This study sought to determine the human papillomavirus (HPV)-16 E7 epitopes that would be presented by HLA-DR molecules to CD4-positive T cells in patients with cervical carcinoma.
HLA-DR binding assays were performed using HPV-16 E7-derived synthetic peptides and, after incubation with these DR-binding peptides, helper T cell frequencies were analyzed in patients whose HLA and HPV genotypes were confirmed.
We determined that the E7d peptide, 61CDSTLRLCVQSTHVDIRTL80E, was bound by HLA-DRB1*0901. An increased frequency (0.3-2.4%) of type 2 helper T cell responses was found in HLA-DRB1*0901-positive patients with cervical dysplasia and carcinoma. We found that when IL-12 was combined with E7d-peptide stimulation in vitro, the frequency of type 1 helper T cell responses also increased in patients with carcinoma.
Thus HPV-16 E7d peptide as an HLA-DRB1*0901-restricted helper T cell epitope might usefully be incorporated into an understanding of the immunological mechanism and immunotherapy for this disease.
To evaluate the risk of recurrence of fetal chromosomal aberrations in women who had offspring with numeric chromosomal abnormalities.
This collaborative study consisted of 1,076 Japanese women with a history of offspring with trisomy-21, -18, -13, or 45,X. Second-trimester amniocenteses were performed, resulting in 1,248 fetal karyotypes that were analyzed with reference to prior offspring karyotypes and maternal age.
Of the 842 women with trisomy-21 offspring, 10 conceived another such fetus. In 2 women with 3 or more such offspring, parental mosaicism of trisomy-21 was suspected. The incidence of recurrence of trisomy-21 increased with age, and significantly exceeded the incidence of trisomy-21 fetuses in the general population. None of the 170 women with trisomy-18 offspring, and none of the 46 women with trisomy-13 offspring, had another such fetus. Of the 18 women with 45,X offspring, 1 with mos 45,X/46,XX had another such fetus.
The risk of recurrence of trisomy-21 is affected by maternal age and parental germline mosaicism. The risk of recurrence of trisomy-18 or -13 appears to be much lower than that of trisomy-21. Women who give birth to more than 1 offspring with 45,X should be examined for mos 45,X/46,XX.
In view of the potential of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] as a cell-differentiation-inducing agent in endometrial cancer, the localization of the vitamin D receptor (VDR) was examined immunohistochemically in 21 endometrial adenocarcinoma specimens, and the effect of 1,25(OH)2D3 on cell growth, as well as the phenotypic changes for cell maturation after treatment with 1,25(OH)2D3, was investigated in 2 endometrial carcinoma cell lines (AMEC-1, RL95-2). The VDR was detected in 14 of the 21 endometrial carcinoma specimens. The growth of RL95-2 cells expressing VDR was inhibited to 44% when cultured with 50 nM 1,25(OH)2D3 for 6 days. In contrast, the growth of AMEC-1 cells not expressing VDR was completely uninhibited even when cultured with 100 nM 1,25(OH)2D3 for 6 days. The RL95-2 cells exposed to 50 nM 1,25(OH)2D3 for 6 days had an increasing expression for 52.5 kD or 45 kD cytokeratin polypeptide, and they became columnar with pronounced polarity and formed gland-like structures when cultured in collagen gel. These results suggest that endometrial adenocarcinoma is a target for 1,25(OH)2D3, which appears to function as a cell-differentiation-inducing agent for the treatment of endometrial cancer.
To review 10,016 cases of total vaginal hysterectomy (TVH) performed in our department by a method without ligation of the paracervical ligaments.
From 1955 to 1997, a total of 10,016 TVHs without ligation of the paracervical ligaments were performed at the Department of Obstetrics and Gynecology, Sapporo Medical University Hospital.
Of all 22,509 gynecological operations, 44.5% were TVHs, and 8.7% were total abdominal hysterectomies (TAHs). The operative time of our TVHs ranged from 31-60 minutes in 44.1% of the cases, and from 61-90 minutes in 35.3% of the cases. Blood loss was less than 300 ml in 85% of the cases. Abdominal conversion from the vaginal approach occurred in 110 cases (1%). Operative complications also occurred only in 0.7% (69) of the cases.
TVH without ligation of the paracervical ligaments is a safe and convenient method that has very few complications and that can be utilized by many gynecologists.
We tested the hypothesis that murine embryonic cardiovascular (CV) function is vulnerable to transient changes in maternal transplacental oxygen support during the critical period of CV morphogenesis.
We measured maternal heart rate (MHR), maternal blood pressure (MBP), and embryonic heart rate (EHR) during mechanical ventilatory support, then induced transient maternal hypoxia daily from gestation day (ED) 10.5 to ED16.5 in pregnant ICR mice. Hypoxia was induced by suspending mechanical ventilation for 30 s or by the replacement of inspired oxygen with nitrogen (75% or 100%) for 30 s while maintaining ventilation.
We noted a rapid onset of maternal hypotension in response to hypoxia that quickly recovered following reoxygenation. Following a brief lag time that was not gestation specific, EHR decreased in response to hypoxia. The magnitude of embryo bradycardia and the rate of EHR decline and recovery displayed gestation specific patterns. The magnitude of embryo bradycardia was similar from ED10.5 to ED13.5 and then increased with gestation. Before ED13.5, only 40% of embryos recovered to the baseline EHR following transient maternal hypoxia (vs 80% of embryos after ED 13.5). EHR following recovery exceeded baseline EHR after ED15.5. Nitrogen inhalation (75% or 100%) produced changes in maternal and embryonic hemodynamics similar to suspended ventilation induced hypoxia.
The mammalian embryo is vulnerable to transient decreases in maternal oxygenation during the critical period of organogenesis and the gestational specific EHR response to hypoxia may reflect both increased embryonic oxygen demand and the maturation of neurohumoral heart rate regulation.
The assessment of the first trimester ultrasonographic and progesterone measurements to predict spontaneous abortion risk.
Ninety-nine women at the 10th week of pregnancy were included in this prospective study. Their ages, progesterone (P) levels, mean gestational sac diameters (MGSD), crown-rump lengths (CRL), MGSD-CRL measurements and fetal heart rates (FHR) were recorded. These variables were compared by abortion status.
