Outpatient management of severe early OHSS by administration of GnRH antagonist in the luteal phase: an observational cohort study

ABSTRACT: BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.     

The Structure and Development of the Pineal Complex in the Lanternfish Triphoturus mexicanus (Family Myctophidae)

The pineal complex of the lanternfish Triphoturus mexicanus was studied by light and electron microscopy. Receptor, supportive and ganglion cells were identified in the pineal end-vesicle. The presence of receptor cells and the prominent pineal window strongly suggest a photoreceptive function. Numerous unmyelinated nerve fibers were also found in the end-vesicle. These converge to form part of the pineal stalk. Two kinds of cells (Types I and II) were distinguished in the dorsal sac, which is very well developed. Type I cells are non-ciliated ependymal cells and contain large parcels of glycogen. Type II cells contain large lipidlike inclusions and a distinct band of filaments around the entire periphery of the cell. Receptor cells appear very early in the development of T. mexicanus. They seem to originate from ependymal cells lining the roof of the third ventricle.     

When a Virus-like Particle is a Virus

Reasons are given why the term "virus-like particle" should not be used when describing viruses of the cryptic group. Also, an attempt is made to define viruses taking into consideration recent knowledge.     

Studies on the bioactivity of radiolabeled,highly-purified bovine thyrotropin

Bovine thyrotropin radiolabeled stoichiometrically with chloramine T was subjected to high pressure liquid chromatography on a Waters' Protein I-125 column. More than 80% of the radioactivity eluted after the Na¹²⁵I (“salt”) peak. In contrast, thyrotropin bioactivity eluted before the salt peak. Radiolabeled thyrotropin affinity-purified with thyroid plasma membranes eluted after the salt peak. Discordance between the thyrotropin bioactivity and radioactivity elution profiles was confirmed by labeling thyrotropin with ¹²⁵I by lactoperoxidase and then measuring both bioactivity and radioactivity in each chromatographic fraction. These data suggest that the bioactivity in radiolabeled thyrotropin may not be inherent in the radiolabeled molecules.