Stroke in ovarian hyperstimulation syndrome in early pregnancy treated with intra-arterial rt-PA

Ovarian hyperstimulation syndrome (OHSS) caused by fertility medications can predispose women to thrombosis. The authors present a case of a previously healthy woman who underwent in vitro fertilization and experienced a middle cerebral artery thrombosis that was subsequently lysed with intra-arterial recombinant tissue plasminogen activator (rt-PA). To the authors' knowledge, this is the first reported case of successful use of rt-PA to lyse a cerebral arterial thrombus resulting from severe OHSS. The patient made a near complete neurologic recovery and delivered a healthy infant at term, illustrating that intra-arterial thrombolysis can be used with relative safety even in very early pregnancy.     

Continuous Intrapartum Fetal Monitoring: A Prospective Randomized Comparison of 2 Types of Fetal Scalp Electrode

Summary: This trial was conducted to compare 2 commonly used fetal scalp electrodes with regard to ease of use, frequency and extent of neonatal injury and quality of cardiotocographic record. A randomized design was employed to study a group of 106 patients divided between a Surgicraft Copeland clip fetal scalp electrode (52 patients) and a Meditrace spiral single helix scalp electrode (54 patients). Patients were eligible for trial entry if they required an intrapartum fetal scalp electrode, at term with a singleton cephalic pregnancy. Ease of application was rated by the operator using a linear analogue score. Unidentified traces were reviewed independently for quality by 2 obstetricians and neonates were examined on day-2 postpartum for injury. The Meditrace spiral fetal scalp electrode was significantly easier to apply (unpaired t-test p <0.02). It also obtained higher ratings for trace quality (unpaired t-test p <0.02). There were no serious neonatal injuries and no difference was found between the 2 electrodes in this regard.     

Myoglobin: an evaluation of its role as a marker of rhabdomyosarcomas

Tumour markers now have an established role in tumour diagnosis and patient management. However, antibodies used to detect these tumour markers have in some instances proved unreliable, with a low rate of sensitivity and specificity. In this study we wished to evaluate the role of a commercial antibody to myoglobin as a marker of rhabdomyosarcomas. The purpose of this investigation was to assess the sensitivity and specificity of myoglobin antiserum as a marker of rhabdomyosarcomas. This was performed by reacting a large number of tumours (sarcomas, carcinomas and melanomas) with a polyclonal anti human myoglobin antiserum. Staining was demonstrated in 60% of rhabdomyosarcomas. Only two tumours from a total of 226 non-skeletal muscle tumours showed a positive reaction (0.88%). One was a leiomyosarcoma and the other had been classified as an undifferentiated sarcoma but a rhabdomyosarcoma was included in its differential diagnosis. It is of interest that both had been earlier irradiated. This antiserum was therefore a specific but not a very sensitive tumor marker. Its rate of staining of rhabdomyosarcomas is compared with the results in the literature. A great disparity is found and the reasons for this are discussed.     

Successful first trimester abortion with 15(S) 15-methyl-prostaglandin F2alpha-methyl ester vaginal suppositories.

First trimester abortion was successfully performed in 58 women by the serial self-administration of vaginal suppositories containing 15(S)15-methyl PGF_2α-methyl ester. A total of 4 or 6 mg of the compound was given over a 12-hour period and vacuum aspiration was performed 18 hours after the start of therapy. Cervical dilatation, operative bleeding and the presence of the products of conception were noted. All patients aborted prior to vacuum aspiration and cervical dilatation was sufficient to perform easy curettage. The major side effect was pain; this was easily controlled. Based on the microscopic examination of the aspirated material, 36 per cent of the patients who received the lower dose aborted completely, while 57 per cent of those who received a total of 6 mg of the compound, aborted completely. A greater proportion of women in the 8–9th week than those in the 11–12th week aborted completely. There was no significant relationship between the parity of the patients and the completeness of the abortion. The results of this study suggest that the compound may be a safe, effective and easily administered method of inducing complete abortion through the 9th week of pregnancy. In the 10–12th week, pre-treatment with this prostaglandin facilitates the evacuation of the uterus by surgical means.     

Delayed disease progression after allogeneic cell vaccination in hormone-resistant prostate cancer and correlation with immunologic variables.