Patients were followed up until the 20th weeks, and 8 (8.08%) aborted. We evaluated the variables by receiver operator characteristic curve to predict abortion. Only the areas under the curve for P levels (0.29) and for MGSD--CRL (0.16) were statistically significant We. also made logistic regression analysis to predict abortion. P level and FHR were statistically significant (P < 0.01) when the threshold value was 50%. Negative predictive value of the model was 98.9%, and positive predictive value was 50%. Overall, this model can correctly classify 94.9% of the groups. We determined threshold values for MGSD-CRL (> or =10 mm) and P (> or =25 ng/mL) to predict abortion, but not for FHR. Interestingly, 14 patients with FHR > or =175 beats/min did not abort. For the MGSD-CRL threshold, we can predict that the pregnancy will continue with 95.78% probability, with 67% sensitivity and 89% specificity. For the P threshold, the pregnancy will continue with 97.85% probability, with 80% sensitivity and 80% specificity.
MGSD-CRL and P could predict patients with low abortion risk. However, at the 10th week of pregnancy, FHR > or =175 beats/min should be evaluated for this purpose by future studies with larger sample sizes.
This report presents a sonographic diagnosis of exencephaly combined with omphalocele at 11 weeks of gestation. The transvaginal ultrasound showed frog-eye appearance face with no skull, abnormal shape of disorganized brain with covering membrane separated from brain mass by anechoic fluid in some area, and omphalocele of 8 mm diameter. Therapeutic abortion was successfully done with misoprostol. Postabortal macroscopic findings confirmed the prenatal diagnosis. The combination of exencephaly and omphalocele is rare, and this is one of the earliest diagnosis of not only exencephaly but also omphalocele. To our best knowledge, this represents the earliest diagnosis of the combination. In conclusion, transvaginal ultrasound proved highly informative for both exencephaly and omphalocele as early as in first trimester.
To compare the survival and prognostic factors of patients with dual primary ovarian and endometrial cancers (primary group), and endometrial cancers metastatic to the ovaries (metastatic group).
Thirty-six patients with gross tumors confined to the pelvis and of endometrioid adenocarcinoma subtype in both the endometrium and ovary were selected from our file of 546 Japanese women with endometrial carcinoma. The patients were divided into two groups. Eleven were classified into the primary group. Twenty-five were classified into the metastatic group. Both univariate and multivariate regression analyses were carried out.
The mean age of the primary group was significantly younger than that of the metastatic group (45.2 years vs 51.2 years; P < 0.01). The cumulative 10-year survival of the primary group was significantly better than that of the metastatic group (90.9%vs 46.6%; P < 0.05). Univariate analyses showed that older age (P < 0.05) and the presence of lymphovascular space invasion (LVSI; P < 0.004) of the tumor of the uterus were significantly associated with a poor prognosis in the metastatic group. Multivariate analysis including the above variables showed no independent prognostic factor (older age, P < 0.60 and LVSI, P < 0.06).
When encountering women with coexisting endometrioid carcinoma in the endometrium and ovary with gross tumor limited to the pelvis, more attention should be paid to LVSI of the tumor of the uterus as a poor prognostic indicator.
Although many reports have been published about germ cell tumors of the ovary in developed countries, there has been no such documentation from Nepal. The retrospective study presented here reports the clinicopathologic profile of germ cell tumors of the ovary studied at B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
A retrospective analysis of 121 histopathologically proven cases of germ cell tumor of the ovary operated on at either our institute or somewhere else (but processed in our institute) from November 1995 to April 2001 (5.5 years) was done. Clinical data, histopathologic findings and complications were recorded.
The prevalence of germ cell tumors was 43.36% (121/279) of all ovarian neoplasms. Patient age varied from 8 to 65 years (median 31 years). Tumor occurrence was most frequent in patients aged 21-40 years. Only eight of 121 cases (6.61%) were malignant; the rest (93.39%) were mature teratomas. Of great interest was the unexpectedly high number of cases (47.93%) found in patients who were hill natives such as Rai and Gurung. Pain and abdominal fullness were common symptoms noted in 85.95% and 79.31% of patients, respectively. Seventeen (14%) asymptomatic cases were found either on routine physical examination (12 cases) or during pregnancy (five cases). The left ovary was involved in 39.7% cases and the right in 35.5%. Bilateral involvement was seen in 24.8% of cases. Torsion was noted in 20.66% and was the most common complication. Of all the germ cell tumors 93.39% were cystic and only 6.61% were solid on gross appearance. There were three cases of monodermal benign teratoma, four cases of immature teratoma and one case of malignant transformation.
Mature teratoma is the most common germ cell tumor and accounts for 40.50% of all ovarian neoplasms. The high prevalence of germ cell tumors of the ovary found among patients who were hill natives needs to be explored further.
The aim of this study was to evaluate the effect of non-closure of the peritoneum at cesarean delivery on postoperative complications and the interval time to the next pregnancy, and to investigate the incidence of adhesion following cesarean and the association between adhesion formation and peritoneal closure.
One hundred and twenty four women scheduled for cesarean section were randomized to either closure of both the visceral and parietal peritoneum (C-group, n = 70) or non-closure (NC-group, n = 54). At repeated cesarean, the levels and extent of adhesion, operating time, and any complications were examined.
There was no difference in the incidence of postoperative complications at the first cesarean section. The operating time of the C-group was significantly longer than that of the NC-group. The frequency of analgesic use was significantly higher in the C-group. The time interval from cesarean section to the next pregnancy in the NC-group was significantly shorter than that in the C-group. There are no significant differences between the rates of complications in the C-group and the NC-group at repeated cesarean. The incidence of adhesion in the C-group was significantly higher than that in the NC-group (P < 0.05). The mean total operating time and the mean interval time for skin incision to delivery in the C-group were significantly longer than those in the NC-group (P < 0.05 and P < 0.001, respectively) at repeated cesarean section.
Non-closure of the peritoneum at cesarean delivery appears to have no adverse effect on postoperative recovery, it also decreases the number of analgesic doses and shortens the operating time and may be more desirable in achieving a next pregnancy. The present study demonstrated that surgical peritoneal closure resulted in more advanced adhesion formation. The practice of non-closure of the peritoneum should be performed at cesarean.
The aim of this study was to evaluate the beta-adrenergic receptor (beta-AR) selectivity, organ specificity and efficacy of delaying the onset of spontaneous delivery of bedoradrine (KUR-1246), a novel uterine relaxant.
beta-AR selectivity was evaluated in terms of the amount of cyclic adenosine monophosphate produced by bedoradrine, ritodrine and isoprenaline in Chinese hamster ovary cells expressing human beta(1)-, beta(2)-AR or beta(3)-AR. Inhibition of contractions of the atrium, trachea and proximal colon by bedoradrine were compared with those of the uterus in pregnant rats using an organ bath method. Finally, the delaying effect of bedoradrine on spontaneous labor was evaluated by an in vivo study using term pregnant rats.
