome, multiorgan failure and septic shock.

Localized giant pseudopolyposis in ulcerative colitis

Localized giant pseudopolyposis is an interesting but unusual manifestation of both ulcerative colitis and Crohn's disease. The purpose of this report is to present a case of localized giant pseudopolyposis complicating an ulcerative colitis, and review other cases reported in the literature. The clinical and pathological findings are described. The authors also discuss the possible aspect of proper management in this type of lesion.

Ewing's sarcoma of the talus in a four-year-old child

Ewing's sarcoma is a rare malignant tumor of the foot in children. We report a case of Ewing's sarcoma of the talus in a four-year-old Chinese girl to highlight the initial difficulty in diagnosis and the clinical course of the disease. She was initially diagnosed as osteomyelitis of the talus and died eight months after presentation with pleural and spinal metastases. To the best of our knowledge, Ewing's sarcoma of the talus in a young child has never been reported in Malaysia.

Sylvatic transmission of arboviruses among Bornean orangutans

Wild populations of nonhuman primates live in regions of sylvatic arbovirus transmission. To assess the status of arbovirus transmission in Bornean forests and the susceptibility of wild orangutans to arboviral infection, blood samples of wild orangutans, semi-captive orangutans, and humans were examined. Samples were tested by plaque reduction neutralization test for antibodies to viruses representing three families (Flaviviridae, Alphaviridae, and Bunyaviridae), including dengue-2, Japanese encephalitis, Zika, Langat, Tembusu, Sindbis, Chikungunya, and Batai viruses. Both wild and semi-captive orangutan groups as well as local human populations showed serologic evidence of arbovirus infection. The presence of neutralizing antibodies among wild orangutans strongly suggests the existence of sylvatic cycles for dengue, Japanese encephalitis, and sindbis viruses in North Borneo. The present study demonstrates that orangutans are susceptible to arboviralinfections in the wild, although the impact of arboviral infections on this endangered ape remain unknown.

Short report: differences in dihydrofolate reductase but not dihydropteroate synthase alleles in Plasmodium falciparum isolates from geographically distinct areas in Malaysia

Dihydropteroate synthase (dhps) and dihydrofolate reductase (dhfr) alleles were typed in 67 Malaysian Plasmodium falciparum isolates. The isolates were collected from two geographically distinct locations: 51 from Sabah, Malaysian Borneo, where sulfadoxine/pyrimethamine (SDX/PYR) is used to treat uncomplicated malaria and 16 from Peninsular Malaysia where in vivo resistance to SDX/PYR has been reported. A total of seven dhps alleles were identified with no significant difference in allele frequency between the 2 populations. Two of the dhps alleles described here have not been previously reported. Four dhfr alleles were detected in 67 P. falciparum isolates. Eighty-seven percent of the isolates from the Peninsula, where clinical SDX/PYR failure has been reported, had dhfr alleles with triple point mutations while all of the isolates from Sabah had dhfr alleles with 2 or less point mutations. The difference in dhfr allele frequency between the two populations was highly significant. There was no correlation between in vitro PYR response and accumulation of dhfr point mutations.

Sensitivity of the nested-polymerase chain reaction (PCR) assay for Brugia malayi and significance of 'free' DNA in PCR-based assays

The blood filtration method was used as the gold standard to determine the detection level of simple blood-spot sampling and nested-polymerase chain reaction (PCR) for Brugia malayi. Of 100 samples, 48 were filtration-positive. Of these, 26 had microfilaria counts that were low enough (<1-29 microfilariae/ml) to accurately assess the limit of detection by nested-PCR. Nested-PCR consistently detected B. malayi DNA in samples with > or = 10 microfilariae/ml. Post-filtration, microfilaria-depleted, blood-spots from microfilaria-positive samples were screened by nested-PCR and B. malayi specific 'free' DNA was detected in 51.7% of these samples. There was no evidence for 'free' DNA in microfilaria-negative individuals from this endemic community.