PURPOSE: There are a significant number of patients with asymptomatic hormone-resistant prostate cancer who have increasing prostate-specific antigen (PSA) levels but little or no evaluable disease. The immunogenicity and minimal toxicity associated with cell-based vaccine therapy makes this approach attractive for these patients. EXPERIMENTAL DESIGN: We have evaluated a vaccine comprising monthly intradermal injection of three irradiated allogeneic prostate cell lines (8 x 10(6) cells each) over 1 year. The first two doses were supplemented with bacille Calmette-Guérin as vaccine adjuvant. Twenty-eight hormone-resistant prostate cancer patients were enrolled. Patients were assessed clinically and PSA levels were measured monthly. Radiologic scans (X-ray, computed tomography, and bone scan) were taken at baseline and at intervals throughout the treatment period. Comprehensive monthly immunologic monitoring was undertaken including proliferation studies, activation markers, cytokine protein expression, and gene copy number. This longitudinal data was analyzed through predictive modeling using artificial neural network feed-forward/back-propagation algorithms with multilayer perceptron architecture.RESULTS: Eleven of the 26 patients showed statistically significant, prolonged decreases in their PSA velocity (PSAV). None experienced any significant toxicity. Median time to disease progression was 58 weeks, compared with recent studies of other agents and historical control values of around 28 weeks. PSAV-responding patients showed a titratable T(H)1 cytokine release profile in response to restimulation with a vaccine lysate, while nonresponders showed a mixed T(H)1 and T(H)2 response. Furthermore, immunologic profile correlated with PSAV response by artificial neural network analysis. We found predictive power not only in expression of cytokines after maximal stimulation with phorbol 12-myristate 13-acetate, but also the method of analysis (qPCR measurement of IFN-gamma > qPCR measurement tumor necrosis factor-alpha > protein expression of IFN-gamma > protein expression of interleukin 2). CONCLUSIONS: Whole cell allogeneic vaccination in hormone-resistant prostate cancer is nontoxic and improves the natural history of the disease. Longitudinal changes in immunologic function in vaccinated patients may be better interpreted through predictive modeling using tools such as the artificial neural network rather than periodic "snapshot" readouts.     

Effect of oral misoprostol after second-trimester delivery: a randomized,blinded study

OBJECTIVE: To determine whether serial oral misoprostol shortens the third stage of labor in second-trimester pregnancy loss. METHODS: This was a randomized, double-blind, placebo-controlled study of women between 13 and 28 weeks' gestation admitted for spontaneous or induced pregnancy termination. Subjects were randomized to receive either misoprostol (200 microg) or placebo orally every hour for a maximum of three doses if the placenta had not delivered spontaneously within 10 minutes of the fetus. A dilute oxytocin infusion was given to women in both groups. The patients were managed expectantly until intervention was required or up to 6 hours when curettage was scheduled. RESULTS: One hundred eighteen women were randomized to misoprostol and 119 randomized to placebo. Fifty-eight (49%) and 55 (46%) of the misoprostol and placebo groups, respectively, did not receive their medication (P =.65, chi(2) test). There was no difference between the groups with regard to demographic features, method of pregnancy termination, or gestational age. Sixty-seven (57%) and 62 (52%) of the misoprostol and placebo groups, respectively, completed the third stage of labor within 2 hours (P =.47, chi(2) test). There was no statistically significant difference in the median time from fetus to placenta (60 versus 91 minutes in the misoprostol versus placebo group, P =.57, Mann-Whitney U test). There was no difference between the groups in the incidence of hemorrhage, need for transfusion, or curettage rate. CONCLUSION: The therapeutic use of oral misoprostol in the third stage of labor in second-trimester pregnancy loss does not reduce the time to complete spontaneous placental delivery.     

Urinary aquaporin-2 levels in healthy volunteers

SUMMARY:   Renal water handling is regulated by the release of arginine vasopressin (AVP) and the subsequent insertion of aquaporin 2 (AQP2) in the apical membrane of collecting duct cells. This in turn increases the membrane permeability to water and the passive reabsorption of water down the concentration gradient present in the medulla. Aquaporin 2 can be detected in the urine under conditions of antidiuresis. We wish to validate an assay for urinary AQP2. Fourteen volunteers participated in studies of water loading and water deprivation followed by the administration of 1-deamino-8- d -arginine vasopressin (dDAVP). Urine osmolality was measured by vapour pressure osmometry. Urinary AQP2 was measured by using a chemiluminescent assay. Baseline correlations between serum AVP levels, urinary osmolality and urinary AQP2 levels were not significant. Following the administration of dDAVP, a positive correlation between urine osmolality and urinary AQP2 was evident ( r  = 0.762). For specific conditions where renal water retention is stimulated via AVP, urinary AQP2 measurements provide a reproducible measurement of the renal actions of AVP.