EC(50) values of bedoradrine for cyclic adenosine monophosphate production in Chinese hamster ovary cells via beta(1)-, beta(2)- and beta(3)-AR were 2400 +/- 30, 2.9 +/- 0.10 and 363 +/- 3 nmol/L, respectively, indicating that bedoradrine had 832- and 126-fold higher selectivity for beta(2)-AR than for beta(1)- and beta(3)-AR. EC(50) values of bedoradrine for the uterus, atrium, trachea and proximal colon were 1.01 +/- 0.27, 2300 +/- 356, 1610 +/- 299 and 219 +/- 23.5 nmol/L, respectively. Thus, bedoradrine was 2280-, 1590- and 217-fold more specific for the uterus than for the atrium, trachea and proximal colon, respectively. Bedoradrine delayed the spontaneous delivery of 21-day-pregnant rats in a dose-dependent manner.
Bedoradrine is a promising drug for the treatment of preterm labor in obstetrical practice because it has better selectivity for beta(2)-AR and specificity for the uterus than currently used agents and may effectively delay spontaneous delivery.
To evaluate the safety of KUR-1246 as a tocolytic agent, we determined the effects of its constant infusion on efficacy, transplacental passage, and transmigration to milk in pregnant or puerperal animals and compared them to the effects of ritodrine hydrochloride.
A balloon method was used to evaluate the inhibitory effects of KUR-1246 constant infusion on spontaneous uterine motility in pregnant rats. We also measured transplacental passage and transmigration to milk of KUR-1246 in pregnant and/or puerperal animals. KUR-1246 and ritodrine hydrochloride concentrations were quantified using a liquid chromatography-tandem mass spectrometry method.
Constant infusion of KUR-1246 and ritodrine hydrochloride clearly inhibited spontaneous uterine motility in vivo. The ED50 value for KUR-1246 was 1.1 mg/kg/min, a potency which was approximately 40-fold greater than that of ritodrine hydrochloride. Transplacental passage (proportions of fetal plasma/maternal plasma) of KUR-1246 in pregnant rats and/or guinea pigs were approximately one-half to one-third of that of ritodrine hydrochloride. Transmigration of KUR-1246 to milk in puerperal rats disappeared by 48 h after injection.
KUR-1246 is a promising drug for the treatment of preterm labor in obstetric practice because it is as efficacious as currently used agents yet less likely to produce direct effects on the fetus.
Meigs' syndrome caused by sclerosing stromal tumor is extremely rare and only two cases have been reported to date. An elevated serum level of CA-125 is also unusual and it has been thought that it is the consequence of physical irritation and inflammation. In this report, we present the case of a 50-year-old postmenopausal woman with a sclerosing stromal tumor presenting with Meigs' syndrome and an elevated CA-125 level (1476.8 IU/mL). This case highlights the difficulty in discerning the diagnosis of Meigs' syndrome from that of an ovarian malignancy and it should be considered in the differential diagnosis in postmenopausal patients with pelvic mass, ascites, pleural effusions and elevated serum CA-125.
This prospective, single-blind and controlled clinical study aimed to research if CA-125 levels could be a useful test in the differential diagnosis of intact and ruptured tubal ectopic pregnancy.
Sixty-five women with tubal ectopic pregnancy of 5-10 weeks' duration (27 women with ruptured tubal ectopic pregnancy [REP] and 38 women with unruptured tubal ectopic pregnancy [UREP]) and 65 women with normal intrauterine pregnancy (NIUP) of the same gestational age were studied prospectively. Serum CA-125 levels were measured in all women and these levels were compared among the REP, UREP, and NIUP groups.
The mean CA-125 levels didn't show any significant difference between the REP and NIUP groups (P > 0.05). The mean CA-125 levels of these two groups were higher than that in the UREP group (P < 0.01, P < 0.001, respectively). The dispersion ratios of the CA-125 levels had a statistically significant difference between the REP and UREP groups (chi(2): 42.44, P < 0.0001). CA-125 levels weren't correlated with gestational weeks in the REP and UREP groups (r: 0.005, P > 0.05; r: 0.008, P > 0.05, respectively).
In intact tubal ectopic pregnancies, expectant or managed with medical treatment, the increase of CA-125 levels in the serial measurements could be a supplementary test for an early diagnosis of tubal rupture.
A 51-year-old patient presented with an abdominal mass and ascites as well as a left pleural effusion. Her serum CA125 was 820 U/ml. Surgical exploration revealed a benign leiomyoma of the uterus without malignant cytology in the ascites. Postoperatively, the pleural effusion was resolved dramatically and the CA125 decreased to the normal range after 4 months post-operatively. This is an extremely rare case of pseudo-Meigs' syndrome caused by uterine leiomyoma.
New biomarkers other than carbohydrate antigen (CA) 125 are needed for the detection of ovarian cancer. Osteopontin (OPN) is one of the candidates identified by high-throughput complementary DNA microarray techniques. We evaluated the preoperative plasma OPN level as a diagnostic biomarker for ovarian cancer in comparison with CA125.
Preoperative plasma OPN and CA125 levels were measured and compared in 32 patients with ovarian cancer, 34 patients with benign ovarian tumor, 30 patients with other gynecologic cancers and 31 healthy women. Preoperative plasma OPN levels were also assessed according to tumor stage, the volume of ascites and histological types. The sensitivity and specificity for predicting ovarian cancer was compared between OPN and CA125.
Preoperative plasma OPN levels were significantly higher in patients with ovarian cancer than in those with benign ovarian tumor, in other gynecologic patients or in healthy women. Stage IV ovarian cancer patients and ovarian cancer patients with ascites had higher plasma OPN levels than those without ascites and in a lower stage. There was no relation between OPN and the histological type. The sensitivity of preoperative plasma OPN in detecting ovarian cancer was 81.3% and almost reached that of CA125. The specificity was moderate. Sensitivity increased to 93.8% with the combination of CA125, compared to 84.4% with CA125 alone.
Preoperative OPN is a useful biomarker for predicting ovarian cancer. It is especially useful when used complementary to CA125. Larger studies of patients with ovarian cancer showing a low CA125 level or in early stages of ovarian cancer are needed.
Hemivertebra is a rare congenital spinal disorder where only one side of the vertebral body develops, leading to deformation of the spine, such as scoliosis or kyphosis. Previous reports suggest that the diagnosis may be based on antenatal sonographic examination after 14 weeks. We present the sonographic features of a fetus with solitary hemivertebra at 13 weeks' gestation confirmed by postmortem babygram, magnetic resonance imaging (MRI) and pathological examination. It shows that the condition may manifest in the first trimester of pregnancy.
