Asia-Oceania journal of obstetrics and gynaecology / AOFOG

Print ISSN: 0389-2328
PIP This study evaluated the effectiveness of extraovular .1% ethacridine lactate alone and edacridine lactate plus spartein sulfate in midtrimester pregnancy termination. In the 60 cases where ethacridine lactate alone was administered, 50 cases aborted within 48 hours of instillation (83.3% success rate). Of these 50, 25 aborted within 24 hours (41.7%). Abortion was complete in 45 cases. The time of onset of uterine contractions ranged from 1 hour to 16.5 hours, with a mean 21-1/4 hours. The mean time of membrane rupture in the series was 23 hours and the induction-abortion interval averaged 27-1/4 hours. Side effects included vomiting (18.3%), shivering (16.6%), fever (3.3%), cervical injuries (6.6%), and excessive blood loss (1.7%). Blood loss until expulsion of the fetus averaged 54.1 ml, and blood loss up to 4 hours after abortion averaged 115.1 ml in cases of complete abortion and 219 ml in cases of incomplete abortion. In the 90 cases where both ethacridine lactate and spartein sulfate were used, 76 aborted within 48 hours (success rate 84.6%) and 40 aborted within 24 hours (44.4%). Abortion was complete in 75% of cases. The abortion-induction interval ranged from 4 hours to 47-3/4 hours, with a mean of 28-1/2 hours. These results, which are comparable to those obtained in other studies, indicate that extraovular ethacridine lactate alone appears to be a safe, efficient, and relatively inexpensive method of midtrimester abortion. Although there were fewer reports of side effects in the group that received spartein sulfate, use of this compound does not reduce the induction-abortion interval. The relatively low incidence of side effects such as vomiting and diarrhea, the antiseptic properties of ethacridine lactate, and the absence of serious complications such as rupture of the uterus and cervicovaginal fistula are advantages of the ethacridine lactate method that nullify the disadvantage of its slightly prolonged induction-abortion interval.
The 102 fetuses diagnosed by ultrasound to be asymmetrically growth-retarded had blood flow velocity waveforms of the umbilical artery studied. Sixty-two cases had normal blood flow, 28 had abnormal blood flow but with present end-diastolic flow, 8 had absent end-diastolic flow, and 4 had reversal of end-diastolic flow. Comparison was made between the blood flow status and other biophysical methods of antenatal surveillance and perinatal outcome. There is a strong correlation between abnormal blood flow and abnormalities detected by other biophysical methods of antenatal surveillance. Our study shows that fetuses with severe blood flow impairment tend to be more severely growth-retarded and to be delivered earlier. Our results also show abnormal blood flow to be associated with a poor perinatal outcome. Those fetuses with severe impairment of blood flow suffered a high incidence of operative delivery for fetal distress, acidosis at birth, perinatal mortality and morbidity. The association between abnormal blood flow and the 5-minute Apgar score is significant only in those with the severest impairment of blood flow. Our results are in close agreement with similar studies recorded in the literature.
The effect of a calcium antagonist (a derivative of dihydropyridazinone: ICI 109,081), upon oocyte maturation, and steroid production by pre-ovulatory hamster follicles was determined. Sexually immature golden hamsters were injected with 40 iu PMSG, and pre-ovulatory follicles (591–740 μm) were isolated after 72–78h. The culture of intact follicles in medium containing 1 μg/ml ICI 109,081 showed an increased output of progesterone (p<0.05). However, in the presence of LH, ICI 109,081 was seen to cause significant decreases in the output of progesterone, 17α-hydroxyprogesterone and androstenedione (all p<0.05) with a significant increase in the production of oes-tradiol (p<0.05). The culture of oocytes isolated 72h after PMSG showed significant reductions in the number of oocytes resuming meiosis when compared with controls (94%) for ICI 109,081 concentrations of 0.1 μg/ml (58%, p<0.05) and 1 μg/ml (32%, p<0.05). Smilarly, the pre-treatment of animals with 3 mg ICI 190,081 lh before injection of 25 iu hCG, caused the ovulation of 96/98 ova with an intact germinal vesicle. The results suggest a role of calcium in the regulation of oocyte maturation, and as a mediator in the action of LH upon steroidogenesis by pre-ovulatory follicles.
