No abstract

The most common anomalies of the fetal ventral abdominal wall include omphalocele and gastroschisis. Umbilical cord hernia is another abdominal wall defect that is poorly defined and usually mistakenly considered as a small omphalocele. The present report describes the sonographic features and clinical significance of four cases of umbilical cord hernia identified transvaginally in the early second trimester of pregnancy. These cases seemed to present a different entity from that of simple omphalocele. The transvaginal sonographic approach provided a clear image of the midgut protruding into the umbilical cord, precise localization of cord insertion in the region of the umbilical ring. Doppler flow evaluation of the umbilical vessels and their relation to the protruding mass. Serial sonographic observations revealed a stable umbilical cord mass in three fetuses, and an enlarging mass in one. Normal karyotype was determined and no associated malformations were detected prenatally. However, in one case that underwent immediate correction of the hernia after delivery at term, the neonate was subsequently found to have pulmonic stenosis and severe neonatal seizures developed at 4 months of age. In two cases, pregnancy was terminated due to parental request. The fourth fetus was delivered vaginally at term and catastrophic division of the umbilical cord containing a loop of small intestine was avoided only by the diligent observation of the midwife. We suggest that umbilical cord hernia is a distinct anomaly originating at a different stage of embryogenesis, thereby having a unique clinical significance, unlike simple omphalocele. Umbilical cord hernia should therefore be defined and considered as a separate entity.

An increase in endogenous androgen production has been observed following long-term physical training and the beneficial effects of training have been attributed in part to this phenomenon. Other investigators, however, found, in contrast lower testosterone levels in trained compared with untrained subjects. The purpose of the present study was to follow the long-term changes in total testosterone (T) and cortisol (C) levels in intensely training individuals. The changes in the body's anabolic state, induced by intense long-term physical training, were determined using the plasma resting T/C ratio. T and C levels of 35 young untrained subjects were measured at 6 week intervals during 18 weeks of strenuous physical training. All samples were drawn within one half hour of awaking (05.30-06.00). Mean serum T levels increased significantly at 6 weeks (28.7%, p less than 0.02) and decreased significantly at 12 weeks (20.6%, p less than 0.02), but did not differ at 18 weeks compared with levels before training was commenced (mean +/- SE, 16.9 +/- 0.2, 21.8 +/- 0.3, 12.8 +/- 0.2 and 17.3 +/- 0.2 nmol/l at 0, 6, 12, and 18 weeks, respectively). Mean serum C was increased significantly (21.3%, p less than 0.005) at 18 weeks (463.5 +/- 19.3, 507.7 +/- 22.1, 480.1 +/- 19.3, and 565.6 +/- 22.1 nmol/l). T/C ratio decreased significantly after 12 and 18 weeks of training. Our results do not support an association between reduced total testosterone levels and prolonged training. However, hypercorticolism with a relative catabolic state may occur.

Adequate ovarian response, essential for successful IVF, cannot be accurately predicted. This study retrospectively reviewed all patients undergoing IVF from 1998 to 2001. Inclusion criteria were age <41 years at treatment onset and a basal day 3 serum FSH concentration <12 IU/l. Women with FSH or=3 in group 1 and <3 in group 2 (controls). Age at treatment initiation, basal serum day 3 FSH and LH concentrations, peak serum oestradiol concentration, number of retrieved and fertilized oocytes and pregnancy rate were analysed. Groups 1 (n = 41, 111 IVF treatment cycles) and 2 (n = 596, 1,434 IVF treatment cycles) were similar in term of woman's mean age. Group 1 had significantly higher mean basal day 3 FSH concentration (P < 0.01) and significantly lower oestradiol concentrations at oocyte retrieval (P < 0.01), mean number of oocytes retrieved and fertilized (P < 0.01) and pregnancy rate (P = 0.016). The same trend persisted after excluding 98 patients with basal FSH concentrations >8 IU/l. In conclusion, elevated day 3 FSH/LH ratio is associated with an inferior outcome in IVF treatment cycles and may be used as an additional predictor for decreased ovarian response.