To evaluate prognostic importance of p53, PCNA and vascularization alteration in patients with locally advanced cervical squamous cell carcinoma (SCC) after combination therapy with 13-cis-retinoic acid (13cRA) and interferon-alpha 2a (IFN-alpha 2a).
13cRA and IFN-alpha 2a were administered to patients with locally advanced cervical SCC. Formalin fixed, paraffin embedded tissues sections obtained at pre- and post-therapy, respectively, were stained immunohistochemically with anti-p53, anti-PCNA and anti CD31.
p53 alteration was demonstrated in 5/10 patients and 3/10 patients pre- and post-therapy, respectively. There was no correlation between p53 alteration and prognosis. After therapy, two patients with complete response had lower PCNA expression whereas the non-responders demonstrated the opposite result. The vascularization showed a correlation with PCNA and prognosis. In the response group, patients had lower microvessel count while the metastatic group exhibited higher count.
The present study suggests that p53 alteration is neither related to the prognosis of cervical SCC nor is it influenced by the combination therapy while PCNA expression and vascularization might be constitute potential markers for tumorigenesis, prognosis and responsiveness to this novel regimen.
To evaluate the sonographic characteristics of the fetuses with trisomy 18 at 16-22 weeks of gestation.
The subjects were recruited from pregnant women undergoing prenatal sonographic examinations at 16-22 weeks of gestation and subsequently proven to be trisomy 18. The results of ultrasound findings were retrospectively reviewed in 25 cases with chromosomes which were confirmed as trisomy 18.
All cases had at least one abnormal sonographic finding. There was only one case that had no structural abnormality, but fetal growth restriction was documented. The common sonographic findings included fetal growth restriction, choroid plexus cysts, cardiac anomalies, clenched hand, omphalocele and cleft lip. Fetal growth restriction was the most common finding demonstrated in nearly half of all cases. Other less common findings were diaphragmatic hernia, abnormal head shape, polyhydramnios, single umbilical artery.
Nearly all fetuses with trisomy 18 had characteristic sonographic patterns of abnormalities demonstrated at midpregnancy. Detailed ultrasound at midpregnancy could effectively screen fetuses with trisomy 18 for further genetic testing.
To determine whether there is a relationship between Helicobacter pylori (H. pylori) infection, iron deficiency anemia and thrombocytopenia in pregnant women.
Hemoglobin and ferritin levels and platelet counts of pregnant women were measured during the third trimester. H. pylori infection was determined using a 14C-urea breath test (14C-UBT) after delivery. Statistical analyses were determined with a Mann-Whitney U-test and the chi(2) test. Statistical significance was determined with a P-value less than .05.
Seventy-two of 117 women had positive results on the 14C-UBT. Overall, 27 of 117 pregnant women had anemia (23.1%), and all them were in the H. pylori-positive group; 18 of 27 (66.7%) had iron deficiency anemia. Median hemoglobin levels and neonatal body weights were 12.0 g/dL vs 12.0 g/dL and 3320.0 grams vs 3520.0 grams in the H. pylori-positive and negative groups, respectively. Serum hemoglobin and ferritin levels and neonatal body weight were found to be lower in the anemic group compared with the non-anemic group among H. pylori-infected women (P = 0.0001, P = 0.02, P = 0.008, respectively). There were no statistically significant differences with regard to gestational thrombocytopenia between the H. pylori-positive and H. pylori-negative groups (P = 0.532).
Our study indicates that there is a strong relationship between H. pylori infection and iron deficiency anemia in women with uncomplicated pregnancy. However, an association between H. pylori infection and thrombocytopenia was not found.
Placental protein 14 (PP14) is known to be one of the endometrial proteins that reflect endometrial functioning throughout the menstrual cycle. In this study, we examined PP14 as a marker for human endometrial receptivity in order to predict the outcome of in vitro fertilization and the embryo-transfer (IVF-ET) cycle.
The subjects were 72 women who had 96 IVF-ET cycles and who were examined at Tokyo Medical University Hospital during the period of January 1998 to June 1998 because of mechanical or unexplained infertility for a duration of at least 2 years. Serum samples were collected from all patients during treatment cycles, and serum PP14 concentrations were measured by a newly established enzyme-linked immunosorbent assay (ELISA).
In the pregnant group, serum PP14 concentrations were markedly increased after ET, and a significant difference between the pregnant group and the nonpregnant group was observed 8 days following ET (p < 0.01). PP14 concentrations were higher in patients with endometria that exhibited homogenous patterns and that were more than 7 mm thicker than in other patients, as determined by ultrasound on the day of oocyte collection (p < 0.005). The pregnancy rates of patients with homogeneous patterns were lower than those of patients showing a trilaminar pattern. No pregnancies were observed when serum PP14 concentrations were greater than 6.85 U/l on the day of oocyte collection.
PP14 might be a useful marker for human endometrial receptivity to predict the outcome of IVF-ET cycles.
To determine whether inflammation and hypoxic-ischemic insult (HI) act additively to cause brain damage in perinatal animals by examining the dose-response effect of lipopolysaccharide (LPS) administration on HI insult in neonatal rat pups.
Seven-day-old Wistar rats (n = 119) were divided into three groups: (i) a group that received a pre-injection of LPS and HI (LPS/HI, 1 mg/kg, n = 31; 0.5 mg/kg, n = 20; 0.1 mg/kg, n = 17); (ii) a group that received a pre-injection of saline and HI (saline/HI, n = 35); and (iii) those that received LPS alone (1 mg/kg, n = 16). At 4 h after the injection, rat pups from groups (i) and (11) were exposed to unilateral carotid artery ligation, followed by 1 h of hypoxia (8% oxygen in 92% nitrogen) at 33 degrees C. Seven days after the insult, they were sacrificed and their brains removed for histological study. Neuronal damage was categorized as mild, < or =25%; moderate, 25-50%; and severe, > or =50% of surface area on a single section.
Mortality rate during the experiment was significantly increased in the 1 mg/kg of LPS/HI group (12 of 31, 39%) compared with the saline/HI group (0%). No neuronal damage was observed in the LPS only group. However, when LPS was added to HI, neuronal loss in the cerebral cortex and hippocampus was significantly increased in a dose-response manner.
LPS potentiates hypoxic-ischemic insult in a dose-dependent fashion to cause brain damage in neonatal rats.