During the period 1971–1980 a total of 1226 diagnostic laparoscopies were performed at the Department of Obstetrics and Gynecology of Turku University Central Hospital. In 591 patients the indication for laparoscopy was chronic pelvic pain. The most common pathology in these patients was endometriosis (36 per cent). Adhesions and pelvic varicosis were the next most common findings. In 197 patients (33 per cent) no pathology was found in laparoscopic examination. Endometriosis and adhesions were also the most common finding in the 288 infertile patients; 43 per cent of the 55 infertile patients with a normal HSG showed pathology in laparoscopy. Laparoscopy is also an important tool in the decision for or against tuboplasty. Suspected ectopic pregnancy was the indication for 182 patients. In 73 of the patients (40 per cent) the finding was a tubal pregnancy and in three cases an ovarian pregnancy was found. Other indications for diagnostic laparoscopy had been for example primary and secondary amenorrhoea, hirsutism and anomalies in the genital tract. Often laparoscopy can be both diagnostic and therapeutic.
For a preoperative differentiation between leiomyomata uteri and adenomyosis, we measured serum levels of the antigen CA 125, which is specific to ovarian non-mucinous epithelial carcinoma, in patients with benign gynecologic diseases (39 leiomyomata uteri, 10 adenomyosis, 4 adenomyosis with leiomyomata uteri, 3 adenomyosis with external endometriosis and 4 external endometriosis). Using radio-immunoassay (RIA) kit, we found the normal range of CA 125 levels to be below 34 U/ml. The mean CA 125 level (±S.D.) was 20.3 ± 10.3 U/ml in patients with leiomyomata uteri and 151.2 ± 157.3 U/ml in those with adenomyosis. The mean CA 125 level in patients with leiomyomata uteri was not statistically higher than that in disease-free women. The mean CA 125 level in patients with adenomyosis was statistically higher than that in disease-free women. Of 17 patients with surgically demonstrable adenomyosis, the CA 125 values were over 34 U/ml in 16 (94.1%). Three (75%) of 4 patients with surgically demonstrable external endometriosis had a serum CA 125 level in excess of 34 U/ml. Of 39 patients with surgically demonstrable leiomyomata uteri, CA 125 levels were below 34 U/ml in 37 (94%). CA 125 levels in patients with adenomyosis gradually decreased postoperatively and all were below 34 U/ml within four weeks. Using this approach, leiomyomata uteri and adenomyosis can be differentiated preoperatively and the response to treatment in patients with endometriosis can be monitored.
A new human endometrial carcinoma cell line, designated OMC-2, was established from the endometrial adenocarcinoma of a 59-year-old woman. This cell line has grown well for 51 months and has been subcultured more than 50 times. Monolayer cultured cells are polygonal in shape, showing a pavement-like arrangement and a piling up tendency without contact inhibition. The chromosomal number shows aneuploidy and the modal chromosomal number is in the diploid range. The cells were transplanted into the subcutis of nude mice and produced tumors resembling the original tumor. 1 X 10(5) OMC-2 cells produced CA 125 (184-682 U) during 19 days in culture media. CA 125 was demonstrated immunohistochemically in the original tumor, heterotransplanted tumor, and OMC-2 cells. The cells contain no estrogen or progesterone receptors. Twenty-nine other reports of endometrial carcinoma cell lines are reviewed.
An ultrasonographic examination revealed increased fetal bladder size as well as fetal bilateral hydronephrosis at 13-weeks' gestation. Diagnosis of the fetal urethral obstruction was made. Repeated ultrasonography was undertaken from the 13th to through 16th weeks of gestation. Percutaneous puncture with aspiration and laboratory analysis of fetal urine was performed at 15-weeks' gestation. The fetal renal function seemed not to be damaged by use of these antenatal procedures. Following induced abortion at 16-weeks' gestation, an autopsy showed that the fetal urethral obstruction was caused by a posterior valve, with no histological evidence of fetal renal dysplasia.
Septic induced abortion is still posing a problem in our community. Out of 14 grade III septic induced abortion, 12 required surgical intervention as part of active management for appropriate therapy. Clinical variables like patient characteristics, method of induction, person responsible for induction, the methods, the reason for delay in admission were analysed in detail with a view to obtain a comprehensive idea of this socio-medical problem and its prevention.