Differential permethrin susceptibility of head lice sampled in the United States and Borneo

BACKGROUND

Pediculiasis is treated aggressively in the United States, mainly with permethrin- and pyrethrin-containing pediculicides. Increasingly frequent anecdotal reports of treatment failure suggest the emergence of insecticidal resistance by these lice.

OBJECTIVE

To confirm or refute the susceptibility of head lice sampled in the United States to permethrin.

DESIGN

Survey. Head lice were removed from children residing where pediculicides are readily available and where such products are essentially unknown. Their survival was compared following exposure to residues of graded doses of permethrin in an in vitro bioassay.

SETTING

School children from Massachusetts, Idaho, and Sabah (Malaysian Borneo).

SUBJECTS

In the United States, 75 children aged 5 to 8 years. In Sabah, 59 boys aged 6 to 13 years. Virtually all sampled US children had previously been treated with pediculicides containing pyrethrins or permethrin; none of the Sabahan children were so exposed.

MAIN OUTCOME MEASURE

Survival of head lice exposed to permethrin.

RESULTS

Permethrin did not affect head lice sampled from chronically infested US children who had previously been treated for pediculiasis. The slope of the dose-response regression line for these lice did not differ significantly from zero (P = .66). This pediculicide immobilized lice sampled in Sabah. Mortality correlated closely with permethrin concentration (P = .008).

CONCLUSIONS

Head lice in the United States are less susceptible to permethrin than are those in Sabah. The pyrethroid susceptibility of the general population of head lice in the United States, however, remains poorly defined. Accordingly, these relatively safe over-the-counter preparations may remain the pediculicides of choice for newly recognized louse infestations.

The use of an in-house modified double antibody sandwich ELISA to detect Aspergillus antigens in sera of immunosuppressed patients

AIM

The purpose of this study was to retrospectively detect Aspergillus antigens in sera obtained from immunocompromised host using an in-house modified double antibody sandwich ELISA.

MATERIALS AND METHODS

The ELISA employed the use of polyclonal antibodies raised against a water-soluble (WS) mycelial component of a clinical isolate of Aspergillus fumigatus. Rabbit and guinea-pig anti-WS antibodies were used as the capture and detector antibodies respectively. This was followed by the addition of anti-guinea pig antibodies conjugated to horse radish peroxidase and orthophenylenediamine.

RESULTS

Of 143 specimens obtained from 140 patients, only 5 (3.5%) specimens demonstrated the presence of antigen. The 5 antigen-positive sera were from three patients. One was a confirmed case of paranasal aspergillosis and the other two were probable cases of invasive aspergillosis.

CONCLUSION

The clinical validity of the ELISA should be determined by prospective detection of Aspergillus antigens in multiple serum samples collected from proven cases of invasive aspergillosis.

Simple blood-spot sampling with nested polymerase chain reaction detection for epidemiology studies on Brugia malayi

In the absence of a suitable Brugia malayi antigen detection assay, PCR remains one of the more sensitive alternatives to Giemsa-stained thick blood films for B. malayi detection. The need for refrigerated storage and transportation of blood has limited the use of PCR for large-scale epidemiology studies in remote endemic areas. Here we report simple finger-prick blood-spot collection, a one-tube DNA template extraction method and the development of a B. malayi-specific nested PCR assay. The assay was tested on 145 field samples and was positive for all 30 microscopy-positive samples and for an additional 13 samples which were microscopy-negative.