Squamous cell carcinoma (SCC) of the fallopian tube is rare and often diagnosed postoperatively. Cervical cancer is considered as a long-term sequaele, resulting from sexual transmitted infection with certain common high-risk human papilloma virus (HPV) types. The role of human papilloma virus in the development of the tubal SCC is unknown. We report an unusual case of SCC of the fallopian tube, synchronously occurring with cervical SCC in situ in a 49-year-old patient. Histological examination of the entire endometrium revealed no involvement Both tubal and cervical lesions showed the presence of high risk HPV 16 by PCR and increased expression of p16(INK4a) protein. Both SCC of the fallopian tube and cervical SCC in situ were positive for p63, while the non-involved tubal epithelium was positive for WT-1, but negative for p63. In conclusion, the concomitant occurrence of fallopian tube and cervical SCC can be explained by: (i) the 'field effect' of HPV infection resulting in the concomitant development of primary SCC in various sites of the female genital tract; (ii) the primary fallopian tube SSC metastasizing to the uterine cervix; or (iii) primary cervical SCC metastasizing to the fallopian tube. The detection of HPV 16 and p16(INK4a) in both the fallopian tube and cervicalSCCs strengthens the hypothesis of the 'field effect' of HPV infection.
A 17-year-old girl had a large abdominopelvic mass (12 x 8cm) extending from vagina, due to the presence of a complete transverse vaginal septum in its middle third which on resection facilitated the drainage and disappearance of the mass finally diagnosed as a case of mucocolpos.
Long-term estrogen replacement therapy has favorable results on autonomic cardiovascular functions in postmenopausal women. Although acute estrogen administration has beneficial modulations on autonomic tone in animal studies, there are still controversies about the effects of acute estrogen on autonomic modulation to the heart in humans. The aim of this double-blind study was to investigate the acute effects of intranasal 17beta-estradiol administration on autonomic control of heart rate.
Nineteen postmenopausal women with typical hormone profiles were crossover randomized to 300 micro g nasal 17beta-estradiol (Aerodiol, Servier, Chambray-les-Tours, France) or an identical placebo at least 5 days apart. Both time domain and frequency domain heart rate variability (HRV) parameters were obtained during controlled respiration (CR) and handgrip exercise (HGE), before and 45 min after 17beta-estradiol or placebo administration.
Baseline HRV parameters were similar for each occasion. Time domain indices obtained after 17beta-estradiol administration were not significantly different from results obtained with the placebo. In frequency domain parameters, 17beta-estradiol administration resulted in a reduced low frequency to high frequency ratio (LF/HF ratio) when compared with the placebo during CR (0.72 +/- 0.09 vs 1.00 +/- 0.15, P < 0.05) but not during HGE (3.03 +/- 0.37 vs 2.86 +/- 0.30, P > 0.05).
A single intranasal 17beta-estradiol administration acutely reduced sympathovagal balance to the heart during the course of parasympathetic maneuver in healthy postmenopausal women.
To investigate the effects of 17 beta-estradiol and progesterone on the expression of glucose transporter 4 (GLUT4) in the adipose tissue and skeletal-muscle tissue of ovariectomized rats.
Female Sprague-Dawley rats (n = 63) received a daily subcutaneous injection of 10 micrograms, 50 micrograms, or 250 micrograms of 17 beta-estradiol (Group E) or of 1 mg, 5 mg or 25 mg of progesterone (Group P) for 3 days, 7 days, or 10 days (n = 3, at each dose). The expression of GLUT4 mRNA was assessed by performing ribonuclease protection assays.
The levels of GLUT4 mRNA in adipose tissue was significantly reduced by treatment with estradiol, 50 micrograms or 250 micrograms, relative to findings in control rats (p < 0.01). No such reductions were seen regarding the progesterone treatment. The level of GLUT4 mRNA in skeletal-muscle tissue did not change, regardless of treatment.
In ovariectomized rats, higher than physiologic dosages of 17 beta-estradiol can suppress the expression of GLUT4 mRNA in adipose tissue.
We present the case of a 39-year-old woman with a subfascial abscess. The patient had undergone radical hysterectomy for stage Ib1 cervical cancer. Six months after the surgery, she was found to have an elevated concentration of the serum squamous cell carcinoma antigen. Thereafter, she underwent magnetic resonance imaging and positron emission tomography-computed tomography. Magnetic resonance imaging revealed an irregular mass (diameter: 2 cm) in the abdominal wall. Increased (18)F-fluorodeoxyglucose uptake into the mass was observed on positron emission tomography. Therefore, we could not rule out the possibility of the peritoneal dissemination of cervical cancer, and we resected the mass. The mass was pathologically and microbiologically diagnosed as a subfascial aspergilloma. The lesion was located in the subfascial area where a drain was inserted at the time of the primary laparotomy.
To demonstrate the limitation of complete reliance on computer generated interpretations and to highlight the need for understanding of pregnancy-related biochemistry when offering prenatal screening.
Four cases of cytogenetically confirmed trisomy 18 pregnancies are presented. All four cases underwent prenatal screening (Triple Test-AFP, uE3, t beta-hCG) at midgestation and risk assessment by the alpha algorithm.
All four cases of trisomy 18 were assessed as being at low risk for DS and/or open NTD. Although marker levels were not consistent with either of these clinical situations, they were indicative of a compromised pregnancy. Circulating levels of trophoblast-derived antigens (uE3, t beta-hCG) were depressed (< or = 0.5 MoM) in all four cases. Further investigations (ultrasonography, amniocentesis) confirmed a trisomy 18 fetus.
Risk assessment by computer based algorithms relies on maternal factors and specific DS/NTD marker profiles. Aberrant marker profiles are not distinguished from normal. Therefore, it is essential that prenatal screening is offered only by those competent in pregnancy biochemistry and able to identify these abnormal situations.
The aims of this study were to investigate the ability of positron emission tomography (PET) with the glucose analog [(18)F]-fluoro-2-deoxy-D-glucose (FDG) to detect pelvic lymph node metastasis of uterine corpus cancer and to perform a retrospective comparison with computed tomography (CT) and magnetic resonance imaging (MRI) findings.
Forty-six patients with uterine corpus cancer scheduled for surgery, including bilateral pelvic and/or para-aortic lymphadenectomy, were eligible for this study. CT and MRI of the pelvis and abdomen were performed in all patients within 2 weeks preceding whole-body FDG-PET. FDG-PET images were analyzed visually for objective assessment of regional tracer uptake. The sensitivity and specificity of each imaging modality for detecting pelvic lymph node metastasis were determined, respectively.