One hundred and forty-three pregnancies conceived by assisted reproductive techniques (ART) from October 1985 to June 1989 in the National University Hospital, Singapore, resulted in 66 deliveries and 89 babies. There were 27 (18.7%) biochemical pregnancies, 44 (30.7%) clinical miscarriages and 6 (4.2%) ectopic pregnancies when total pregnancies were considered. Of those who continued pregnancy to second trimester multiple births occurred in 20 (13.3%) patients. A high incidence of vaginal bleeding and hypertension in pregnancy was noted in 32 (48.5%) patients and 18 (27.3%) patients, respectively. Caesarean section was the method of delivery in 48.5% of patients. Twenty-six (29.2%) babies required admission to the neonatal intensive care unit. All babies except one set of twins delivered at 24 weeks of amenorrhoea survived. Fetal abnormality was noted in 2 cases.
(15S)-15 Methyl Prostaglandin F2 Alpha (Carboprost trometha-mine) was used as an abortificient drug in early pregnancy not exceeding 49 days. Its efficacy, side effects and complications were studied and discussed.
PIP A new analog of prostaglandin E1 (PGE1) was administered vaginally to women with (n=20) and without (n=29) laminaria tents and metreurynter for therapeutic abortion during the 2nd trimester. All patients aborted successfully. The abortion time was short, bleeding was minimal, and there was little difference between patients treated with 16 DM-PGE1 alone and those treated with 16 DM-PGE1, laminaria tents, and metreurynter. However, amounts of 16 DM-PGE1 required for abortion were significantly greater in patients treated with 16 DM-PGE1 alone. Occurrences of side effects increased with increased amounts of 16 DM-PGE1 administered. Therefore, vaginal administration of that in combination with the use of laminaria tents and metreurynter successfully induced abortion in women during the midtrimester with minimal side effects, and was considered to be the best method presently available for midtrimester therapeutic abortion.
For this stud-, Preglandin (16, 16 dimeth-l trans-Δ2-PGE1 meth-l ester) was used for midtrimester artificial abortion. The methodolog-, however, differed from that described in other reports. Our present method includes first inserting laminaria tents to dilate the cervix and administering albumin tannate to prevent side effects. We then insert PGEj vaginal suppositories to induce artificial abortion and use epidural anesthesia to relieve pain. A total of 19 patients were used for this stud-. In 15 patients, the abortion was performable before 5 or less PGE1 vaginal suppositories had been used. The remaining 4 patients did not reach this stage until after intravenous drip PGF2α had been administered the following da-. PGE1 is simple to use and appears to be effective in midtrimester artificial abortion if attention is given to the possibilit- of bag rupture, which ma- occur during the earl- stage of the treatment.
Over a period of one year, 16,365 consecutively live born neonates were prospectively studied for evidence of birth asphyxia using the requirement of greater than one minute of positive pressure ventilation for identifying infants suffering from birth asphyxia. Asphyxia occurred in 2.8% of all neonates. Multivariate analysis of high risk factors associated with increased risk of asphyxia showed that low birth weight was the most significant predictor of asphyxia: asphyxia occurred in 68% of infants of less than 1,000 g birth weight and decreased to 1.2% in infants of 3-4 kg birth weight. Perinatal risk factors associated with a higher incidence of asphyxia include: postmaturity, birth weight (less than or equal to 2.5 kg) and with the presence of maternal and/or obstetric complications. The impact of asphyxia on neonatal mortality was most pronounced in more mature infants and the mortality was increased 3 fold in infants of less than 34 week gestation and greater than 27 fold for infants greater than 38 week gestation. Of the asphyxiated neonates, intrauterine growth retardation, fetal macrosomia, hypothermia, hyaline membrane disease, seizures, hypoglycemia and hyponatremia were significantly associated with an increased risk of death.
We developed an enzyme immunoassay (EIA) for placental protein 17 (PP17) using avidin biotin binding, and measured the serum-PP17 levels of 37 healthy men, 103 nonpregnant women, 48 pregnant women, and 86 patients with gynecologic malignancies. The mean level was 12.8 ng/ml in healthy men and 44.2 ng/ml in nonpregnant women (p < 0.05). The calculated upper limit of normal was 97.8 ng/ml (mean + 2 sigma). The serum PP17 concentration was remarkedly reduced postmenopausally. Pregnant women showed a mean serum level of 19.2 ng/ml, which was significantly lower than that of nonpregnant women. Immunoserological results strongly suggest that PP17 is produced far more in the normal endometrium than in the placentae and decidua. Patients with gynecologic malignancies had obviously lower mean serum PP17 levels (8.3-19.9 ng/ml) than those found in healthy nonpregnant women. Measurement of the serum PP17 concentration might be useful in distinguishing gynecologic malignancies from various normal conditions.
