Congenital TRIGGER digit and thumb is a steno sing tenosynovities of the flexor tendon that is relatively uncommon in children. Presented here, is an unusual case of congenital bilateral TRIGGER digits that was developed as bilateral TRIGGER thumb in a 4-year-old boy.

Routinely, a bolus of 5. 000-10. 000 IU human chorionic gonadotropin (hCG) is used for the final follicular maturation and ovulation as a standard method. HCG has the same effect of luteinizing hormone (LH) with long half-life. It has the long lutheotrophic effect which increases the risk of ovarian hyper stimulation syndrome (OHSS). Recently, gonadotropin-releasing hormone agonist (GnRH-a) TRIGGER has been used for the induction of final follicular maturation and ovulation with the aim of reducing the OHSS risk. Several studies have shown that the releases of endogenous follicular stimulating hormone (FSH) and LH after administration of GnRH agonist in in vitro fertilization (IVF) cycles are able to precede the final follicular maturation leading to removal of fertile oocyte with normal development of the embryo and ultimately pregnancy. But based on the results of some studies, using GnRH-a TRIGGER leads to defect luteal-phase resulting to reduce the implantation and clinical pregnancy rates and also increase abortion in fresh embryo transfer cycles compared to routine IVF cycle with hCG TRIGGERing. Also, in recent years, studies have continued to modify the luteal phase support, so that the fresh embryo transfer is possible too. In this review, we examined the benefits, problems, and also ways to reform GnRH agonist TRIGGERing complications.

Background: TRIGGER wrist is a relatively rare hand disorder that refers to the painful snapping and clicking or TRIGGERing at the wrist level during finger or wrist movements. Objectives: In this study, we aimed at reporting a series of TRIGGER wrist and discussing their etiology, as well as their clinical manifestation and outcomes. Methods: In this retrospective study, the patients with the definitive diagnosis of TRIGGER wrist were reviewed. Their demographics and clinical symptoms were extracted from their medical records. The symptoms of median neuropathy, including weakness or atrophy of the thenar muscles, persistent numbness, and paresthesia were recorded to investigate the association with Carpal Tunnel Syndrome (CTS). Results: A total of seven patients with the Mean± SD age of 35. 5± 10. 3 years were included in the study. A benign mass was the etiology of TRIGGER wrist in all cases, with giant cell tumor of flexor tendon sheet as the most common etiology (57. 1%). TRIGGER wrist was associated with CTS in three cases (42. 8%), in all of whom the tumor size was larger than the average. Pain and snapping with or without palpable mass were the main clinical symptoms of the patients that completely disappeared by surgical removal of the lesion. A mean 40. 3 months follow-up of the patients was uneventful. Conclusion: Benign neoplasms could be considered as the most common etiology of TRIGGER wrist. Since many patients with TRIGGER wrist might have CTS, too, the careful differentiation of these entities is necessary. Once accurately diagnosed, surgical intervention is entirely curative.