Comparison of clinical characteristics between early and late patterns in hospitalized patients with ovarian hyperstimulation syndrome
Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul 110-744, South Korea. Fertility and sterility
(Impact Factor: 4.59).
02/2009; 93(7):2274-80. DOI: 10.1016/j.fertnstert.2009.01.057
To clarify the differences in clinical characteristics between early and late ovarian hyperstimulation syndrome (OHSS).
Tertiary university hospital.
Ninety-four patients/cycles hospitalized for moderate-to-severe OHSS after controlled ovarian hyperstimulation (COH) for IVF/intracytoplasmic sperm injection (ICSI); early type (n = 69) and late type (n = 25).
The COH and pregnancy outcomes, preclinical and clinical miscarriage rate, and hospital courses.
Serum E(2) levels (4,955.5 +/- 3,268.5 pg/mL vs. 2,340.8 +/- 960.6 pg/mL) and the number of follicles > or =11 mm on day of hCG administration (15.9 +/- 6.0 vs. 13.0 +/- 4.0), and the number of oocytes retrieved (21.9 +/- 9.7 vs. 13.2 +/- 5.9) were significantly higher in the early OHSS group compared with the late OHSS group. Clinical pregnancy rate (PR) was significantly higher in the late OHSS group (23.6% [13/55] vs. 92.0% [23/25]). There were no significant differences in multiple PR and disease severity between the two groups.
Early OHSS is associated with excessive ovarian response to gonadotropin stimulation, whereas late OHSS is closely associated with conception cycle. Our findings do not support that late OHSS is more severe and closely associated with multiple pregnancies compared with early OHSS.
Available from: Ioannis Sfontouris
- "In addition, it was recently proposed that early OHSS can be equally severe as late OHSS, requiring a mean of 6.8 to 20 days of hospitalization depending on whether the women subsequently became pregnant or not
, despite previous reports showing that late pregnancy-induced OHSS is associated with more severe symptoms
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Management of established severe OHSS requires prolonged hospitalization, occasionally in intensive care units, accompanied by multiple ascites punctures, correction of intravascular fluid volume and electrolyte imbalance. The aim of the present study was to evaluate whether it is feasible to manage women with severe OHSS as outpatients by treating them with GnRH antagonists in the luteal phase.
This is a single-centre, prospective, observational, cohort study. Forty patients diagnosed with severe OHSS, five days post oocyte retrieval, were managed as outpatients after administration of GnRH antagonist (0.25 mg) daily from days 5 to 8 post oocyte retrieval, combined with cryopreservation of all embryos. The primary outcome measure was the proportion of patients with severe OHSS, in whom outpatient management was not feasible.
11.3% (95% CI 8.3%-15.0%) of patients (40/353) developed severe early OHSS. None of the 40 patients required hospitalization following luteal antagonist administration and embryo cryopreservation. Ovarian volume, ascites, hematocrit, WBC, serum oestradiol and progesterone decreased significantly (P < 0.001) by the end of the monitoring period, indicating rapid resolution of severe OHSS.
The current study suggests, for the first time, that successful outpatient management of severe OHSS with antagonist treatment in the luteal phase is feasible and is associated with rapid regression of the syndrome, challenging the dogma of inpatient management. The proposed management is a flexible approach that minimizes unnecessary embryo transfer cancellations in the majority (88.7%) of high risk for OHSS patients.
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ABSTRACT: This paper extends the theory of hybrid position/force control to the case of multiarm cooperating robots. Cooperation between n robot arms is achieved by controlling each arm such that the burden of actuation is shared between the arms in a non-conflicting way as they control the position of and force on a designated point on an object. The object which may or may not be in contact with a rigid environment, is assumed to be held rigidly by n robot end-effectors. Natural and artificial position and force constraints are defined for a point on the object and two selection matrices are obtained to control the arms. The position control loops are designed based on each manipulator's Cartesian space dynamic equations. In the position control subspace, a feature is provided which allows the robot arms to exert additional forces/torques to achieve compression, tension, or torsion in the object without affecting the execution of the motion trajectories. In the force control subspace, a method is introduced to minimize the total force/torque magnitude square while realizing the net desired force/ torque on the environment.
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ABSTRACT: High fire point (HFP) dielectric liquids have been in use since
the demise of Askarels (PCB/TCB) in the mid-1970s. Having fire points of
at least 300°C, their main application has been in the role of power
transformer impregnants particularly in units located in, on, or near
buildings. This study was aimed at evaluating the suitability of such
liquids for application in arcing environments. At present, most HFP
liquids are produced from one of three different chemical bases. These
are: (a) polyol ester; (b) high molecular weight hydrocarbon (HMWH); and
(c) dimethyl silicone. Samples of these liquids were evaluated in a
typical oil switch primarily utilized in capacitor switching
applications. Although not an HFP liquid, transformer oil was included
in the test matrix to provide a base line to which the other liquids
could be compared. Each liquid was exposed to 250 cycles of switching
8,000 volts at 50 amps (a duty well within the capability of the
switch). The results show that both polyol-ester and high molecular
weight hydrocarbons compare favorably to transformer oil in this
application. However, the dielectric breakdown value of dimethyl
silicone was so rapidly degraded that its use under such conditions
requires considerable caution
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