The effects of Estracyt®, HN2 (nitrogen mustard) derivative of estradiol-17β, and free HN2 on the cell kinetics of the estrogen receptor (ER) positive human endometrial cancer cell line HEC-1, were investigated using flow cytometry. HN2 at 1 μg/ml showed a marked increase in the S phase and a decrease in the G0 + Gi phase. However, with equivalent doses of Estracyt® at 10 μg/ml, the accumulation in the G2 + M phase was even more marked. Synchronization in the S phase with methotrexate (MTX) showed no increase in sensitivity to these drugs. The above results suggest that the free HN2 has an effect regardless of the cell cycle phase, whereas the effects of Estracyt® may depend on a fixed population of target cells existing in the G0+G1, S and G2 + M phases. Synchronization in the G1 phase with sodium n-butyrate could increase the target effects of Estracyt® in the S phase.
1973, 1976, 1977 and 1978 are the only years that national data is available that measure fetal outcome and birth statistics for Maoris, Pacific Islanders, and others. Pacific Islanders have the highest stillbirth rate but overall the lowest infant mortality. Maoris have the highest infant mortality and the highest proportion of lower birth weight infants. In 1976, Maoris formed 8.6% of the New Zealand population but produced 12% of the births. Pacific Islanders formed 2% of the population and produced 5.7% of the births. European birth rates averaged 16.3/1000, Maori birth rates averaged 24.7/1000, while the Pacific Islanders rate was 57.1/1000. Auckland now contains the largest Polynesian population in the world. It appears that Maori and possibly Pacific Islanders are disadvantaged in terms of employment, education, income, health and legal offending. It is postulated that ‘cycles of disadvantage’ could be broken by preventive education and health incentives from an early age.
Maoris and New Zealand Pacific Islanders are steadily forming a larger portion of New Zealand̂s population. The purpose of this paper is to explore possible ethnic medico-social disadvantages and propose remedial action. It appears Maoris and Pacific Islanders are disadvantaged in terms of health, education, employment/occupation, income and legal offending. In general, socio-economic status, rather than ethnicity is the important factor in terms of health outcome. This paper proposes that health priorities be concentrated in the first five years of life and special effort must be directed towards the lower socio-economic groups. Mechanisms to allow this are discussed.
An early experience of camp laparoscopic sterilization in Gujarat State, India, resulted in 22 deaths among 106,500 women undergoing the operation during 1979 and 1980. Increased risk of death was seen when larger numbers of procedures were performed by year or month of year. The least experienced surgeons had the highest case-fatality rate. Improvised settings (i.e., school buildings) exacerbated the risk of death, as did advanced age, and, to a lesser extent, high parity. Errors in clinical judgment were identified in some fatal procedures. A system of health audit of large sterilization programs is needed. PIP A physician analyzed 1978-80 data on 22 laparoscopic deaths among 106,500 women who underwent sterilization at camps in Gujarat State in India to determine the programmatic and clinical risk factors in these camps. The death rate stood at 20.65/1000,000 procedures compared with 1.5/1000,000 for the US. The laparoscopic sterilization camps were set up in district hospitals, primary health centers, and school buildings. The leading causes of death were peritonitis (9), septicemia (4), and tetanus (2). 5 women also died on the operating table of lignocaine sensitivity (2), cardiac arrest (2), and air embolism (1). The death rate climbed with age (0 deaths for 25 year old, 17 for 26-30 year old, 25.2 for 31-35 year old, and 40.4 for 36-40 year old). It also increased with parity (11.9 for women with 2 living children and 29.8 for those with at least 5 children). 10 of the 22 sterilization deaths were women =or 30 years old with at least 4 children. The number of sterilizations grew 3-fold between 1979-80 and the risk of death grew almost 2-fold. The risk of deaths was especially high during the campaign season (December-March) indicating an increased risk of speedy completions to meet quotas. Surgeons with 6 months experience in laparoscopic sterilization were responsible for most deaths (67%) in camps with 50-100 sterilizations. The case fatality rate for these surgeons was 54.2/1000,000 compared with 8.1 for surgeons with at least 25 months, experience. The same percentage of deaths in these camps occurred to women operated on in school buildings. The case fatality rate for school building operations was 71/1000,000 compared with 15.4 for district hospitals and 13.5 for primary health centers. An unacceptable risk would remain even if school buildings were excluded and laparoscopic sterilization training would not occur at sterilization camps. Improved sterilization of equipment and improved surgical judgment of complications could have prevented many deaths. A medical audit of camps services is justified.
