Intrauterine fallopian tube incarceration: an uncommon complication of termination of pregnancy by vacuum aspiration

A 34-year-old woman presented with an intermittent abdominal pain 5 years after voluntary vacuum aspiration for interruption of a first-trimester pregnancy. Magnetic resonance imaging demonstrated complete septate uterus and a cystic mass that infiltrated the posterior myometrial wall of the right side of the uterus. Laparoscopy and hysteroscopy revealed an intra uterine fallopian tube incarceration.     

Use of the Optimality Index-United States in perinatal clinical research: a validation study

The objective of this study was to assess the validity and observed effect size of a new instrument, the Optimality Index-United States (OI-US), for use in perinatal clinical research. Using a large, hospital-based, midwifery service clinical database that included complete obstetric data for 3425 women, we examined discriminant validity and the effects of two different scoring methods used with the OI-US. Discriminant validity was confirmed by comparing OI scores for women who remained low risk and did not require physician involvement in their care (OI score mean = 84%; standard deviation [SD] = 8%) compared to those whose condition changed to require physician involvement in their care (mean = 71%; SD = 10%; P < .001). Two methods of scoring the OI-US were compared, finding no significant difference and suggesting that the types of data available and the research question can drive this decision. Finally, effect size was calculated by two methods: Cohen's d (-1.4) and the effect size correlation (r = -0.548), the latter of which corresponds to a d of -1.3, both resulting in a similarly large effect size estimation. The OI-US is a new instrument that shows promise for use in perinatal clinical research, particularly when assessing more subtle clinical differences in outcomes between study groups.     

Mental health, demographic, and risk behavior profiles of pregnant survivors of childhood and adult abuse

Our objective was to address the gap in knowledge about the extent to which perinatal mental health and risk behaviors are associated with childhood and adult experiences of abuse that arises because of barriers to screening and disclosure about past and current abuse. Survey data from an ongoing study of the effects of posttraumatic stress on childbearing were used to describe four groups of nulliparous women: those with no abuse history, adult abuse only, childhood abuse only, and abuse that occurred during both periods. The rates of abuse history disclosure were higher in the research context than in the clinical settings. Mental health morbidity and risk behaviors occurred in a dose-response pattern with cumulative abuse exposure. Rates of current posttraumatic stress disorder ranged from 4.1% among those never abused to 11.4% (adult only), 16.0% (childhood only), and 39.2% (both periods). Women abused during both periods also were more likely to be using tobacco (21.5%) and drugs (16.5%) during pregnancy. We conclude that mental health and behavioral risk sequelae affect a significant portion of both childhood and adult abuse survivors in prenatal care. The integration into the maternity setting of existing evidence-based interventions for the mental health and behavioral sequelae of abuse is needed.     

IMMUNITY IN MUMPS : V. THE CORRELATION OF THE PRESENCE OF DERMAL HYPERSENSITIVITY AND RESISTANCE TO MUMPS

The results of skin tests read at 48 hours on several hundred adults and children in which heat-inactivated mumps virus was the antigen have been presented and discussed. They can be summarized as follows:— Of 89 persons tested before the onset of mumps, 89 per cent exhibited erythematous reactions 10 mm. or less in diameter and 95 per cent, reactions 15 mm. or less in diameter. Of 40 persons tested during the first 5 days of mumps, 95 per cent exhibited reactions 10 mm. or less and 98 per cent reactions 15 mm. or less. Of 480 exposed persons the attack rate of mumps was 46 per cent among 340 with reactions 10 mm. or less and 10 per cent among 240 with reactions greater than 10 mm. The attack rate was only 2 per cent among 161 with reactions exceeding 15 mm. The attack rates in 13 skin-tested groups which were exposed to mumps tended to be inversely proportional to the incidence of reactions exceeding 10 mm. The incidence of reactions exceeding 10 mm. was approximately twice as high among 529 adults (persons 18 years or older) as it was among 306 children (persons under 18 years). Of 179 adults giving positive histories of mumps, 82 per cent exhibited skin reactions exceeding 10 mm. In certain groups the correlation between history and positive skin test was as high as 0.9. Of 132 adults giving negative histories, 58 per cent exhibited skin reactions of this magnitude. The proportion of reactions exceeding 10 mm. in a small number of children giving positive histories was 75 per cent. The proportion of reactions less than 10 mm. was 15 per cent. Of 167 adults with positive complement fixation tests, 87 per cent exhibited skin reactions exceeding 10 mm. Of 111 adults with negative complement fixation tests, 52 per cent exhibited reactions exceeding 10 mm. Of 43 children with positive complement fixation tests, the skin test reactions exceeded 10 mm. in 70 per cent. The skin reactions exceeded 10 mm. in 29 per cent of 105 children with negative complement fixation tests. In 69 of 72 individuals in whom skin reactions exceeded 10 mm., complement-fixing antibody either appeared in the blood or increased in amount within about 2 weeks after the tests were done. Such antibody responses likewise were observed in 34 of 76 individuals in whom skin reactions were 10 mm. or less. The data summarized up to this point were obtained with virus derived from the infected parotid gland of monkeys. The results of simultaneous tests in 82 individuals employing materials prepared from infected monkey parotid gland and amniotic membrane of chick embryos infected with mumps virus indicated in general that the same individual responded in a similar manner to both antigens. In many instances, however, the membrane material produced weaker reactions. Occasionally an individual failed to react at all to one of these materials but did respond to the other.     