Eleven (7 with myometrial invasion less than 1/2, 4 with myometrial invasion over 1/2) of the 46 patients (23.9%) were revealed to have pelvic lymph node metastasis. The sensitivity and specificity for detecting pelvic lymph node metastasis in patients with uterine corpus cancer by FDG-PET were 31.3% and 96.1% by lymph node region, respectively, and 36.4% and 91.4% by patient, respectively. No significant difference was noted among each imaging modality with sensitivity or specificity. Moreover, the sensitivity and specificity for detecting pelvic lymph node metastasis in 29 patients with endometrioid adenocarcinomas by FDG-PET were 28.6% and 96.1% by lymph node region, respectively, and 50% and 92% by patient, respectively. No significant difference was noted among each imaging modality in terms of sensitivity or specificity. Among 11 patients with pathologically positive pelvic lymph node metastasis, three out of four patients with myometrial invasion over 1/2 were diagnosed as pelvic lymph node metastasis positive by all diagnostic modalities, however, only one of seven patients with myometrial invasion less than 1/2 was diagnosed as pelvic lymph node metastasis positive by PDF-PET and CT. MRI could not detect pelvic lymph node metastasis in patients with myometrial invasion less than 1/2.
We suggest that current imaging modalities including FDG-PET cannot change medical management of patients with uterine corpus cancer before surgery.
To report the results of prenatal triple marker screening on a population of Japanese pregnant women.
From April 1994 through March 1999, a total of 32,925 native Japanese women with singleton pregnancies requested a triple marker-screening test. Multiples of the median values for 3 markers and individual risks for each patient were calculated following adjustment for the Japanese weight correction factor. The risk cut-off values used for Down syndrome (T21), open spina bifida (OSB) and trisomy 18 (T18) were 1: 295, 1: 290, and 1: 100, respectively. Follow-up information was collected postpartum and statistically analyzed.
Detection rates (DR) of T21 for women less than 35 years, over 35 years and overall were 58, 94, and 83%, respectively. DR of T18 for women less than 35 years, over 35 years and overall were 75, 79, and 79%, respectively. DR of open neural tube defects (ONTD) was 100%.
The first cumulative data of an intervention program and prospective follow-up studies in Japan have proven to be similar to other published reports. Individual risk values were calculated for each pregnancy for T21, T18 and ONTD. This screening program is more effective than age-dependent screening for detecting T21, T18 and ONTD pregnancies.
To learn if the increased incidence of uterine cervical adenocarcinomas in developed populations exists in developing ones.
We studied age-adjusted (world) incidence rates of pathologic types of cervical cancer from 1965 through 1990 in the population-based Bombay Cancer Registry and in the National Cancer Registry's hospital-based frequencies of 1985-1987. The t-test was used to measure the statistical significance of change. International comparisons were made.
In Bombay, the incidence rates of adenocarcinoma per 10(6) women rose from 5.0 in 1965 to 12.9 in 1990 (p < 0.05). However, cervical cancers overall declined, from 244 per 10(6) in 1965 to 176 in 1990 (p < 0.001), squamous carcinomas declined from 167 to 129 per 10(6) (p < 0.05), other types of cervical cancers declined from 10.9 to 2.9 per 10(6) women (nsi and nonpathologically diagnosed cervical cancers declined from 61 to 31 per 10(6) (p < 0.05). Adenocarcinomas were 2.5% of all cervical cancers in Bombay's overall population in 1965, and were 7.0% in 1990; they were only 3.3% in 5 Indian hospital registries but were a higher percent in the Tata Hospital Bombay and internationally. The peak age of adenocarcinoma patients was 50-55 years in Bombay, unlike a younger peak age in the West, and 60-65 years for squamous carcinomas.
These Occidental-type trends might be due to increased awareness of cervical adenocarcinomas and/or changes associated with industrialization. Such trends might occur in other developing countries in the future. Greater awareness of cervical adenocarcinoma and its early diagnosis by endocervical brush cytology are needed in such populations.
To investigate possible factors related to the recent rise in prevalence of low-birth-weight (LBW) infants in Japan.
A data set comprising 11,746 infants from the Children and Infant Growth Surveys (1980, 1990, and 2000) was analyzed.
The proportion of LBW infants was 4.2% in 1980, 6.1% in 1990, and 8.3% in 2000. The maternal smoking prevalence increased from 6.5% in 1990 to 10.9% in 2000. When multivariate logistic regression analysis was applied to estimate the risk for LBW from 1990 to 2000, the following were selected as independent factors: preterm delivery, early term delivery, female sex of the infant, maternal primiparity, multiple gestation, maternal short stature, older maternal age (>24 years), and maternal smoking. The population attributable fraction (PAF) of preterm plus early term delivery and multiple gestations to LBW was 85.1% in 1990, and 89.3% in 2000. The PAF of maternal smoking was 6.4% in 1990, and 7.4% in 2000.
The increase in preterm deliveries and multiple gestations were found to be the important factors with regard to the increase in LBW infants in Japan. The increased prevalence of maternal smoking was not substantially associated with the increase in LBW infants.
Teenage pregnancies have always been considered at increased risk for obstetric complications. Deliveries in adolescent primiparas in the 5-year time periods 1983-1987 and 1999-2005 were compared against each other, the general population and against primiparas aged 20-29 years in order to reveal trends and differences in obstetric outcome.
A total of 186 primiparas delivering at an age of 17 or less between October 1999 and October 2005 were compared with 353 adolescent primiparas delivered between 1983 and 1987. Type of delivery and complications such as low birthweight, pre-eclampsia, breech presentation and third stage complications were studied.
The percentage of adolescents in the overall obstetric population decreased. The cesarean section rate remained the same in the adolescents while increasing in the general population. Rates of low birthweight and operative vaginal delivery increased in the adolescent group and overall. Third stage complications (abnormally adherent or incomplete placentas) decreased in both groups. There were no intrauterine fetal deaths in adolescent pregnancies in either time period. Other obstetric variables were unchanged in the adolescent as well as in the general population between 1999 and 2005. When comparing the adolescents' outcome with the outcome of the 20-29-year-old primiparas between 1999 and 2005, it was noted that the rates of abstracted obstetric variables were higher in the population of the 20-29-year-olds.
The obstetric outcome of adolescent pregnancies has remained favorable over the last 18 years. We do not consider adolescence as an obstetrical risk. We suggest that adolescent pregnancy is more a public health issue than a clinical problem.
Human endometrium is an active site of cytokine production and action. Among these cytokines, the interleukin-1 (IL-1) system seems to be relevant to the embryonic implantation process. We have previously reported the production of GnRH-I by human blastocyst, as well as the presence of GnRH-I receptor in human endometrium. This suggests a close interaction between the immune and endocrine systems through these cytokine mediators in embryonic implantation.