The monoclonal antibody 1C5 reacts with an antigenic determinant present in 90% of the cases of adenocarcinoma of the uterine cervix. The antigen defined by the 1C5 antibody exhibits immunological characteristics similar to those of skim milk (bovine buttermilk). 1C5-defined antigen obtained from tumor extract and skim milk binds specifically to wheat germ agglutinin (WGA) lectin. The 1C5-defined antigenic activity of a WGA lectin-bound fraction was eluted at 0.7-0.8 M NaCl off a Mono Q column. Use of an inhibition assay and a dot immunobinding assay revealed that the antigenic epitope defined by the 1C5 MoAb from skim milk exists within the first 28 amino acids of the beta-casein peptide.
In a trial local treatment of carcinoma of the uterine body by inserting bleomycin and carboquone suppositories into the uterine cavity, we found that bleomycin was effective against adenocarcinoma to a certain extent, and that the combined use of the 2 suppositories resulted in an augmented effect. However, morphological changes caused by the therapy in tumor tissue and cells were confined only to a relatively superficial layer. Therefore, it may be impossible to attain a complete remission of advanced cancer only by this suppository therapy, but it may be possible to cure early carcinoma of the uterine body sited only in the superficial layer. If no operation is to follow the suppository therapy, the cases so treated need a careful follow-up. No severe adverse reactions occurred, and virtually no effects on major organs e.g., bone marrow, liver, kidney, heart and lung, were observed. For local cancer therapy, letting the anticancer drug act only on the target tissue suffices. Therefore, it is desirable to use a suppository base suitable for this purpose. A mixture of hydroxypropyl cellulose (HPC) and Carbopole 934 (CP) seems preferable to Witepsol in this respect. The combined use of footnotes; this suppository therapy and other cancer therapies should also be considered in the future.
Data of 20,119 deliveries in Dhaka Medical College Hospital are presented. Dhaka Medical College Hospital is the chief referral hospital in Dhaka city. The 15% of patient were 18 years of age or below and 18% were above 35 years of age or above. The 48.22% were primaegravida and 51.78% were multigravida, of these 28% were grandmultigravida. The 89% had no previous antenatal checkup. The 92.72% had cephalic presentation, 65.52% had normal vaginal delivery, 21.07% had caesarean section, 11.18% had forceps delivery. Perinatal mortality during hospital stay was 143/1,000 deliveries, maternal mortality 2,510/100,000, mainly due to eclampsia. Complications during delivery were mainly in the form of ruptured uterus (1.10%), P.P.H. (1.06%), and retained placenta (3.88%).
PIP 201 women who sought abortion and sterilization were randomly assigned to 2 study groups to compare the incidence of psychosocial sequelae. The 1st group (95 women) had abortion and concurrent sterilization, while the 2nd group (106 patients) had abortion followed by interval sterilization 6 weeks-3 months later. 6 weeks after concurrent abortion and sterilization, 96% of the women in the 1st group were satisfied with the concurrent approach. In contrast, at 6 weeks after sterilization, only 75% of women in the 2nd group were satisfied with the interval approach. At 12 months, 2-3% of women in both groups expressed regret at having been sterilized. There was no difference in the self-perceived health status of the women in the 2 groups, nor were there any significant differences in perceived changes in menstrual patterns, marital relationships, and libido. There was a tendency for women in the 2nd group who failed to return within 6 weeks for interval sterilization to be Moslem Malays, to have a nuclear family, and to have 1 or no sons. In general, factors to be taken into account in determining whether sterilization should be concurrent or interval include whether the couple has any sons, whether the woman has thought about sterilization before the current pregnancy, and whether the husband and wife have reached agreement on sterilization.
To correlate the clinical picture with the endometrial pattern, 2000 symptomatic postmenopausal Indian women were studied over a 5‐year period (1977–82). Patients were categorized into two groups:— A: Symptoms other than bleeding (1250 patients) B: Postmenopausal bleeding (750 patients) High incidence of genital malignancy (37.8%) was observed in Group B compared to Group A (0.4%). Atrophic endometrium was found in 49.6% in Group A in contrast to 4.1% in Group B. Proliferative endometrium was similar in A and B groups (40.5% and 41.1% respectively). Hyperplastic endometrium was found in 20.1% in Group B compared to 7.7% in Group A. Incidence of associated genital lesions was much higher in Group B (66.8%) as compared to Group A (20.4%). Menopausal syndrome was infrequent (4.2%) and menopause occurred relatively earlier (Mean age: 46.2 ± 2.46 years [mean ± SD]).
