Management of abnormal Papanicolaou smears in pregnancy.

All pregnant patients with abnormal cervical cytologic smears were evaluated as outpatients in the colposcopy clinic. Of the 131 patients, 84% had colposcopically directed biosies. Initial biopsy diagnosis of severe dysplasia/carcinoma in situ was noted in 16% of patients with class II smears and 43% of patients with class III smears. Two patients underwent conization and 2 had modified conizations because they failed to meet our criteria for adequate colposcopic evaluation. Of the 110 patients available for postpartum follow-up, all had either the same or a lesser degree of cervical intraepithelial neoplasia. Invasive carcinoma was not detected in any patient who underwent subsequent hysterectomy or conization. No abortions or premature labors could be directly attributed to the procedure.     

Flow cytometric evaluation of epithelial ovarian cancer

We investigated the prognostic significance of deoxyribonucleic acid content and proliferative activity of tumor cell populations as measured by flow cytometry of the tumor specimens from 115 women with epithelial ovarian cancer. Deoxyribonucleic acid aneuploidy was found in 87 of 115 (76%) of these cancers with a mean deoxyribonucleic acid index of 1.6 and S-phase fraction of 14.7%. The S-phase fraction of the 28 (24%) diploid tumors was 7.0%. Deoxyribonucleic acid ploidy was significantly correlated with survival. S-phase fraction was significantly correlated with ploidy, residual tumor, histology, grade, ascites, time to recurrence, and survival. Diploidy versus aneuploidy were the best discriminating values for deoxyribonucleic acid index and an S-phase fraction of greater or less than 18% for that parameter. Multivariate analysis revealed stage, S-phase fraction, residual tumor, and grade to be independently associated with time to recurrence, and stage, age, S-phase fraction, and largest metastases were factors associated with survival. Deoxyribonucleic acid ploidy did not significantly improve either model. These results suggest that abnormalities of deoxyribonucleic acid content and the proliferative activity of tumor cell populations are reflective of their biologic activity.     

Choriocarcinoma associated with ectopic pregnancy

Eight patients with choriocarcinoma associated with ectopic pregnancy were treated at the John I. Brewer Trophoblastic Disease Center of Northwestern University Medical School from 1962 through 1981. This represented 4% of the 197 patients with documented choriocarcinoma or 1.7% of all 459 patients with gestational trophoblastic disease treated with chemotherapy at the center during this 20-year period. The presenting signs and symptoms were similar to those classically outlined for ectopic pregnancies: amenorrhea and abdominal pain (88%), irregular vaginal bleeding (75%), positive pregnancy test (100%), and adnexal mass (50%). Six patients (75%) had metastatic disease and four of these six had one or more high-risk factors. Two patients (25%) died of metastatic disease, both of whom had received chemotherapy elsewhere before referral to the center.     

SEAT-BELT SYNDROME REVISITED

This report describes a complex syndrome of injuries occurring in a young female who was a back seat passenger wearing a lap-belt restraint in a high-speed road traffic accident. As a consequence of the forced flexion distraction injury of her lumbar spine, she sustained a fracture-subluxation of the first lumbar vertebra in association with a jejunal perforation and extensive small intestinal mesenteric laceration. She also had a large traumatic hernia of the anterior abdominal wall, which was overlooked at primary laparotomy. This report highlights collectively the classical combination of injuries associated with the lap-belt syndrome and demonstrates the importance of carefully inspecting the anterior abdominal wall for deficiencies, because traumatic herniation may be easily overlooked.     

HYPERVENTILATION AND DIZZINESS: CASE REPORTS AND MANAGEMENT

SUMMARY Dizziness is a common symptom in patients presenting to an otorhinolaryngologist. Hyperventilation accounts for up to 5% of cases with dizziness and is a contributory factor in a further 20% of cases. Six cases of dizziness due to hyperventilation are presented to illustrate the authors' simple management policy. A high index of suspicion in the absence of an organic cause of dizziness and a simple provocation test will identify these cases. Management is aimed at demonstrating resting hypocapnia, investigations to exclude organic causes of hyperventilation and rehabilitation in collaboration with a clinical psychologist ensures the appropriate treatment for the dizziness and can avoid the development of chronic somatisation behaviours.     

H5N1亚型禽流感病毒NSl蛋白表达影响因素分析

目的 优化高表达禽流感病毒NS1蛋白的实验方法。方法将基因工程菌接种LB培养基,设定IPTG终浓度为0.3mmol／L,诱导温度为37℃,诱导表达6．0h,SDS-PAGE分析融合蛋白表达情况,确定最佳诱导时间。以o．1mm01／L为梯度,设置不同IPTG诱导浓度,37℃诱导4.0h,分析融合蛋白表达,确定最佳IPTG诱导浓度。设定IPTG至终浓度为0。6mmo1／L,分别于24℃、28℃、32℃、37℃和42℃下诱导表达4．0h,分析融合蛋白表达,确定最适诱导温度。采用最优表达条件,超声裂菌后SDS-PAGE分析融合蛋白,Westernblotting对融合蛋白进行鉴定。结果当培养温度为37℃,IPTG浓度为0。3mmol／L时,融合蛋白GST-NSl在IPTG诱导5．0h时的表达量最高,达28．5％;当IPTG诱导浓度为0。6ram01／L,在37℃诱导表达4。0h时,融合蛋白的表达量可达27．9％。选用优化的表达条件,IPTG0．6mmo1／L,37℃诱导表达4．0h,融合蛋白的表达量最高可达33．2％。进一步分析显示,融合蛋白大部分以可溶形式表达,其表达量可占菌体总蛋白的25．1％。经SDS-PAGE电泳、电转移后,用小鼠抗GST单克隆抗体进行免疫印迹分析,出现一条阳性反应带。结论通过实验优化了工程菌诱导表达的最佳IPTG浓度、最适时间和培养温度,实现了融合蛋白的可溶性高表达。