To test the relevance of this interaction during embryonic implantation, we investigated GnRH-I regulation of IL-1b and IL-1ra mRNA and protein expression in human endometrial stromal cells using quantitative competitive polymerase chain reaction and ELISA.
IL-1b mRNA and protein expression in cultured human endometrial stromal cells was significantly enhanced by GnRH-agonist in comparison to control groups. IL-1ra mRNA and protein was significantly decreased by GnRH-agonist in comparison to control groups. In contrast, the GnRH-antagonist ablated the regulatory effects of GnRH agonist in 1b and IL-1ra mRNA and protein levels in a dose-dependent manner.
In conclusion, these results suggest a possible close interaction between the immune and endocrine systems in human embryonic implantation through the classical neuropeptide hormone GnRH and its receptor.
To investigate the effect of IL-1beta on NO production and steroidogenesis in human granulosa-luteal cells obtained from women undergoing in vitro fertilization procedures.
To investigate the effect of IL-1beta, granulosa-luteal cells were cultured with various doses of IL-1beta (0, 0.05, 0.5, 5, 50, 100 ng/ml), IL-1beta (5 ng/ml) with NG-nitro-L-arginine-methyl ester (L-NAME), selective inhibitors of NOS, sodium nitroprusside (SNP), NO donors and Genistain, a tyrosine kinase inhibitor.
IL-1beta induced a dose-dependent stimulation of NO production and inhibited the production of estradiol in a significant way in a dose-dependent manner. L-NAME significantly decreased NO production and increased the production of estradiol and progesterone. SNP significantly increased NO production and caused decreases in the production of both estradiol and progesterone. Genistain decreased NO production and significantly increased the production of estradiol and progesterone. Inducible NOS (iNOS) messenger RNA was present in granulosa-luteal cells before treatment with IL-1beta.
IL-1beta stimulated NO production, and NO inhibited the production of estradiol.
We investigated microwave power and duration of use, which does not affect extrauterine organs, in order to treat organic menorrhagia caused by myomas or adenomyosis.
Electric fields around a microwave applicator at a frequency of 2.45 GHz were calculated using the finite element method with commercially available software for analysis of electromagnetic fields. Transient temperature distributions around the applicator were obtained by numerically solving the bioheat transfer equation during microwave irradiation for 120 s in the human uterus and swine liver. We compared areas enclosed by the 60 degrees C isotherm obtained using numerical simulations and necrosis areas after microwave irradiation. Postoperative avascular areas in a Gd-enhanced MRI of a uterus enlarged by adenomyosis after clinical microwave endomyometrial ablation were compared with numerical simulations.
There was good agreement between the calculated results and the experiments. At 40 W of output power for 50 s of duration and 64.5 W for 100 s, the depth of the necrotized uterine wall did not increase beyond 7 mm and 11 mm, respectively, either in the calculations or the experiments. Generally, the 50 degrees C isotherm was located approximately 2 mm external to the 60 degrees C isotherm in temperature distributions. The Gd-enhanced MRI after the operation depicted avascular areas, which agreed with the results of numerical simulations.
The myometrial portion of a uterine wall > or = 13 mm throughout the uterus irradiated for < or = 64.5 W for 100 s is sufficient to avoid thermal damage of the extrauterine organs during microwave endomyometrial ablation.
To determine the clinical characteristics of vulvovaginal candidiasis (VVC), the Candida species involved and the antifungal susceptibility of Candida species isolated from patients with VVC.
Candida organisms were cultured from samples obtained from patients who presented with VVC to the Gynecology Department, Peking University Shenzhen Hospital. Antifungal susceptibility testing was performed using a commercial agar diffusion test.
Of the 1,070 cases of VVC reported in this study, 36.5% were uncomplicated VVC, and 63.5% were complicated VVC. Twenty-four patients were identified as having two species of Candida. Candid albicans alone was isolated from 89.5% of cases (n = 958). Candida glabrata was isolated from 85 cases (7.9%), Candida tropicalis from 10 (0.9%), Saccharomyces cerevisiae from eight (0.7%), Candida parapsilosis from six (0.6%), Candida famata from two (0.2%), and Candida krusei from one case (0.1%). All isolates of Candida albicans were susceptible to nystatin. The resistant rate of Candida albicans to azole agents was 0-4.9%.
Candida albicans was the predominant Candida species isolated from this series of patients with VVC. Resistance of vaginal Candida albicans isolates to antifungal agents was infrequent.
This paper presents the serological and epidemiological background of the rubella-infected pregnant women following the rubella outbreak throughout Tokunoshima Island that occurred after the revision of the immunization law in Japan.
Twelve of 149 pregnant women managed in Miyagami Hospital were enrolled as having a high risk for congenital rubella infection. They were interviewed about their immunization history with rubella vaccine, the presence of rash, onset of rash, and the presence and timing of contact with rubella-infected patients. The obstetric histories were investigated for past rubella HI antibody titer. Nine of 12 women continued their pregnancy and delivered a baby. A serological test for rubella IgM antibody and a reversed transcription-nested PCR assay using umbilical cord blood and the newborn urine for virus genome detection were performed for all babies. We also enrolled all 309 mothers who delivered during the last 2 years in Miyagami Hospital, and retrospectively collected their rubella HI titers.
Congenital rubella syndrome (CRS) and congenitally infected babies were born from 12 high-risk mothers. In our study, six pregnant women to be immunized by a catch-up program showed a lack of immunity to rubella. The remaining six women had low rubella immunity. Nine acquired rubella from members of their family, including their husband. The incidence of negative HI titer was 25% in women less than 25 years old who delivered during the last 2 years in this hospital.
More intensive immunization should be considered to eradicate CRS completely in Japan.
Ovarian cancer is today the most lethal female cancer with an overall survival of only 49.9%. The currently available screening modalities are disappointing in detecting highly curable early stage ovarian cancer. Natural history of ovarian cancer is unknown; it appears it can develop quickly from normal looking ovaries. Timely referral of women with non-specific symptoms (such as abdominal bloating, pelvic pain) for an ultrasound scan or blood CA125 assessments may help in the early diagnosis. Patients with Stage IA or IB disease with grade 1 tumors have a cure rate of >90%; this is likely to be compromised by laparoscopic surgery. In selected patients fertility preservation with good obstetric outcome is possible. However, the relapse rate in 'high risk' early stage ovarian cancers is 40-45%; adjuvant chemotherapy is needed. Only 20-25% of those with stage III and IV disease are cured. Despite a high primary response (70%) majority (70-75%) will relapse and all are likely to succumb. Optimal debulking surgery followed by adjuvant chemotherapy are needed for stages III and IV disease; the outcome is superior if managed by gynecologic oncologists. Where cost of drugs is an important consideration, an alternative is carboplatin (an affordable and equally effective drug). The role of vaccines needs further study. When relapses occur palliation will be the aim in most instances. Oral contraceptives, breast feeding, tubal sterilization and hysterectomy also have a protective effect. Risk-reducing salpingo-oopherectomy has been suggested in women with BRCA mutations.