A 38-year-old patient with choriocarcinoma who was tolerant to MTX and Act-D and highly refractory to MECA therapy after hysterectomy and bilateral oophorec-tomy was treated with 4 courses of BCE therapy. One course of BCE therapy consisted of bleomycin (Bleo Inj.®, Nihon Kayaku Co., Ltd., Tokyo Japan. Day 1–5: 5 mg i.v. infusion/day); cisplatin (Briplatin®, Bristol-Myers Co., Ltd., Tokyo, Japan. Day 1; 50 mg i.v. infusion/m2); and VP16-213, (Etoposide, Day 1–5: 100 mg i.v. infusion/m2 /day). This treatment was successful in achieving complete remission.
Heat stable and heat labile alkaline phosphatase isoenzymes were estimated in 162 healthy pregnant Nigerians between 10–26 weeks gestation. No significant association was found between the levels of these isoenzymes and maternal ABO blood groups. Eleven percent (11%) of these patients with apparently uncomplicated pregnancies had no detectable heat stable alkaline phosphatase isoenzyme even as late as 18 weeks gestational age. No association was identified between this non-secretor status and maternal ABO blood groups.
A case of endometrial cancer, detected and treated 2 years and 7 months after childbirth, is reported. The patient was born in 1948. After a spontaneous delivery in January of 1979, endometrial carcinoma was detected in August of 1981. There was no history of pill usage or menstrual cycle irregularities. No associated illnesses, such as diabetes mellitus, obesity, or hypertension, were present. Preoperative determination of hormone levels did not indicate any marked abnormalities. Histologically, the lesion was a mixed adenosquamous carcinoma with no invasion of the myometrium.
Maternal deaths over a 5-year period were reviewed retrospectively. The aim was to compare the incidence and causes of maternal deaths and the fetal outcome in women aged 35 years and above with women in the 20-24 age bracket. The classic triad of haemorrhage, sepsis and hypertensive disorders were the major causes of deaths in the 2 groups but were commoner amongst the elderly women. A higher incidence of perinatal mortality was also found in the elderly women's group compared to the younger women's group. Pregnancy and delivery at an advanced age is associated with increased risk and should be prevented by the use of effective contraception.
Thirty-five cases of non-immune fetal ascites, seen over a period of 11.5 years, are described. Associated maternal polyhydramnios was present in 9 and antenatal diagnosis was established or suspected in only 8 cases. Causes of ascites observed were: circulatory and cardiac (11), urinary (5), chylous (4), hepatobiliary (3), storage diseases (2), malignancy (2) and gastrointestinal disease (2). No cause for ascites was identified in 6 infants. The overall neonatal and infant mortality rate was 60%. Common indices of adverse prognosis include: prematurity, hydrops, severe respiratory distress, hypoproteinemia, pericardial or bilateral pleural effusions and severe birth asphyxia. Clinical problems encountered in the management of these infants are also reviewed.
M-mode echocardiographic examination was carried out in utero on one fetus of twins in the state between normal heart rate and bradycardia. Diastolic dimensions, systolic dimensions, stroke volumes, ejection fractions, fractional shortenings, and cardiac output of both ventricles on fetal echocardiograms are discussed.
Disseminated intravascular coagulation (DIC) diagnostic criteria for obstetrics as a clinical scoring system were established. These criteria, in which more weight was given to the underlying disease and to clinical findings than to laboratory parameters (coagulation tests), agree closely with the DIC diagnostic criteria of the Japanese Ministry of Health and Welfare. Efficacy evaluation criteria for obstetric DIC were also defined to enable follow-up of the clinical efficacy of DIC therapy. The clinical usefulness of these criteria was confirmed by comparison of infusion efficacy between AT III concentrate (Behring-werke AG) and injectable FOY? (Ono Pharmaceutical Co., Ltd.) for the 38 DIC cases with abruptio placentae collected here. The total score, FDP score, and platelet score were improved markedly in the AT III group compared with the FOY group.