A genus- and species-specific nested polymerase chain reaction malaria detection assay for epidemiologic studies

A nested polymerase chain reaction (PCR) assay that uses Plasmodium genus-specific primers for the initial PCR (nest 1) amplification and either genus- or species-specific primers for the nest 2 amplifications was tested on laboratory and field samples. With in vitro cultured Plasmodium falciparum-infected blood samples, it was capable of detecting six parasites/microl of blood using DNA prepared from 25-microl blood spots on filter paper. The assay was evaluated on fingerprick blood samples collected on filter paper from 129 individuals living in a malaria-endemic area in Malaysia. Malaria prevalence by genus-specific nested PCR was 35.6% (46 of 129) compared with 28.7% (37 of 129) by microscopy. The nested PCR detected seven more malaria samples than microscopy in the first round of microscopic examination, malaria in three microscopically negative samples, six double infections identified as single infections by microscopy and one triple infection identified as a double infection by microscopy. The nested PCR assay described is a sensitive technique for collecting accurate malaria epidemiologic data. When coupled with simple blood spot sampling, it is particularly useful for screening communities in remote regions of the world.

Detection of malaria in Malaysia by nested polymerase chain reaction amplification of dried blood spots on filter papers

A modified nested polymerase chain reaction (PCR) method for detection of Plasmodium falciparum, P. vivax and P. malariae was combined with a simple blood collection and deoxyribonucleic acid (DNA) extraction method and evaluated in Malaysia. Finger-prick blood samples from 46 hospital patients and 120 individuals living in malaria endemic areas were spotted on filter papers and dried. The simple Chelex method was used to prepare DNA templates for the nested PCR assay. Higher malaria prevalence rates for both clinical (78.2%) and field samples (30.8%) were obtained with the nested PCR method than by microscopy (76.1% and 27.5%, respectively). Nested PCR was more sensitive than microscopy in detecting mixed P. falciparum and P. vivax infections, detected 5 more malaria samples than microscopy on the first round of microscopical examination, and detected malaria in 3 microscopically negative samples. Nested PCR failed to detect parasite DNA in 2 microscopically positive samples, an overall sensitivity of 97.4% compared to microscopy. The nested PCR method, when coupled with simple dried blood spot sampling, is a useful tool for collecting accurate malaria epidemiological data, particularly in remote regions of the world.

Evaluation of the paraskeletal clamp system (Mennen plate) in treatment of mandibular fractures

In this study, we used the relatively recent Paraskeletal clamp system (Mennen plate) to evaluate its effectiveness in the treatment of mandibular fractures. This study was conducted on eight patients with mandibular fractures selected from the out patient clinic, Oral Surgery Department, Faculty of Oral and Dental Medicine, Cairo University. Patient sample consisted of six males and two females, four patients were children below the age of 11 years, while the other four were edentulous above the age of 58. Each patient was thoroughly examined both clinically and radiographically. Data collected from each patient were recorded in a special examination chart. Under general anesthesia, the fracture was exposed using a submandibular approach. The fractured segments were reduced and fixed using micro-5 Mennen plates. All patients were followed up both clinically and radiographically for six months postoperatively. Results obtained from this study showed uneventful healing of all patients with no cases of non-union, bony infection or osteomyelitis as proven both clinically and radiographically. All the patients presented normal functioning occlusion and facial symmetry. No bony step deformities were detected.

A study on the projection patterns of aberrant retinal ganglion cells in the albino rat

Injecting the retrograde fluorescent neuronal tracer fluoro-gold into the dorsal nucleus of the lateral geniculate body (dLGN), the olivary pretectal nucleus (OPN), and the superior colliculus (SC) revealed the existence of some ganglion cells (RGCs) scattered outside the temporoventral crescent of the ipsilateral retina in the adult albino rats. We studied the projection patterns, topographic distribution, number, and the soma size of these aberrant RGCs in 12 adult albino rats. We estimated a mean of 50 aberrant cells projecting to the dLGN. Their soma size ranged from 40.6 to 211.0 microns2, with an average of 108.6 microns2. The soma size of the 45.5 aberrant cells projecting to the OPN ranged from 41.5 to 312.5 microns2, with an average of 147.2 microns2. The SC received projection from 38.3 aberrant cells whose soma size ranged from 42.0 to 315.1 microns2, with an average of 120.7 microns2. These cells were almost equally distributed between the central and peripheral portions of the ipsilateral nasal retina. The mean cell count of the SC-projecting population was significantly lower than those of the other 2 groups. The mean soma size of the OPN-projecting aberrant cells was larger, and their soma size histogram was significantly different from those of the other 2 groups, whose histograms were almost alike. Though their physiological role in processing visual information is not fully understood, the aberrant RGCs might project their axons to--in addition to the dLGN, OPN, and SC--other visual centers.

