T C Yang — Page 5 | Search PubMed

Ectopic pregnancy (EP) after in vitro fertilization and embryo transfer (IVF/ET) is not rare, but triplet tubal pregnancy after IVF/ET is very rare. We describe a patient with hydrosalpinx in whom a triplet tubal pregnancy occurred on the same side as the hydrosalpinx. Close hormonal and sonographic monitoring of pregnancies achieved through IVF is recommended to ensure the early diagnosis of EP and to avert complications. A triplet tubal EP was considered highly probable after 3 gestational sacs were observed outside the uterus during sonography performed at 6 weeks' gestation. Therapeutic laparoscopy was then performed because methotrexate treatment failed. Appropriate management strategies are discussed.

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Calculation of 6-hour D/P creatinine ratio from the 4-hour peritoneal equilibration test. The effect of dwell duration on the results.

OBJECTIVES: Since the introduction of the peritoneal equilibration test (PET), the 4-hour dialysate/plasma creatinine (D/P Cr) has been used by several authors for determining continuous ambulatory peritoneal dialysis (CAPD) prescriptions. However, the results have been unsatisfactory because the 4-hr D/P Cr does not accurately reflect the D/P Cr in 24-hr collections. The PET and the 24-hr dialysate collections differ in the duration of dwell and the tonicity and volume of dialysate, all of which influence the equilibrated D/P Cr. It can be assumed that the D/P Cr in 24-hr collections in these patients is closer to a 6-hr D/P Cr. Because a 6-hr PET is inconvenient, we developed a mathematical model to calculate the 5- and 6-hr D/P using the results of a standard PET. DESIGN: In a retrospective analysis, D/P Cr ratios in 24-hr collections and D/P Cr ratios calculated from a mathematical formula were correlated. Using a mathematical model, the data collected fit an exponential relation of the type D/P = a(1-e-t/tau). The values of a and tau are unique for a given patient and were determined using a nonlinear regression technique. The formula performed well on our published data-the true and predicted 6-hr D/P Cr being 0.696 and 0.71, respectively. SETTING: The University Hospital and Clinics, Dalton Cardiovascular Research Center and Dialysis Clinic, Inc., Columbia, Missouri. PATIENTS: All CAPD patients on four 2-L exchanges/day at the time of the 24-hr collections were included. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Closeness of 4-hr and 6-hr D/P Cr values to those of 24-hr ratios. RESULTS: The study group comprised 74 patients (age, mean +/- SEM: 56.4 +/- 1.8 yr) with 80 PETs and 145 (24-hr) collections. The interval between the two tests was 8.3 +/- 0.9 months (0-48.7 months). The median 24-hr D/P Cr of 0.760 did not differ significantly from the predicted median 6-hr D/P Cr of 0.755. A subgroup analysis, based on transport type, showed that this relationship was most precise in the high-average transporters. The predicted 6-hr D/P Cr was within 10% of the 24-hr D/P Cr in 48% of patients and within 20% in 77% of patients. The margin of error was greatest in the low transporters. CONCLUSIONS: To conclude, the 4-hr D/P Cr from a PET cannot be used interchangeably with the D/P Cr in the 24-hr dialysate collections, hence, the clearances calculated thereof will be inaccurate. Using the proposed model, it is feasible to use the 4-hr PET results to obtain 5- and 6-hr D/P Cr values. In our study, using this model, the extrapolated 6-hr D/P Cr is similar to the D/P Cr in 24-hr dialysate collections only in the high-average transporters. Hence, the best way to determine clearances in peritoneal dialysis patients is still by collecting 24-hr dialysates.

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