To clarify the action mechanism of OK-432, OK-432 was intraperitoneally (i.p.) administered to 4 ovarian cancer patients with malignant ascites. In 2 of the 4 patients, 4 types of cytokines (tumor necrosis factor, interleukin 1 β, interleukin 2, and interferon γ) were induced in ascites after intraperitoneal injection of OK-432 (i.p. OK-432). In one of these patients, the ascitic supernatant after i.p. OK-432 significantly inhibited colony formation of autologous ascitic tumor cells; the amount of ascites decreased markedly, and the ascitic cytology became negative. In the other 2 patients, only interferon γ was induced in ascites after i.p. OK-432. In these 2, ascitic supernatant did not inhibit colony formation of autologous ascitic tumor cells. These results indicated that i.p. OK-432 can induce various endogenous cytokines in malignant ascites and that these induced cytokines may contribute to the antitumor effect of i.p. OK-432.
In order to estimate the incidence of hydatidiform mole in older women, the records of 369 cases of hydatidiform mole including 27 patients over 45 years of age were investigated and compared with total numbers and distributions of 4964 pregnancies by maternal age during a 6-year period (1975 – 1980) at Tokyo Medical College Hospital. The incidence of hydatidiform mole in women over 45 years of age was extremely high, in spite of the low rate of pregnancy for that age. The increase was 45-fold in such older patients. Eighteen of 27 cases over 45 years of age developed subsequently into malignant changes. The rate of such malignant progressions as choriocarcinoma or invasive mole was 66% in women over the age of 45 as compared with around 15% in those under 44 years of age. Thus, women aged 45 years or more are subject to a 4.4-fold increase in the risk of choriocarcinoma or invasive mole.
Cytochrome P-450 of human fetal livers (P-450HFLa) was demonstrated by the avidin-biotin immunoperoxidase technique in tissue samples as follows: human fetal organs, adult livers, human and cynomolgus placenta, and gynecologic organs which were obtained from 40 patients with gynecologic malignancies and 32 patients with benign diseases. P-450HFLa was clearly localized in the cytoplasm and membranes of the hepatocytes, and the fact was confirmed by an immunoelectron microscopic examination. In addition, a semiquantitative assay of staining intensity demonstrated that this enzyme tended to decrease with advancing age. These findings suggest that hepatic P-450HFLa synthesis is inversely proportional to age, and that this enzyme is one of the differentiation antigens. P-450HFLa was also detected immunohistochemically in other fetal organs. The present study thus confirms that P-450HFLa is not specific to the liver and is ubiquitous even in the fetus. Marked positive staining for P-450HFLa was demonstrated in villous syncytiotrophoblasts. In contrast, no positive staining was found in the cynomolgus-monkey placenta, unlike the case for many other placental antigens. These findings lead to the tentative conclusion that P-450HFLa is a feto-placental enzyme peculiar to humans. P-450HFLa was demonstrated to occur very frequently in gynecologic malignancies. The mean positivity rate for all gynecologic malignancies was 85%, while the rate was below 25% for benign gynecologic diseases, indicating that P-450HFLa is one of the onco-feto-placental enzymes. The present study thus suggests that this enzyme could be a promising new tumor marker for gynecologic malignancies.
A case of gonadal dysgenesis in a patient with 46, X, +mar genotype associated with mixed ovarian germ cell tumors composed of immature teratoma and endodermal sinus tumor is reported. The presence of the Y marker chromosome was not confirmed by quinacrine fluorescence staining or from the clinical findings.
Placentae obtained from RU 486 treated cynomolgus monkeys, with successful pregnancy outcome, could not be distinguished, by microscopic or macroscopic examination, from normal placental morphology of untreated females. However, circulating PAPP-A levels were markedly depressed in RU 486 treated (114.8 +/- 13.1 IU/l) than in control animals (477.2 +/- 150 IU/l), suggesting compromised placental physiology. Microscopic examination of placental tissue obtained from animals with fetal demise, after RU 486 administration, revealed pathological changes. When fetal demise occurred recently (less than 24 h), active villus destruction by infiltrating polymorphonuclear leukocytes was readily observed. Whereas aqueous extracts of placentae, whether obtained by cesarean section or spontaneous delivery, inhibited neutrophil elastase (HGE) activity, extracts of placenta being degraded by host phagocytic-proteolytic defense system were rich in HGE activity. Thus suggesting that parturition was not mediated by leukocyte lysosomal proteases, such as HGE, and that hemochorrially implanted placentae produce PAPP-A, a specific inhibitor of HGE. Administration of RU 486 decreased placental PAPP-A production and secretion, culminating with a neutrophilic infiltration into placental intervillous blood spaces, destruction of villus structure and fetal demise.