A study of the motor neuron pool of the superior rectus muscle in albino rats by retrograde fluorescent double labeling technique

Recent investigations revealed the localized distribution of the motoneuron subgroups within the mammalian oculomotor nucleus. In this study, we examined the motor neuron pool of the superior rectus muscle (SR) in 12 albino rats by injecting the retrograde fluorescent tracers Fluoro-Gold (FG) into one SR and Dil into the contralateral SR. We also examined the topographic and functional correlation between the neurons controlling the muscles of the upward gaze, i.e., SR and the inferior oblique muscle (IO) in another 5 albino rats by means of the same tracers. Our results demonstrated that: 1) the average total number of the neurons in the motor neuron pool of SR was 322.7 +/- 40.1; 2) topographically, about 94.65% of the motoneurons controlling SR were located in the contralateral side, while the remaining 5.35% lay ipsilaterally; 3) all the IO motoneurons were present on the same side of the muscle they innervate; 4) the motoneurons of SR and IO did not form separate subnuclei, but were intermingling with each other; 5) functionally, about 94.59%, 4.26% and 1.15% of the total motoneurons in the SR subnucleus of either oculomotor nucleus were projecting contralaterally, ipsilaterally and bilaterally, respectively; 6) although the distribution of the perikarya was not homogeneous, the bilaterally projecting (i.e., to both SR) cells were disposed centrally, and their double labeling indicated that their axons innervate the bilateral SR via axonal bifurcation and/or collateral branching; and 7) the motoneurons of SR and IO were functionally segregated from each other as no bilaterally projecting neurons (i.e., to SR and IO) were found.

An anomalous cleido-occipitalis muscle

In a Japanese female cadaver, the occipital portion of the trapezius muscle (the cleido-occipitalis) was separated from the rest of the muscle by a triangular gap that resulted from a deficiency of the upper two thirds of the cervical portion on both sides. The right cleido-occipitals blended distally with the cervical fibers of the trapezius and had a normal insertion into the clavicle. The left cleido-occipitalis intermingled partially with the reduced cervical portion, and some of the conjoint fibers formed an independent accessory slip whose tendon inserted into the posterior aspect of the junction of the middle and medial thirds of the clavicle. The other conjoint fibers inserted into the clavicle and scapula as usual. This anomalous morphology may be attributed to a secondary degeneration of a portion of the trapezius anlage concomitant with an abnormal segregation of another portion during development.

The retroesophageal subclavian artery--a case report and review

In an 80-year-old Japanese male cadaver, the right subclavian artery originated from the aortic arch distal to the origin of the left subclavian artery, i.e., it was the last branch of the aortic arch. It coursed obliquely upwards and to the right behind the esophagus and trachea heading for the superior thoracic aperture. Its area of distribution was normal. Here, we describe this rare anomaly, and discuss its morphologic types, development, incidence, common associated anomalies and clinical correlations.

Unique course of the ovarian artery associated with other variations

In a Japanese female cadaver, the left ovarian artery originated from the abdominal aorta superior to the level of the renal vessels. Accompanied by 2 veins, it coursed laterally to the upper pole of the left kidney, then inferiorly along its posterolateral aspect. Two vessels branched from it; the first went to the left suprarenal gland as a substitute for the missing left inferior suprarenal artery, whereas the second supplied the diaphragm as a supernumerary inferior phrenic artery. The venae comitantes drained into the left renal vein. Associated unusual findings were (1) external lobation of the left kidney, (2) supernumerary left renal artery, and (3) the uterine artery being the main arterial supply to the left ovary. The aberrant course of the ovarian artery may have resulted from an abnormal descent of the left ovary under the influence of a wandering gubernaculum during development. Our report also points to the potential for an ectopic artery, i.e. the ovarian to be located in a place other than its definite pelvic position.

