Histologic analysis of placental tissue in first trimester abortions

The value of histologic evaluation in the analysis of material from first trimester abortions is not completely defined. We prospectively analyzed placenta and decidua from 75 first trimester, spontaneous abortions to ascertain if morphologic features were predictive of karyotype. The histologic features analyzed included hydropic villus change, villus fibrosis, villus scalloping with trophoblastic invaginations, atypical stromal cells, aggregates of lymphocytes in placenta or decidua, and acute inflammation of placenta or decidua. Normal karyotypes were observed in 44 cases and abnormal karyotypes were demonstrated in 31. The presence of villus scalloping with trophoblastic invagination was significantly associated with abnormal karyotypes, particularly triploidy, and the demonstration of acute inflammation was seen significantly more often in cases with normal karyotypes. We conclude that histology can provide only a suggestion as to the likelihood of an abnormal karyotype; the findings are not specific enough to obviate the need for karyotyping in the individual case.     

The learning effect in visual field testing of healthy subjects using frequency doubling technology

PURPOSE: To evaluate the presence, duration and magnitude of a learning effect in serial visual field (VF) testing, using the commercially available frequency doubling technology (FDT) instrument. PATIENTS AND METHODS: 21 healthy adults with no prior VF experience underwent 6 serial VF tests, using the full-threshold C-20 program of the Zeiss-Humphrey FDT analyzer, on one randomly chosen eye. Tests were spaced at least two days apart. RESULTS: The average mean sensitivity was 32.37 +/- 2.6 dB; the average mean deviation (MD) was 1.22 +/- 1.8 dB. The MD at the first examination (0.28 +/- 2.1 dB) was significantly poorer than at any of the other testing sessions (p<0.003). Similarly, the mean sensitivity at the first examination (31.16 +/- 3.0 dB) was significantly lower than any other testing session (p<0.004). The proportion of improvement from the first to the second session was 63% and 65% of the total improvement, for mean sensitivity and MD, respectively. Mean test duration showed a modest reduction, from 4.40 +/- 0.3 minutes in the first session to 4.17 +/- 0.4 minutes in the last session (p = 0.023). A sub-analysis comparison of the different VF segments showed a more prominent learning effect in the peripheral and nasal visual segments (p<0.0001). CONCLUSION: Baseline measurements should best rely on the second testing session, since MD and mean sensitivity are somewhat poorer when subjects with no prior VF experience are first tested on the FDT instrument. This may be especially true for the purpose of following patients over time.     

The role of soluble CD23 in distinguishing stable and progressive forms of B-chronic lymphocytic leukemia

Soluble CD23 (sCD23) has been recognized as an important prognostic parameter in patients with chronic lymphocytic leukemia (B-CLL) at early clinical stages. There is, however, no clear information on its prognostic significance in advanced stages and on its role as an indicator for aggressive or indolent courses of disease. Therefore, sCD23 was measured in the serum of 145 patients at diagnosis and serial determinations were carried out for 8 years in 38 patients. The results indicate that in patients with identical clinical stages at first presentation the disease could take different courses depending on initial sCD23 concentrations below or above specific threshold levels (860 and 5900U/ml). sCD23 higher than these thresholds was associated with faster progression into upper clinical stages. Furthermore, sCD23-doubling time (sCD23-DT) indicated that patients with long DT progressed slowly, while those with short DT had more aggressive disease. Particularly in patients with advanced disease stages, long sCD23-DT indicated development of smoldering disease. Since sCD23 levels reflect total tumor mass, determination of sCD23-DT has probably a better predictive value than lymphocyte doubling time. It appears that B-CLL patients can be divided into different risk categories according to initial determinations of sCD23 and that sCD23-DT is an additional important parameter in predicting disease progression.     

