Cellular and molecular basis of natural killer and natural killer-like activity

The capability of killing various tumors or cells infected by certain viruses is a property shared by natural killer (NK) cells and by a subset of cytolytic T lymphocytes (CTLs) termed NK-CTL. Recent analysis of the molecular basis in these phenomena, however, revealed rather different molecular mechanisms. Thus, while NK cell cytotoxicity is regulated by a complex balance between activating signals (delivered by non HLA-class I-specific triggering receptors) and inhibitory signals (delivered by HLA-class I-specific receptors) the effector function of NK-CTL reflects the TCR-mediated recognition of the poorly polymorphic HLA-E.     

Selective uterine artery embolization in the management of uterine myomas

OBJECTIVE: To evaluate the effectiveness of uterine artery embolization in women with uterine myomas in terms of the clinical results for the relief of related symptoms. DESIGN: A pilot study on 26 women affected by uterine single myoma. SETTING: Tertiary level care in an university hospital. PATIENT(S): Twenty-six patients, aged 32 to 54 years, suffering of menorrhagia, pelvic pain, and abdominal mass for single myoma, intramural localization. INTERVENTION(S): Selective uterine artery embolization performed under peridural anesthesia. MAIN OUTCOME MEASURE(S): We measured the x-ray dose to which patients were exposed. Color power Doppler ultrasound examinations were performed during the follow-up evaluations at 1 to 6 months and 1 year after the procedure. RESULT(S): Uterine artery embolization was successfully performed in 100% of cases. The mean fluoroscopy time was of 20 minutes during the procedure. The mean dose of x-ray absorbed by the ovary was estimated at 18.7 cGy and the mean dose of x-ray absorbed by the skin was 126.7 cGy. A reduction of myoma volume of 55% was found at 6 months' ultrasound examination and 75% at the 1-year examination. CONCLUSION(S): Patients are well satisfied and have short recovery times with this procedure. Uterine artery embolization may be a valid alternative to traditional surgery.     

Magnetic resonance imaging and ultrasound in the assessment of the fetal central nervous system

Ultrasound is the screening modality of choice for evaluation of the fetal central nervous system (CNS). However, in cases of difficult diagnosis further fetal investigation is desirable. Due to ultrafast magnetic resonance imaging (MRI) techniques artifacts from fetal motions are minimized. MRI involves no exposure to radiation and hence appears to be safe. Due to the better soft tissue contrast, additional investigation by MRI may extend the sonographic diagnosis of fetal CNS-anomalies. Ultrasound and MRI are complementary imaging methods in the evaluation of the fetal CNS. The most important indications for ultrasound are screening for CNS anomalies and serial assessment of the dynamic of the disorder. The most important indications for fetal MRI are the "second opinion" and investigation by fetal MRI instead of postpartum MRI (especially in cases of planned postpartum intervention). In this article the indications and limitations of ultrasound and magnetic resonance imaging in the evaluation of the fetal CNS are discussed.     

The treatment of ductal carcinoma in situ of the breast

As screening mammography has become more frequently used to screen asvmptomatic women, the diagnosis of ductal carcrinoma in situ (DCIS) has become commonplace. Its treatment remains contentious, ranging from mastectomy to local excision alone. The goal of treatment for DCIS is breast conservation, however, as many as 25% of women with this diagnosis may require mastectomy. Although no clear selection criteria have been adopted to subdivide patients into groups best treated by either mastectomy or local excision with or without radiation therapy, many patients with DCIS are candidates for local excision alone, if the biology of the disease is favorable, the size is small, and the margins are negative. Radiation therapy added to local excision decreases the likelihood of recurrence; however, if there is recurrence when first radiation is employed, the patient's only remaining choice often is mastectomy.     

Under-reporting of direct and indirect obstetrical deaths in Austria, 1980-98

BACKGROUND: Under-reporting and misclassification of maternal deaths are common, even in countries with a high quality of death statistics. The aims of this study were to determine to what extent maternal deaths are under-reported in Austria and to determine factors that might explain under-reporting. METHODS: Confidential enquiries on maternal deaths for the period 1980-98 were linked with the official mortality statistics from Statistics Austria. Maternal deaths were classified as direct and indirect obstetric deaths. RESULTS: Between 1980 and 1998 a total of 119 maternal deaths (112 direct and seven indirect obstetric deaths) were registered at Statistics Austria. Confidential inquiries into maternal deaths accumulated 191 maternal deaths (an additional 43 direct obstetric deaths and 29 indirect obstetric deaths). Total under-reporting was 38% (95% CI 31-45). Significantly more indirect obstetrical deaths were under-reported (81%; 95% CI 64-92) than direct obstetrical deaths (28%; 95% CI 21-36). CONCLUSIONS: This study demonstrates the shortcomings of official registration of maternal deaths. Thus, maternal mortality cannot be seen as a reliable basis for health policy decisions.     

Response to activated protein C decreases throughout pregnancy

BACKGROUND: The possibility that changes in activated protein C anticoagulant activity may contribute to the hemostatic changes associated with pregnancy has been previously investigated, but the results of the studies are still controversial. METHODS: Nine hundred and sixty-one healthy nonpregnant and 711 normal pregnant women who were noncarriers of factor V Leiden at different weeks' gestation were included in a cross-sectional trial. Moreover, the APC ratio was repeatedly measured in 45 women throughout pregnancy. The activated protein C ratio was tested using the modified activated partial thromboplastin time-based assay. RESULTS: A significantly lower APC ratio was observed at 20-28 and 32-38 (p = 0.0001) weeks' gestation compared with nonpregnant values. The decrease in the APC ratio throughout pregnancy showed a significant trend (p = 0.014). In none of the subjects did the APC ratio reach the cut-off values for APC resistance. CONCLUSIONS: Our data confirm a reduction in the APC ratio throughout pregnancy. In our series, an APC ratio of less than 2.0 according to the cut-off point of our laboratory).