Chromatic aberration and optical power of a diffractive bifocal contact lens

Although diffractive contact lenses have been well documented in theory, no definitive experimental data have been reported which confirm that the near image is in fact created by diffraction rather than by refraction. We have tested the diffraction hypothesis for one type of diffractive contact lens (the Hydron Echelon bifocal) experimentally by measuring its longitudinal chromatic aberration in isolation and when worn on the eye. The basis of this test is that, according to theory, diffractive lenses should have chromatic aberration which is opposite in sign to that measured for the eye. Objective measurements of chromatic aberration were made with a focimeter when the lens was in a wet cell. Subjective measurements were made with a Badal optometer when the lens was worn on the eye. Four control experiments were conducted to provide baseline measurements of the eye's chromatic aberration, against which we compared the results obtained for the diffractive contact lens. The data were also compared with conventional measurements of refractive error obtained by standard subjective techniques and by an automated infrared refractor. Our results showed that the longitudinal chromatic aberration of the diffraction image of the Echelon bifocal lens was about one-half that obtained under the four control conditions: for the naked eye, for the nondiffraction image of the Echelon lens, or for either image of a refractive bifocal contact lens (CIBA Bisoft). These results are consistent with the theoretical prediction that the negative chromatic aberration of a diffractive contact lens should partially cancel the positive chromatic aberration of the human eye.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of pork and lard as adulterants in processed meat: liquid chromatographic analysis of derivatized triglycerides

A new method is described for detection of pork and lard as adulterants in processed beef and mutton mixtures. The unsaturated triglycerides in the fat are ozonized and then derivatized. The mixture of derivatized and saturated triglycerides is analyzed by liquid chromatography using a reverse-phase column and a UV detector. Pork fat has larger amounts of triglyceride containing saturated fatty acid at the C-2 position than does the fat of other meat. The ratio of triglyceride containing saturated fatty acid vs triglyceride containing unsaturated fatty acid at the same (C-2) position (SSU/SUS) in a sample is compared with those of pure meats. The presence of pork in the sample causes the ratio to increase compared with ratios for pure beef or mutton. The increase in the SSU/SUS ratio is significant for the addition of 1% pork in beef. In the case of mutton, the addition of 3% pork causes a noticeable change. The method is reliable and is also applicable to samples containing only fat. Processing (heating or cooking) does not affect the ratios.

Bromocriptine in polycystic ovarian disease: a controlled clinical trial

Bromocriptine and placebo were given to a group of 20 polycystic ovarian disease patients on a double-blind, cross-over basis. Patients were studied for three cycles: a baseline cycle without any medication, a placebo-treated cycle, and a bromocriptine-treated cycle with multiple plasma samples taken during the different phases of the menstrual cycle. The clinical response to bromocriptine was compared with that of a placebo for the following hormones: prolactin (PRL), luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratio, testosterone, androstenedione, estradiol-17 beta (E2), estrone (E1), and progesterone. Patients were divided into two subgroups: hyperprolactinemic (basal PRL greater than 20 ng/mL) and normoprolactinemic (basal PRL less than 20 ng/mL), and the response of both subgroups to bromocriptine was compared. Prolactin, LH/FSH ratio, testosterone, and E1 showed a significant drop with bromocriptine, whereas E2 significantly increased. Two out of nine amenorrheic polycystic ovarian disease patients menstruated during bromocriptine treatment, and three patients showed evidence of ovulation.

