Frequent Laboratory Tests Research Articles

Monitoring of Ovulation Induction

The plasma hormonal patterns of the normal menstrual cycle have been reviewed. A consistent cyclic pattern of plasma hormone levels is observed in LH, FSH, estrogens, and progestins in the menstrual cycle. Other plasma hormones, such as ACTH, growth hormone, TSH, and PRL, as well as androgens and corticosteroids, fluctuate throughout the menstrual cycle without any consistent pattern during the ovulatory cycle. FSH, LH, E2, E1, P, T, and A levels during the induced ovulatory cycle are presneted for comparison. In the gonadotropin-induced ovulatory cycle most hormones behave in a manner similar to that in the normal ovulatory cycle, except for FSH levels, which rise continuously throughout the follicular phase of the cycle. Following ovulation in the gonadotropin-induced cycle, T rises above normal levels. Early in the clomiphene-induced ovulatory cycle, unlike the normal cycle, LH is distinctly elevated. Levels of both LH and FSH in the rest of the cycle simulate those in the normal cycle. However, T and A levels rise from the very beginning of clomiphene therapy and continue to rise throughout the clomiphene-induced ovulatory cycle. Levels of E and P are higher than in the normal ovulatory cycle, but a similar pattern is preserved. Because of the potential dangers of gonadotropin therapy, monitoring by frequent examination and laboratory tests is required. E monitoring is mandatory to evaluate follicular maturation, to time hCG administration, and to minimize hyperstimulation. Cervical mucus is an unreliable parameter for monitoring gonadotropin therapy alone. In addition to cervical mucus, plasma or urinary E should be monitored regularly. Clomiphene therapy is less dangerous than gonadotropin therapy. Because of its lesser risk, monitoring is rarely performed during clomiphene use. An active monitoring approach has been described. While this approach may not necessarily improve the outcome of clomiphene therapy, it may hasten the process of selecting the appropriate dose. Although other ovulation-inducing agents are available, their use is rarely associated with serious medical complications, and monitoring would seem unnecessary.

Side effects of antihemophilic concentrates

Liver disease and thromboembolism are the most frequent and severe side effects associated with the use of clotting-factor concentrates in haemophiliacs. Knowledge and careful evaluation of the risk factors related to their development appear to be the most reasonable policy for prevention. themolysis due to significant isoantibody infusion and bleeding associated to abnormal platelet function occur more rarely during intensive replacement therapy with clotting factor concentrates. Finally, abnormalities of renal function have been observed in a number of patients, though they seem to be of minor clinical importance. These complications do not justify withdrawal or limitation of the very effective and life-changing use of concentrates. However, awareness of their occurrence and of their danger requires that specialized hemophilia centres carry out, at frequent intervals, clinical and laboratory testing of the target organs to allow an early detection.

A guide to anticoagulant therapy.

The physician who undertakes anticoagulant therapy tampers with one of the most important homeostatic functions of the body. In so doing, he subjects the patient to the calculated hazard of possible hemorrhage balanced against the risks of the thrombosis or embolism that he seeks to prevent or treat. Agents currently employed are heparin and coumarin-type compounds. These two categories of anticoagulants act at different sites of the coagulation mechanism, are administered differently, are metabolized differently, are reversed by different antidotes, and their effects are measured by different tests. Certain facts about which the physician should be adequately informed have been presented regarding the hemostatic mechanism; the physiology and pharmacology of the anticoagulants, especially as they may explain the wide variation in individual response; certain aspects of methodology; and the various practical problems involved in therapeutic management. Emphasis has been placed on the importance of individualization of treatment, careful clinical observation, and frequent reliable laboratory tests as guides to proper therapy.

The George E. Brown Memorial Lecture; current status of the problem of thrombosis.

The pathogenesis of intravascular thrombosis involves 1 or a combination of 3 factors: an endothelial lesion, a disturbance of blood flow, and hypercoagulability of the blood. The fate of fresh thrombi is probably dependent on the fibrinolytic activity of the plasma. While some tests for coagulation factors have given some positive results among patients with various types of thrombosis, no test has consistently demonstrated its value in predicting a thrombosing tendency. Carefully administered anticoagulant therapy has been effective in the prevention of thrombosis in many patients. Such therapy requires individualization on the basis of frequent laboratory tests and is usually justified only after the patient has suffered one or more episodes of clinical thrombosis. Treatment of acute thrombosis by intravascular injections of fibrinolysins is still in the experimental stage. Recent advances in surgical technic have led to successful restoration of continuity of some of the large arteries previously occluded by thrombosis.

Tibione: Laboratory and Clinical Studies

Tibione is a drug of moderate toxicity. The greatest toxic manifestations are gastro-intestinal disturbances which develop primarily during the third week and generally persist only a short time. Other complications are dermatitis, anemia, and impaired hepatic function. A decrease in cough and sputum, and a sense of well-being occur with tibione. Tibione is a chemotherapeutic agent capable of conversion of the sputum. X-ray film improvement after 120 days of tibione therapy has been noted. The improvement is not as marked as with streptomycin for a comparable period. There has been demonstrated an acquired resistance of M. tuberculosis toward tibione. Tibione should be administered only where adequate laboratory facilities are available so that frequent laboratory tests can be made.