Angiogenic factors for the prediction of pre-eclampsia in women with abnormal midtrimester uterine artery Doppler velocimetry

OBJECTIVE: To determine whether assessing uterine perfusion and angiogenic factors concurrently in the second trimester improves the prediction of pre-eclampsia and intrauterine growth restriction (IUGR). METHOD: Plasma levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) were measured for 108 women with abnormal uterine perfusion on Doppler velocimetry in the 23rd week. Later, 33 cases of pre-eclampsia and 9 of IUGR developed. RESULTS: Compared with the plasma levels of the women whose pregnancies remained normal, sFlt-1 levels were significantly higher and PlGF levels significantly lower in the women whose pregnancies became complicated by pre-eclampsia and/or IUGR (P<0.001). The alterations were more pronounced in cases of early-onset pre-eclampsia and in cases of IUGR that necessitated delivery before 34 weeks. Using the sFlt-1/PlGF ratio, these complications could be predicted with 98% sensitivity, 95% specificity, and 93% positive predictive value. CONCLUSION: Measuring uterine perfusion and angiogenic factors concurrently in the second trimester improved the prediction of pre-eclampsia and IUGR.     

Radiation therapy as definitive treatment for localized carcinoma of prostate

A progress report on the treatment of 116 patients with adenocarcinoma of the prostate treated by external irradiation is presented. Fifteen, 60, and 41 patients presented initially with Stages A, B, and C, respectively. The majority of the patients received 7,000–7,500 rads during a period of seven to eight weeks, locally to the prostate gland. The five-year actuarial survival were 90, 70, and 40 per cent for Stages A, B, and C, respectively. The five-year survival rates for patients with well and moderately differentiated tumors were significantly better (45 per cent) than for those with poorly differentiated tumors (24 per cent). The five-year survival rate in the patients who received prior or concomitant hormone manipulation was lower (33 per cent) as compared with those receiving radiation therapy alone (43 per cent). All of the above differences were statistically significant (0.01 level). Of the patients failing, distant metastases have developed in 88 per cent suggesting that subclinical distant metastases might have been present prior to initiation of radiotherapy. The local control rate was 82 per cent. The morbidity of this mode of therapy was found to be acceptable. Radical radiation therapy is an effective method for control of carcinoma of the prostate and is potentially curative.     

A rare case of adenocarcinoma arising within a duplication cyst of the rectum: curative excision with 9-year follow-up

This case report is novel in that it describes the successful excision of an adenocarcinoma arising within a rectal duplication cyst without evidence of disease recurrence at 9-years of follow-up.     

The safety and efficacy of early withdrawal of calcineurin inhibitors in kidney transplant recipients 6 months' posttransplant

INTRODUCTION: The introduction of calcineurin inhibitors (CNIs) in clinical transplantation has resulted in dramatic reduction in acute rejection rate and improvements in short-term allograft survival. However, CNI-induced chronic nephrotoxicity is a clinical concern since it is a major cause of chronic allograft failure. Recent studies suggest that withdrawal or reduction of CNI dosage results in improvement in graft function and survival. The aim of this study was to evaluate the safety and efficacy of substituting CNIs with mycophenolate mofetil (MMF) at 6 months' postkidney transplant. METHODS: Kidney transplant recipients of first or second grafts (n = 20) maintained on CNI-based therapy and with no history of irreversible acute or vascular rejection were included in the study. Primary end points were the incidence of biopsy-proven acute rejection or treatment failure. Secondary end points included changes in mean serum creatinine and estimated GFR (Cockroft and Gault, CG) over time, incidence of infection, cardiovascular risk factors (blood pressure, cholesterol), graft and patient survival rates, as well as incidence of biopsy-proven chronic allograft nephropathy (CAN). Study patients were compared to a matched control group (n = 20) who remained on CNI-based therapy at equivalent time points. RESULTS: Incidence of acute rejection following CNI withdrawal was 15%. All episodes reversed with steroid pulses. There was no significant difference in mean serum creatinine or estimated GFR during the follow-up period. No significant change occurred in blood pressure or antihypertensive agents between the groups; however, there was a trend toward lower cholesterol levels after CNI withdrawal. No graft or patient loss was seen during the study period. Biopsy-proven CAN was diagnosed in 2 control patients (10%) at 6 to 8 months' posttransplant. CONCLUSIONS: Withdrawal of CNI at 6 months following kidney transplantation is associated with an increased risk of rejection and a trend toward lower serum creatinine and cholesterol levels. Further follow-up is needed to establish the long-term results of CNI-sparing regimens on the development of CAN.