A controlled clinical trial for the effect of bromocriptine on the adrenal contribution in polycystic ovarian disease

Adrenal involvement in polycystic ovarian disease was assessed by measuring dehydroepiandrosterone sulphate in 20 polycystic ovarian disease patients. The response of dehydroepiandrosterone sulphate to bromocriptine treatment was compared to that of placebo, both being given for one cycle on a double-blind, cross over basis. The mean basal DHEA-S was above the upper limit of the normal range (6793 nmol/l) in three patients. The mean basal dehydroepiandrosterone sulphate in the polycystic ovarian disease group was significantly higher than the mean of the normal control group (P less than 0.01). Dehydroepiandrosterone sulphate showed a significant drop with bromocriptine as compared to placebo (P less than 0.001) and a significant correlation with prolactin both before (P less than 0.001) and after treatment with bromocriptine (P less than 0.001). These findings support the hypothesis of adrenal involvement in polycystic ovarian disease and prove the significant effect of bromocriptine on the adrenal which might be of therapeutic value.

Correlation of the ultrasonic appearance of the ovaries in polycystic ovarian disease and the clinical, hormonal, and laparoscopic findings

The ovarian ultrasonic appearance in 20 patients with polycystic ovarian disease was studied and correlated to the clinical, hormonal, and laparoscopic findings. Ultrasound studies showed that both ovaries were enlarged in 15 patients (15.46 +/- 2.5 cm3). Maximum ovarian surface area was 9.75 +/- 3.38 cm2. Three ultrasonic patterns were detected: (1) isoechoic, with no discernible cysts (four patients); (2) hypoechoic, with multiple small cysts of less than 1 cm (11 patients); (3) hypoechoic, with single cyst of greater than 1 cm (five patients). Ultrasonic estimation of ovarian size was superior to clinical assessment and equal to that of laparoscopic examination. Subtle differences existed between the ultrasonic appearance of the ovaries in hyperprolactinemic subgroups of polycystic ovarian disease compared to normoprolactinemic ones. However, no significant relationship was found between the ovarian size and any of the hormones studied. Obesity, amenorrhea, hirsutism, hyperprolactinemia, and elevated testosterone and dehydroepiandrosterone sulfate levels were more common in the group with enlarged ovaries, whereas oligomenorrhea, elevated luteinizing hormone/follicle-stimulating hormone ratio, and elevated androstenedione and estrone levels occurred more frequently in the group with normal-sized ovaries. The value of ultrasound studies in the management of polycystic ovarian disease is emphasized.

Effect of aspirin on the luteal phase of human menstrual cycle

The effect of aspirin (acetylsalicylic acid) on the luteal phase length and function was studied in ten normal cycling women. They received three grams daily for twenty days starting from the fifth day of the cycle. Urinary pregnanediol-3 alpha-glucuronide (Pg-diol- 3G ) and luteinising hormone (LH) were assayed in daily early morning urine samples together with daily vaginal smear for cytohormonal evaluation. The excretion profile of Pg-diol- 3G and LH of another group of ten normal women were taken as controls. Aspirin caused shortening of both cycle length and luteal phase duration. Available evidence suggests the presence of corpus luteum deficiency in the treated cycles.

Aberrant uterine response to prostaglandin E2 as a possible etiologic factor in functional infertility

The clinical entity of functional infertility still remains unexplained and largely lacking a line of proper management. The uterine response to prostaglandin E2 (PGE2) and prostaglandin F2alpha (administered by intravenous and intrauterine routes) was evaluated during different phases of the menstrual cycle in five functionally infertile women. The results (quantitative and qualitative) were compared with those elicited among 20 fertile women. There were no apparent differences between the two groups with respect to either compound (systemic or local) when given during the proliferative or luteal phase of the cycle. However, at midcycle, about the time of ovulation (days 13 to 18), there was a salient deviation in the type of response following local instillation of PGE2; in the normal fertile group there was a definite inhibition of motility, while uteri in the functionally infertile group showed marked stimulation. The possible role of this aberrant uterine response in the etiology of functional infertility is discussed.