When performed based on cytology, histological accuracy of the laser cone specimen improved with the more severe cytology. The incidence of adenocarcinoma in situ is 1.0%. With and without residual disease, the rate of abnormal cytology after laser excision cone are 0.6% and 1.6% respectively. There is good correlation between colposcopic biopsy and cone specimen in the more severe lesions. Out of 139 cases of incomplete excision, only 3 cases had abnormal cytology at follow-up. The complication rates are very low.
A prospective study for detecting gestational diabetes mellitus was undertaken to evaluate the use of one hour plasma glucose level after 50 g glucose loading test (1-hr GLT) as compared to the traditional 3-hours 100 g oral glucose tolerance test (3-hr OGTT) in 396 high risk cases. Each patient, had 1-hr GLT and 3-hr OGTT performed in a separate week. Forty-two cases (10.6%) who had abnormal 3-hr OGTT were classified as gestational diabetes (GDM). One hundred and sixty cases (40.4%) had an abnormal 1-hr GLT (plasma glucose level > or = 140 mg/dl). Thirty-six of these 160 cases (22.5%) had an abnormal 3-hr OGTT. In 236 women (59.6%) that had normal 1-hr GLT (plasma glucose level < 140 mg/dl) only 6 cases (2.5%) had an abnormal 3-hr OGTT. If 1-hr plasma glucose level > or = 150 mg/dl was used as the cutoff point, 110 cases (27.8%) were found to have abnormal 1-hr GLT, and 35 of these 110 cases (31.8%) had an abnormal 3-hr OGTT. Seven of 286 women (2.4%) that had normal 1-hr GLT (plasma glucose level < 150 mg/dl) had an abnormal 3-hr OGTT. The sensitivity and specificity of the 1-hr GLT when abnormal 3-hr OGTT was used as gold standard for detecting GDM were 85.7% and 65% respectively (BS > or = 140 mg/dl). Whereas the sensitivity and specificity were 83.3% and 78.8% respectively when plasma glucose level > 150 mg/dl was used as the cut point.(ABSTRACT TRUNCATED AT 250 WORDS)
The presence of HPV16 and HPV18 is believed to be responsible for the tumorigenesis of cervical cancer. As not all HPV-infected patients proceed consistently to carcinoma of the uterine cervix, it is important to clarify at the genetic level the mechanism of the disease progression following HPV infection. We recently investigated the loss of heterozygosity (LOH) in p53 gene, using the quantitative Southern hybridization-incorporated Imaging Plate method with a p53 cDNA probe. According to the detection of heterozygote in p53 allele, 11 (61.1%) out of 18 patients with cervical cancer, and 4 out of 11 heterozygotes cases (36.4%) exhibited a loss of heterozygosity in p53 allele. It could be suggested that the occurrence of LOH is produced through chromosomal alteration in the tumorigenesis of cervical cancer.
Sixty-one patients with gonadal dysgenesis were grouped under chromosomally incompetent ovarian failure (CIOF) and chromosomally competent ovarian failure (CCOF) according to their karyotypes. Forty-one patients (67.2%) belong to CIOF, including: 12 cases (19.7%) with 45X; 22 cases (36.1%) with 45X/46XX; One case (1.6%) with 45X/46XX/47XXX; One case (1.6%) with 46X, i (Xq); 4 cases (6.6%) with 45X/46XY and one case (1.6%) with 46XY/47XYY. Twenty patients (32.8%) belong to CCOF including 16 cases (26.2%) with 46XX and 4 cases (6.6%) with 46XY. Various degree of phenotypic expression in different chromosomal complements were noted. Patients without X chromosome material were more likely to have complete picture of the Turner stigmata. Cases with mosaic pattern such as 45X/46XX retained some degree of fertility, prenatal genetic counselling should be advised in these cases because their progeny had higher incidence of chromosomal anomalies. As high incidence of germ cell tumors may arise from streak gonads of individuals with a Y chromosome, bilateral gonadectomy should be performed in every case as soon as possible if the diagnosis was confirmed.
Top-cited authors
Sabaratnam Arulkumaran
  • St George's, University of London
Toshiro Tamada
  • Tokyo Zokei University
Ho-Hsiung Lin
  • National Taiwan University
Tamara Oki
  • George Washington University
Shreekant Sharma
  • Poornima Group of Colleges