Many significant advances have been made in assisted reproductive technology since the birth of the first baby conceived with in vitro fertilization and embryo transfer. The development of recombinant gonadotropins and gonadotropin releasing hormone antagonists helps to simplify the ovarian stimulation. Excessive ovarian stimulation should be avoided because of the risks of ovarian hyperstimulation syndrome and reduction in endometrial receptivity. Maturation of oocytes in vitro has been developed in some centers. It is still uncertain whether techniques such as assisted hatching, blastocyst transfer and pre-implantation aneuploidy screening can improve the live birth rates in assisted reproduction. The introduction of pre-implantation genetic diagnosis for selection of human lymphocyte antigens (HLA) compatible embryos for treatment of siblings has raised ethical concerns. There is a higher risk of obstetric complications and congenital abnormalities even in singleton pregnancies achieved with assisted reproduction. Because of the risks of multiple pregnancies, elective single embryo transfer is increasingly used in good-prognosis patients. With a good freezing program, the cumulative pregnancy rate (including the pregnancies from subsequent replacement of frozen-thawed embryos) is not adversely affected. Improvement in cryopreservation techniques has made it possible to cryopreserve slices of ovarian tissue or oocytes, thus helping women who have to receive sterilizing forms of anti-cancer treatment to preserve their fertility. It is important that the development of the new techniques should be based on good scientific evidence. Ethical, legal and social implications should also be considered before the introduction of new techniques.
Huge ovarian tumors are rarely seen in modern surgical practice. As health care education and access to hospitals have improved over the past 30 years, the number of these reports have become almost negligible. However, these huge ovarian tumors still present many challenge, even life-threatening risks due to severe cardiovascular, pulmonary, and circulatory problems, including technical difficulties of surgery, massive hemorrhage, and postoperative complications. A knowledge of the deranged physiology and its management may avert these complications. We present the case of a 21-year-old woman with huge ovarian tumor. The total weight of the tumor was 136 pounds (62 kg). She was treated surgically with good results.
Rapid detection of fetal aneuploidy helps inform a mother's choice about the course of her pregnancy. Obtaining results by fluorescent in situ hybridization (FISH) requires more than 24 h, and thus a more rapid method is needed.
Conventional G-banding and FISH for chromosome 21 were performed for cultured amniocytes. Genomic DNA was extracted from uncultured amniocytes obtained from 23 patients. TaqMan polymerase chain reaction (PCR) primers were designed to amplify the potassium voltage gated channel gene on chromosome 21q22.12 and the ribosomal phosphoprotein gene on 18q21.1. Quantitative real-time PCR was performed for these two gene fragments and the differences of the threshold cycle (Ct) of the two genes (Ct 18-Ct 21) were calculated for each sample.
G-banding revealed that 19 patients had a normal karyotype and four had trisomy 21. FISH resulted in one case of a false positive. The Delta Ct values (Ct 18-Ct 21) of trisomy 21 patients were significantly higher than the values of individuals with normal karyotypes (P < 0.001) and there was no overlapping.
Fetal trisomy 21 is rapidly detectable by gene dosage analysis from amniocytes using quantitative real-time PCR.
The authors report on 23 cases of primary Fallopian tube carcinoma occurring over the past 50 years. In addition, the literature of the past 30 years was reviewed. The 5-year survival rate was 40%, increasing considerably with lower tumor stage or better tumor differentiation. The adjuvant therapies used did not prolong survival. Results were compared to other studies, and diagnostic and therapeutic trends are pointed out. Due to the rareness of the tumor, there are no controlled studies as to the effectiveness of therapeutic regimens. Therapy is purely empiric and usually follows the guidelines for ovarian cancer. There are no established tools for a safe preoperative diagnosis. The tumor is highly aggressive and quickly spreading. Initial tumor stage and differentiation are determinants for the prognosis. Therefore, a radical approach is indicated whenever a tubular malignancy cannot be excluded.
To investigate the effect of pre-existing fetal inflammation on hemodynamics during the first postnatal 24 h in extremely premature infants <or= 25 weeks of gestation.
We defined fetal inflammation as the infiltration of neutrophils into the chorionic plate vessels or umbilical cord vessels on histological examination. In 41 infants born between 22 and 25 weeks of gestation, 23 displayed fetal inflammation and 18 displayed no fetal inflammation. Circulatory indices including blood pressure, heart rate, average urine flow, catecholamine index, ejection fraction of the left ventricle, and volume load for 24 h were compared between the two groups, as well as the incidence of intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), and death. The comparisons were made with repeated measure anova and with Fisher's exact test, or unpaired t-test. Probability values <0.05 were considered significant.
Infants with and without fetal inflammation had similar birthweights and gestational age. There was no significant difference in incidence of PVL and death. However, infants with fetal inflammation had a significantly higher incidence of IVH >or= 3 than infants with no fetal inflammation (49% vs 17%) (P=0.04). Infants with fetal inflammation had significantly higher heart rate (P=0.005), catecholamine index (P=0.019) and volume load (P=0.021).
Histological evidence of fetal inflammation in extremely premature infants is associated with circulatory disturbances over the first 24 h of life and increases in the incidence of IVH >or= 3.
A pregnant woman, gravida 3 with two living children, who frequently experienced syncope from 23(+5) weeks of pregnancy onwards and recurring every week for a period of 3 weeks, was repeatedly treated in line for a case of acid peptic disease/appendicitis in various peripheral hospitals of Nepal, until ultrasonogram/magnetic resonance imaging diagnosis of an (undisturbed) live 27(+5) weeks abdominal pregnancy was made at our hospital. On laparotomy, this materialized to be secondary to the rupture of a left rudimentary horn pregnancy (evidenced from its sealed margin) which still retained a complete placenta, from where an umbilical cord was seen, traversing across towards the right side of the abdominal cavity just below the liver, securing its attachment to the surviving fetus and enclosed in an intact amniotic sac. Excision of the rudimentary horn containing the placenta was accomplished, after the delivery of a live baby weighing 650 g who unfortunately died on the third day of life.