IMMUNITY IN MUMPS : IV. THE CORRELATION OF THE PRESENCE OF COMPLEMENT-FIXING ANTIBODY AND RESISTANCE TO MUMPS IN HUMAN BEINGS

Of 163 persons giving positive complement fixation tests who were exposed to mumps, 1 afterwards developed the disease; of 285 negative reactors similarly exposed, 56 afterwards came down with mumps. Of 78 individuals subjected to intimate exposure to mumps whose tests were originally negative and who failed to develop the disease, 41 per cent gave positive reactions when tested 1 month later. Seventy-seven per cent of complement fixation tests done on the sera of 565 normal adults who admitted a previous attack of mumps were positive. A similar correlation was recorded in tests on the sera of a small group of children with positive histories. Of 356 medical students admitting previous attacks, 80 per cent gave positive tests. Of 386 normal adults who denied previous attacks, 42 per cent gave positive tests; of 85 children giving negative histories, 38 per cent reacted positively. The results of complement fixation tests on the sera of 1665 normal adults (over 17 years) and 679 children (1 to 17 years) are recorded. It has been shown that 63 per cent of the adults and 57 per cent of the children had antibody in their blood which reacted with the virus of mumps. In groups in which exceptionally intense exposure was not known to have occurred in the past, the proportions of positive reactors were: adults, 61 per cent; children, 49 per cent. In contrast to these normal persons, the incidence of positive reactors among permanently institutionalized mental defectives was 38 per cent of 356 adults and 32 per cent of 475 children. In only 2 per cent of 320 normal adults and children did the titer of complement-fixing antibody reach 1–192. In no instance in which the endpoint was determined was a higher titer recorded. The results of complement fixation tests on the sera of mother and newborn infant were essentially the same in 5 instances.     

Exploratory data analysis of hyperlipidemia on the Macintosh: Software tools for analysis of biochemical,clinical, and genetic variables in 1677 consecutive lipid clinic patients

Exploratory data analysis (EDA) software facilitates unstructured, iterative open exploration of complex datasets with the aid of multiple linked graphical displays. We are investigating relationships between plasma lipoproteins and coronary artery disease by retrospective analysis of 1677 consecutive UCSF Lipid Clinic patients. Our preliminary experience is with Data Deck 3.0 although several additional software programs (JMP 2.0, Systat 5.1, Minitab 8.0, StatView 4.0) are mentioned. Lipid diagnosis (751 women and 925 men) was 22% primary hypercholesterolemia, 19% combined hyperlipidemia, 3% dysbetalipoproteinemia, 15% endogenous lipemia, 4% mixed lipemia, 5% elevated Lp(a) and 32% with no major lipid abnormality. We found the Macintosh platform (68030) to be flexible and powerful for analysis of moderate size (less than 1 Mb) clinical datasets. High resolution color monitors (1024 MX 768 pixels), fast hard disks (<18 msec) and moderate amounts of system memory (8 + Mb) facilitate exploratory analysis.     

Obesity and Excess Protein and Carbohydrate Consumption Are Risk Factors for Thyroid Cancer

Conflicting data concerning the association between obesity and differentiated thyroid cancer (DTC) may be attributed to the lack of records showing dietary intake and inadequate evaluation of nutrient composition. We evaluated 115 DTC patients carefully paired with 103 healthy control individuals by using a structured questionnaire, including a 24-h recordatory during 3 days, to investigate calorie intake and macronutrient (proteins, carbohydrates, and lipids) composition of the diet. We observed that excess weight (body mass index > 25 kg/m²) increased individual susceptibility to DTC [odds ratio (OR) = 3.787; 95% confidence interval (CI) = 1.115–6.814; P < 0.0001). This augmented risk was evident in women (OR = 1.925; 95% CI = 1.110–3.338; P = 0.0259) but not in men (P = 0.3498). Excess calorie intake was more frequent in patients with DTC than in controls (OR = 5.890; 95% CI = 3.124–11.103; P < 0.0001), and both excess protein (OR = 4.601; 95% CI = 1.634–12.954; P = 0.0039) and carbohydrate (OR = 4.905; 95% CI = 2.593–9.278; P < 0.0001) consumption were associated with an increased risk of DTC, contrarily to lipid/fiber intake and physical activity (P = 0.894 and 0.5932, respectively). In conclusion, our data indicate that overweight and risk of DTC are associated with higher protein and carbohydrate consumption than the rates recommended by the World Health Organization. The nutritional orientation should be part of preventive strategy targets designed to combat the increasing incidence of both obesity and DTC.     

Determination of ABO genotypes with DNA extracted from formalin-fixed,paraffin-embedded tissues

Summary The gene encoding the specific glycosyltransferases which catalyze the conversion of the H antigen to A or B antigens shows a slight but distinct variation in its allelic nucleotide sequence and can be divided into 6 genotypes when digested with specific restriction enzymes. We extracted DNA from formalin-fixed, paraffin-embedded tissues using SDS/proteinase K treatment followed by phenol/chloroform extraction. The sequence of nucleotides for the A, B and O genes was amplified by the polymerase chain reaction (PCR). DNA fragments of 128 by and 200 by could be amplified in the second round of PCR, using an aliquot of the first round PCR product as template. Degraded DNA from paraffin blocks stored for up to 10.7 years could be successfully typed. The ABO genotype was deduced from the digestion patterns with an appropriate combination of restriction enzymes and was compatible with the phenotype obtained from the blood sample.